Year: 2021
Type: article
Abstract: Due to restraints' consequences for personal liberty and dignity, the threshold to apply restraints is understandably high and heavily regulated.However, there can be clinical scenarios in which restraint use can facilitate a patient's freedom.This article considers such a case and examines conditions under which using restraints offers therapeutic benefit for patients with traumatic brain injuries.Case Albert is a 33-year-old man who was recently the unrestrained driver in a motor vehicle accident.He was found unresponsive by emergency medical services with a Glasgow Coma Scale of 4, which indicates minimal response to defined stimuli.He was intubated and brought to the nearest hospital, where his workup revealed traumatic brain injury (TBI) consistent with severe diffuse axonal injury.Like many patients who suffer from TBI, Albert began to progress through the typical stages of recovery consistent with the Rancho Los Amigos Levels of Cognitive Functioning, a clinical tool used to describe the behaviors and cognitive deficits of patients who have experienced TBI. 1 It is a 10-level scale wherein level I indicates no response (coma) with total assistance required and level X indicates purposeful and appropriate response with modified independence (ie, able to function independently with compensatory devices or cognitive strategies), with a spectrum of progression in-between. 1 After 2 weeks in the intensive care unit, Albert stabilized and was transferred to a small inpatient rehabilitation unit for rehabilitation of his cognitive deficits, poor coordination, and right-sided hemiparesis.During this time, Albert became agitated, restless, hyperactive, confused, and engaged in nonpurposeful behavior, consistent with level IV of the Rancho scale. 1 The care team discussed activities on the unit that would allow Albert to channel his restlessness, thereby aiding his recovery.Permitting Albert to engage in activities outside of his room would provide an outlet for his restlessness and theoretically prevent an escalation of his agitation due to his lying in bed for long periods of time.However, given his disorientation (ie, his inability to remember that he cannot ambulate safely without assistance), increased fall risk due to poor balance and right-sided hemiparesis, and motor restlessness, he would require the use of a lap-belt and wheelchair to minimize potential harms to himself when moving around outside of his room.The staff felt
Source: The AMA Journal of Ethic
Authors: Katherine J. Feder, Janice I. Firn, Ryan Stork
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W3145739420