Rehabilitation

The Role of Rehabilitation

Inpatient or outpatient rehabilitation can begin to address the brain injury issues that cause so much frustration and confusion. Research has found that patients who received inpatient rehabilitation after brain injury had better outcomes than patients who received only acute care. Outcomes were measured in the areas of functional status, daily care requirements, ability to return home and vocational status.

The goal of rehabilitation is to help people regain the most independent level of functioning possible. It’s very important that therapists treating the person with TBI be trained specifically in TBI rehabilitation. Acute inpatient hospital rehabilitation uses a comprehensive approach that includes medical stabilization, physical rehabilitation and cognitive/behavioral rehabilitation. Rehabilitation promotes learning, coping and adapting as the patient faces life-altering changes.

Social skills training and counseling services are provided to address the emotional and adjustment needs of the individual and family. In this environment, interaction among patients provides another opportunity for support. Rehabilitation may be short-term (a few weeks or months) or long-term (several years).
Many individuals with brain injury follow a treatment course in which they initially receive acute medical, proceed to the acute level of rehabilitation and progress to more independent settings such as home with an outpatient program. Some individuals will need long-term care that may occur at home or in an extended care setting.

Home and Community-Based Treatments

Individuals with brain injury who are able to go home may still need therapy or other care. Outpatient therapy is provided at hospitals, clinics and rehabilitation facilities. Outpatient physical therapy will help build up strength and endurance. Outpatient occupational, speech and cognitive therapy may also be needed. Family or friends may need to arrange transportation for therapy appointments.

Home health care programs are available in many communities. Some of the services they offer include in-home nursing care, homemaker and health aides, meals-on-wheels, adult day care, home therapy visits, medical equipment rental/purchase and transportation.

Reference:

‘Traumatic Brain Injury: Independent Study Course’, Department of Veterans Affairs, released January 2004, Michigan Resource for Persons with Traumatic Brain Injury and Their Families, Version 1 2002, Center for Collaborative Research in Health Outcomes and Policy, Michigan Public Health Institute.

Working With Your Health Care Team in the Hospital

Patient: The patient is the most important member of the team. Care will be planned based on how the patient responds to treatment.

Family and Friends: You provide emotional support to the patient. Family and friends also provide the health care team with important facts about the patient’s past history and can help watch for changes. Other team members will show you what you can do to help with the recovery process.

Doctors: Neurosurgeons are specialists who help determine the type of brain injury and its treatment. They may perform surgery on the brain. They will work with other doctors if the patient is in intensive care or has injuries to other parts of the body. Other specialists who may care for the patient include neurologists and physiatrists. Your primary care provider may also coordinate the team. Members of the health care team will work together with the patient, family and friends during the hospital stay. Care will be centered on the individual needs of the patient.

Nurses: Nurses check patient's vitals (temperature, blood pressure, heart and breathing rate) and watch for changes in strength and thinking. They help with daily cares such as eating and bathing. Nurses also coordinate care among the members of the health care team.

Social Workers: Social workers provide emotional support to help the patient and family adjust to being in the hospital. They coordinate discharge planning, referral to community resources, and answer questions about insurance or disability.

Physical Therapists (PT): Physical therapists evaluate and treat weaknesses in the patient's strength, flexibility, balance, rolling, sitting, standing and walking. Treatment may include exercises or instruction in use of equipment such as walkers, canes or wheelchairs.

Occupational Therapists (OT): Occupational therapists evaluate the patient's ability to perform dressing, bathing, homemaking and activities that require memory and organization. They provide treatment or equipment needed for safe independent living.

Speech Therapists: Speech therapists test and treat speech, language, thinking and swallowing problems.

Neuropsychologists: Neuropsychologists test thinking, memory, judgment, emotions, behavior and personality. This information can be used to help guide treatment. It will also help determine the amount of supervision that the patient needs when they leave the hospital.

Dieticians: Dieticians assess nutritional needs. They work with the patient and other team members to help the patient
meet their nutritional goals.

Other staff members may work with the patient and family. These include:

Asking for information

  1. Ask which doctor is in charge of the patient’s care. Find out the best time to talk with the doctor and how to contact him/her.
  2. Nurses have the most contact with the patient each day. Ask which nurse can be the communication link with you and your family. Ask whether this changes each day, evening, shift or weekend.
  3. Ask all therapists to describe what they do and why it is important. Ask for suggestions on what you can do between therapies to help the patient. Write down their names and contact information.
  4. Ask hospital professionals to tell you their names and what part they play in the patient’s care. Writing down names may be helpful.
  5. Ask how the medical team will update you on the patient’s progress. Arrange for a family member to be present if possible.
  6. Ask how to arrange meetings with doctors, therapists and specialists. You may request a meeting any time. Before any meeting, write down questions and use your notes.
  7. Ask how to get involved in the patient’s care and how decisions about treatment will be made.
  8. Tips for Understanding Information
  9. Select one person in your family to be the communications link with the hospital.
  10. If you don’t understand something, ask that it be repeated or stated differently. Ask where you can find more information to read.
  11. Ask hospital staff for an interpreter if English is not your primary language. Try not to rely on family members to interpret, as this may be upsetting and difficult for them.
  12. Take notes or use a tape recorder (with permission) to help you remember important information and instructions.
  13. Ask for written information to help you understand brain injury.

Planning Ahead

  1. Plan the next steps with hospital professionals. Ask when the patient will be discharged and what problems you may expect.
  2. Request a list of traumatic brain injury resources to contact in the future if necessary.
  3. Keep copies of important information, such as consultants’ reports and discharge summaries. Start a three-ring binder to keep them organized.

Finding A Balance

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