How Much Therapy Is Enough for Someone with TBI? Elaine Phillips, BrainLine

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Two years ago, my son, now 29, was injured and sustained a severe TBI. He still has poor speech and poor motor skills. He’s incontinent and in a wheelchair, but his cognition is not too bad. Do you think one hour of physical therapy and speech therapy a week will make a difference? We are paying out of pocket and can’t afford any more therapy. And our insurance is exhausted.

We used to think that most recovery took place within 12-18 months after a brain injury. We know now that recovery can continue for longer periods; however, more likely at a slower pace. Unfortunately, the majority of people can’t afford to provide the optimal amount of rehabilitation or care. In fact, the Brain Injury Association of America estimates that only 5 percent of individuals with severe brain injuries have adequate funding for long-term treatment.

Any rehabilitation during this period should be focused on functional goals. Your description leads me to think that your son’s speech may be difficult to understand or that he may require a great deal of assistance to transfer from his wheelchair to the bed. Generally speaking, one hour a week of physical therapy or speech therapy at this stage may not be enough to see progress. Currently, researchers are trying to establish how much therapy is enough and which therapies are the most effective when.

Depending on your family’s circumstances and your ability to spend time at home practicing skills, a re-evaluation and a few sessions of physical therapy may be useful in setting up a home exercise program to prevent complications such as contractures or skin breakdown. Speech therapy for a limited time could help develop an alternative communication system such as a communication board if verbal expression is frustrating for your son.

If you haven’t already, be sure to contact your state’s governmental agency responsible for people with disability. There may be resources available for care or intervention, especially because your son will continue to have long-term care needs. And if you haven’t already invested supplemental security income under Social Security, that could be another source of support.

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Elaine Phillips, MSP, CCC-SLP has more than 17 years of experience in the field of brain injury, both as a speech-language pathologist as well as managing the outpatient brain injury rehabilitation program at Roger C. Peace Rehabilitation Hospital in Greenville, SC. In addition, she is a Certified Brain Injury Specialist-Trainer and is Board President of the Brain Injury Alliance of South Carolina. Elaine is the research consultant for the BrainLine project.

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