Let’s move the into the practical realm now.

I propose a few concrete steps that survivors can take to provide themselves with the tools they need to become fully functioning again.

Let’s start with the ADL (Activity of Daily Living) of getting clean

First you need the infrastructure to make this achievable.

Second you need the supplies in order to make things work.

And third you need the effort to bring this project to completion.

First is the infrastructure
For an ABI survivor the infrastructure of getting clean is the shower stall and curtain.
This may seem obvious to those taking a shower every day, as most of us have been for a significant portion of our lives. These are the services and products we take for granted: the electricity to run the pumps, and the water to supply them with. Your personal preference is also involved here; choosing the temperature of the water available or desired.

When I was first visiting a home in Guatemala I went in to take a shower figuring no big deal… turn the taps and water flows. Only thing was there was only one tap….. so ok, I figured this must be the temperature they all use. During the shower the temperature was steadily decreasing and I was getting cold – never the less I soldiered on and finished the shower. Afterwards I found out that there was a switch just outside of the shower which turned the hot water on. I was surprised at this feature but understood its origins and necessity.

Like everyone else, ABI survivors need infrastructure in their lives. My getting a cold shower because I didn’t understand the system is a metaphor for ABI survivors trying to get the necessities of life while dealing with an infrastructure they no longer understand.

Second is the Supplies

For a person in ABI, service providers can be like the supplies for getting clean. They provide a service to you, and provide some degree of aid with recovery. For someone in ABI it can be a surprise that people get paid money for doing jobs which seem like helping people out. Where the money comes from is not the issue here, but money is required in order to supply the basic services that make things work, just like money is required for the pumps and pipes to direct water to your shower stall. There is a whole industries for service providing to people in recovery.

This issue should not be lost on those who provide the services to the survivor. You are merely a cog in the wheel and while you cannot be overlooked, neither should you be heralded as the coming messiah. You have an important role to play: you are sorely needed by the survivor who is totally clued out as to what the big picture is. This is a situation that continues to need to be addressed: someone needs to undertake the education of the survivor.

Third is the requirement of effort

This is the effort and the spirit of the survivor. The act of rubbing and scrubbing your body all over requires consistency and thoroughness. It also requires care to ensure that parts are not affected which should not be affected – like keeping the soap out of your eyes.

The effort of keeping clean is a metaphor for a survivors’ core relationships: they require a lot of work, and you don’t want to negatively affect important aspects of the relationships that a person has. Day after day this act must be performed and so doing it in a set manner aids in clearing the mind of thinking for this moment. Habitual tasks are easiest and best for most survivors. ABI survivors have to relearn the habitual act of cleaning themselves in the same way that they have to relearn the importance of key relationships, and how to maintain them.

Changing Needs Through Rehabilitation

The soap and shampoo may be akin to the various supplies that we all need. These change over time, from the baby wipes and diapers to gunk for the grease on your hands. There are also various brands with somewhat different selling features. These can be seen in part as the different companies and personalities involved in rehabilitation. Some are over the top and controlling while some are more relaxed and just let things move along without ruffling any feathers.

From my perspective these need to change during rehabilitation.

In the beginning, the survivor will be clueless, and in this period the professionals need to take more control. But this grip on things also needs to loosen as the survivor and family gain more awareness of the circumstances, as well as the big picture.

After the initial neuro-psychological assessment there should start to be more direct conversations between the survivor as well as with their family and the health care team.