Repetition in choice making

[reo12]

Hi all,

I'm after views from the community. My friend makes a decision to chat with me, made in advance, for say two days time. His care team then check on the day if he still wants to chat with me, then they check again before the call does he still want to chat with me. They appear to be either applying pressure (my view) or, being generous, of the belief that it is good to ask him several times rather than force him to commit to something he decided two days ago.

Since they have adopted this technique, I have had much less contact with him. I am of the view that although repetition is really useful in memory and skill building for functional tasks such as eating and dressing, this should not be attempted in choice making, as it will confuse my friend, and fatigue his brain, he may not remember his former choice, or even know how long ago it was he last spoke with me. Repetition in choice making just doesn't make sense, as every choice is different - that's the point! All they would be doing is training him to make a certain choice - which is surely influence in practise. I worry that it will even increase his perseveration.

I am also worried about his initiation and motivation skills, his Adynamia, and the fact that he does not really have a great short term or even working memory for very long. Since adopting this continual asking, I have only seen more inconsistency with choice making, and frustration, and him starting to throw things.

I was under the belief that schedule was so critically important in brain injury, seeing people on set days, and being encouraged to see things through, even if this might seem more restrictive, it is better for his brain injury health and to result in more consistent decisions and more confidence in decisions in the long run.

Thoughts and views?

[cat3]

Not knowing the reasons for the care team's actions makes it difficult to judge. It's possible they're just overprotective, fearing your friend might have forgotten and since had a mood change ? I do agree though that sticking to a routine, even if slight coercion is needed, is probably in his best interests.

Have you tried discussing the issue with the team Reo ? Unless they have a convincing explanation, perhaps a compromise can be reached..

[New_beginning]

Hello Reo12, my husband sustained TBI 1 year ago and from the day he came home I have stuck to very rigid almost military routine, structure to the point now it has become very natural; although he needs reminding on daily tasks. His home rehabilitation purely formulated on family functioning. I totally agree on routine, now I'm at the point trying to get precise answers on whether he wants to do something, as I noticed past 3months with solid observations he has difficulties making open choices, so past month getting him to make choices. Things we take for granted, like shall we go on walk, what do you want to eat, drink, he says dont mind on everything, but now im getting him to make choice. I am hoping this new technique makes difference over the rest of the year, as will take time.

With care teams situation I can see what they are trying to do but they are not making such theories they have decided to take on board holistic for your friend. Has he got a next of kin who is having such approach and have they had any issues. I know hes your friend, but next of kin are the ones who can reach out to the care team and ask questions reasoning this, so theres no mixed thoughts and jointly working together

Good Luck

[Pairofboots]

Hi reo, I have never known this practice, I cannot see any benefit to your friend, even in the context of rehabilitation.

Choice is often difficult, even ten years on, I can't cope with choice. It something my ex wife couldn't understand. Do I want chips or mash? Answer, I don't know. Even choices I have to make from my own thinking can lead to me giving up.

I'd have a chat with the ward staff to see what the logic is? And if you don't get any answers that make sense, contact PALS in the hospital. I can only see this practice as a negative influence, and possibly a retarding factor.

[reo12]

I need to give some context I think. I am his ex partner. I looked after him for about 8 years and was his advocate, set up his care, etc. I know probably more than anyone about his brain injury. Now we are friends and I helped choose him a home and helped in the renovations for him to moved into independent living with a care team. As his only advocate, I am also the one who raises care concerns. Last time I raised these they were so significant a number of carers were sacked and there was a court case. I have reason to sadly raise concerns again, and a lot of those are around contact and restrictions and being unlawfully stopped from seeing him. These new methods of checking only started in response to my raising concerns. Our contact, even just virtual video contact has dropped off significantly with carers constantly cancelling, even though there is no evidence or recording of them asking my friend. They can pretty much say what they want and exclude at their own will.

[New_beginning]

Hello reo12,. You care and have protective factor being involved with your former partner and my thoughts around the background sits differently now its much more complex, not in a negative manner as you have remained supportive and continue the friendship, do you live in the UK?