Overnight leave

Patients that are able to make good use of their mobility during their time in hospital are able to apply

for an overnight leave during the weekends, this enables them to leave the hospital's vicinity to stay somewhere else overnight and enjoy a life of temporary freedom before coming back to the hospital on the next day to continue therapies. Patients wishing to apply for an overnight leave can only do so if they inform the hospital's ward coordinator a few days prior to the expected leave. This way the hospital staff can prepare medications and other requirements that patients can take when they leave the hospital. When applying for an overnight leave, be sure to inform the hospital of where you're going to spend the night and provide evidence that the accommodation has a disabled access and accommodate the need of any person with a disability, this includes railings in the bathroom that patients can hold on while having a shower or a commode that allows them to sit while having a shower. Most hotels are already come equipped with such facilities and equipment as they are required by law to be able to accommodate anyone with disabilities.

If patients are not able to provide proof that their desired accommodation is disabled friendly then their request for overnight leave would have to be canceled. Another option would be to ask the hospital to find them a suitable accommodation that they have a partnership with the hospital, this way it will be sure that the place will be able to accommodate a disabled person. Before being granted an overnight leave most patients have to routinely attend their occupational therapy to discuss with their therapists regarding their leave and what to expect once they temporarily leave the hospital and how to approach a new environment. The occupational therapist will also teach patients on how to use certain tools that will help them do certain tasks much easily such as a portable plastic mat that gives the patient the ease to eat their meals without moving the plate and to open bottles or any form of sealed containers. In most cases, this isn't necessary especially if the patients are going for an overnight leave accompanied by a family member who can help them with such tasks, however, patients are always encouraged to be independent when they go for an overnight leave and should learn to do things on their own.

Being able to leave the hospital grounds comes with possible dangers that patients may face such as seizures or further head injuries, therefore it's imperative that both patients and carers are taught on how to handle such events, should they occur. In all likelihood, such things will never occur but in some cases, they do so its good to be prepared. The hospital staff will provide patients and their carers with a first aid guidebook, containing all the essential steps and procedures to handle someone with a seizure or a brain injury. If the patient's mobility is still limited, they may be required to take blood-thinning injections to prevent any blood clots from forming in their limbs and the injections would have to be given, this means either patients or their carers have to learn to give the injections. A lot of times, patients are brave enough to inject themselves without any help but if it proves to be difficult then carers can take over and administer the shot. A lot of the time the injection is given on the stomach or the abdomen, this makes it a little bit painful since the skin covering the abdomen is sensitive, so it's best to pinch it hard before injecting to reduce pain.

Once an injection has been done, it's essential that the used syringes are properly disposed of. In most cases, the hospital provides a container to dispose of the syringes that patients can take with them during their leave. When disposing of syringes, both patients and caretakers are reminded to dispose of all use syringes and that none should be left to avoid harming others or improper misuse at the hands of others. Other necessities that may be taken with the patients include their medication such as Keppra, Baclofen, and pantoprazole. However, these medications are only allowed to be taken with patients who truly require them due to specific medical conditions which may arise after the initial surgery or injury to the head; seizures, extreme spasticity, and high gastric acid. If any of them do not occur after surgery then it's not necessary to be taking them for overnight leave or after discharge.

To determine if any of the medications mentioned are necessary, one must ask the doctors in charge of taking care of the patients. Certain tests may have to de done to determine this. An EEG test may be conducted to rule out abnormal brainwaves that signal epilepsy to stop the usage of Keppra (levetiracetam) and baclofen. Other common medications that may be taken include melatonin to ease insomnia and panadol to relieve headaches or pain, as most brain injury patients deal with reoccurring sleep problems and headaches. Alternatives to these may include promethazine to treat reoccurring circadian issues and ibuprofen to treat pain, however these two may not work for some, therefore best consult your rehab doctor in knowing which option is best. For patients who dislike injections to deliver their blood thinner or have an allergic reactions to them, then they maybe allowed to take aspirin as an alternative but this needs to be consulted first with doctors.

Other factors to be considered of temporary hospital leave is the accessibility of one's home, photographs should be taken of Patient's bedroom and hallways in the house to determine if it is safe for disabled access, however this shouldn't be a problem for a single story house but maybe troublesome for multiple stories as stairways would have to be considered. If this is the case then railings would beed to be fitted to ensure safe access. However such measures would not be necessary if patients are willing to spend the majority of their time downstairs and not attempt to go upstairs especially if they are not confident in using the stairs. If the bed room where patients normally sleep or rest are upstairs, consider sleeping downstairs for the time being to reduce risk of falling and injuring. The same can be said for bathrooms, railings maybe required to be fitted in bathrooms for patients with poor mobility or balance. It would also be beneficial if bathroom access is close within the vicinity of where the patient sleeps as this would make it easier for them to access the bathroom during crucial times such as at night when visibility is low.

