The Writing on the Wall: How Foreshadowing Leads to Positive Outcomes After a Brain or Spinal Cord Injury

Parenting Fail

Just the other night, my boys were glued to the TV watching the NBA playoffs. Their team, the Memphis Grizzlies, was facing off against Lebron James and the Los Angeles Lakers. The only problem…tip-off was at 9 pm on a school night.

Normally, we let them stay up on special occasions like this, but they both had district testing the next day. As time ticked away and the first quarter came to an end, we casually mentioned it was time to head to bed. By now, you can probably guess how the rest of the story goes. From being furious about missing the final buzzer to negotiating for just five more minutes, both boys stomped upstairs and begrudgingly crawled into bed.

This all could have been avoided or at least minimized if my wife and I had used one of our most powerful tactics – foreshadowing. Whether it’s preparing the boys for bedtime or a trip to Target where we WON’T be buying basketball cards, simply setting expectations early on helps them prepare for what’s to come and USUALLY avoids unnecessary conflict.

A Heads Up is Nice

Can you relate? Ever feel like you’ve been caught off guard and forced into doing something you don’t want or expect to have to do?
What if you had a heads up? Would you have responded differently?

How about someone who has experienced a traumatic brain or spinal cord injury? What about their family or friends?

Of course, there’s no comparison to missing the Grizzlies/Lakers game, but I’m sure they can relate to the feelings of surprise and frustration when we fail to prepare them for upcoming decisions and challenges they will face after a life-changing injury, such as a brain or spinal cord injury. Because there is more to recovery than addressing physical or cognitive deficits with physical therapy, occupational therapy, and speech-language pathology, the process is much more complex.

Even with an interdisciplinary approach, we can’t eliminate the struggle to adjust to the sudden and drastic changes the injury brings. By using foreshadowing, however, they are able to anticipate and begin to prepare for what’s to come. This helps to manage expectations, implement coping strategies, and proactively address challenges all while reducing stress, anxiety, and the potential for conflict.

Five Tips to Effective Foreshadowing After a Brain or Spinal Cord Injury

Foreshadowing is a skill. Think of every interaction as an opportunity for someone to prepare for the next step in the recovery process. Here are some ways to do it effectively:

1. Build trust and start relationship building early. Ask questions to understand their values, fears, obstacles, family dynamics, etc.
2. Make sure you understand the severity of the brain or spinal cord injury, the continuum of care, and the options on the table. This will help to paint a clear picture of each step in the continuum.
3. Plan your message. Make a list of urgent and important topics and prioritize them. If you don’t know what to say, ask a colleague or mentor who has been in a similar situation. Often, you can pick up some great scripts that have worked for others and make them your own.
4. Practice your delivery. Everything sounds better in our head, so say it out loud to yourself or anyone who will listen. There’s no substitute for this!
5. Pick the right time and place. Know your audience and make sure they are ready to hear the message. Hint: You may want to foreshadow the reason for conversation!

Brain Injury Rehabilitation, Spinal Cord Injuries, The Continuum of Care