Kitchen access needs to be assessed and modified as well, consider placing plastic kitchen mats on the kitchen bench as a tool to assist patients in opening and closing jar lids. Essential cooking utensils such as spatulas, knives, tongs, spoons, cutting boards and etc should be relocated to areas within easy reach especially for patients who are only mobile with a wheelchair, this means placing them in drawers that are up to knee height only. cooking essentials such as spices, ingredients, salt pepper and etc should be placed within these drawers to or inside an accessible fridge. making these adjustments in the kitchen should help patients become independent in cooking and feeding themselves. It should be reminded again that the purpose of an overnight leave is to help patients become independent as possible without any assistance or external intervention.

Self-care should also be done independently starting from showering their own and going to the bathroom unassisted. Certain bathroom modifications are necessary for those with poor mobility and lack of balance, railings must be fitted on shower walls to allow patients to support themselves when standing on the showers, anti-slip shower mats have to be placed on the shower floors to prevent patients from slipping when showering while standing up. All of these essential fittings can be purchased at a hardware store like IKEA or Bunnings warehouse. These are also sold online on eBay and Amazon, especially the portable ones that are used for traveling. Consider the price when buying them but in all likelihood, they are almost always affordable. If not it's also possible to improvise and using something else as an alternative, i.e using a plastic chair or stool as a showering chair instead of a standard hospital showering chair or rubber slippers the patients can wear on their feet while they are showering instead of using a non-slip mat.

The purpose of any overnight leaves to build up patient's confidence in being independent and to stimulate learning, consider doing activities that engage the mind into doing complex tasks to build new neural pathways, below are some examples of daily activities that one may adopt while being at home:

• Language learning: For those with mild to severe aphasia r dysarthria, this can be beneficial in engaging te broncas area of the brain's prefrontal cortex that deals with language comprehension. Studies have also proven that individuals who are multilingual tend to have very plastic brain and are capable of recovering faster. therefore learning a second or even third language helps with neuroplasticity. Learning a language doesn't have to begin from scratch if patients have studied a foreign language before in the past but discontinued or along time, it's best to start learning again and reawaken dormant pathways that were made for the learning of that specific language.
• Journals: Keeping a journal is not only the best way to plan our days ahead but to have a clear and detailed steps on what we want to achieve in a certain period of time. This comes in handy for patients with mild to severe short term memory loss. A journal can help them stay focus and on track with what they're doing.
• mindfulness meditation: meditating isn't just for monks, it's also used by athletes and health professionals to train the mind to be aware of itself and to be intuned with the body and all physical sensations.
• Physical exercise: This may be challenging to most patients especially when they have paralysis, making it hard to do any physical exercises but it doesn't have to be exhausting as ding cardio or weights, it can be as simple as doing repeated movements like singing your arms up and down repeatedly for a few minutes until you sweat. This is already enough to tire the body and brain and stimulates neurons to grow back.
• Adopt healthy habits: This could mean waking up early, sleeping on time and getting more sunlight exposure.
• Adopt a healthy diet: What we eat influences our body and how we use them, Food with a high carbohydrate intake causes too much overactivation of the central nervous system, which may slow down plasticity.

All in all the key to an effective and productive overnight leave is persistent mind and body stimulation. Being idle is a negative habit that should be reduced, if not avoided at all times, always keep the mind engaged with anything. Below are some habits to be avoided  or reduced,

• Excessive screen time: prolonged usage of electronics, isn't just bad for the eyes, it also inhibits some of the neural synapses in the brain as it reduces the brain's capability to concentrate and focus another more important task and it may even cause addiction, too much screen time is also linked to the release of excess dopamine and delta-foss B, two neurotransmitters responsible for addiction. 
• Excessive sitting/ resting: If possible, patients should spend the majority of their time standing instead of sitting, the human body was not designed to sit, this further worsens atrophy in muscles and puts pressure on your intestines.When standing patients must be able to distribute their weight evenly on both legs, while maintaining a good centre of mass.    
• Favoring dominant side: Patients with hemiplegia are encouraged to use their weaker side more to find alternative neural pathways to retrieve lost motor function, this could mean opening and closing doors using the affected arm, using affected leg to carry all of the body weight when climbing on stairs or turning on the lights using fingers on the affected hand.
• Excessive time in dim places: how much light we are exposed to also affects the brain, places that are bright stimulates neurons to fire synapses, thus increasing communication between one neuron with another, increasing the chances of plasticity better than spending time in dark places. 
• High intake of carbohydrates and sugar: Excess consumption of sugar and carbohydrates can cause neurons to become over stimulated and fire synapses too fast, causing disorganized communication in the brain, this eventually inhibits necessary chatter for neuroplasticity.  

With the list of do's and don'ts of overnight leave mentioned above, patients or care takers are free to plan out their activities and how they want to approach them, it's best that any planned activity is first consulted with doctors to ensure safety and effectiveness, if any suggestions mentioned here do not correspond with the individual need of a patients then adjustments and be made and the list of suggestions can be amended.