The Role of Rehabilitation

North Carolina Department of Health & Human Services
The Role of Rehabilitation

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.

Elements of TBI Rehabilitation
According to Cope (1995), comprehensive TBI rehabilitation today consists of at least the following elements:

  • The rehabilitation physician (also known as a physiatrist) and rehabilitation nurse have special training in diagnosing and treating people with disabilities. Their goal is to help the patient function as independently as possible.
  • The prevention of secondary deterioration is important. Evidence clearly confirms that specific interventions can prevent deterioration and complications. These interventions may not reliably occur in non-rehabilitation environments.
  • Rehabilitation builds upon natural recovery processes. Rehabilitation interventions are incremental and work toward functional gains. The challenges of mobility, self-care and communication can be overwhelming for the patient. This may result in a hopeless “giving-up” response by the patient. Over time and with comprehensive rehabilitation, progress can occur.
  • An optimal environment for neurological recovery is provided by rehabilitation settings.
  • Various compensatory techniques are provided and taught to promote recovery and help with the tasks of daily living.
  • Adaptive and specialized equipment, such as wheelchairs or orthoses, is available in this setting.
  • Environmental modifications are available. These include architectural and transportation interventions. Even more important may be interventions in the patient’s social milieu, which include modifications at home, at work and in the community.

In the Report of the Panel for Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury dated October 1998, Diane Murphy, a survivor since 1990, made these comments below concerning the need for rehabilitation services and difficulties associated with under diagnosis of TBI:

“I am six years post-accident. However, getting here was not an easy task. Taking the advice of very educated doctors, my husband brought my broken body home after being in the hospital in critical condition for two weeks. My family did not worry about my brain injury, at least not out loud. They tended to the visible injuries, thanking God every day that my daughter and I had survived the accident. Who ever heard of a brain injury that doesn’t kill the person or put them in a lifelong coma? Right? Becoming better wasn’t nearly as hard as finding the right place to get better. I would really like to see the health community and general population informed about all the problems associated with a mild brain injury. I am hoping that the next person with a brain injury gets directed to immediate care, not a band aid excuse of ‘Don’t worry —  it will all work itself out.’”

Unfortunately, the story described does occur. Inpatient or outpatient rehabilitation can begin to address the brain injury issues that cause so much frustration and confusion.

Posted on BrainLine May 5, 2009

This fact sheet is part of the TBI Toolkit produced by the Washington State Department of Social & Health Services, Aging & Disability Services Administration. Reprinted from: ‘Skill Pak for Hospital Staff to Help Families Understand Brain Injury’, TBI Project A.C.C.E.S.S., North Carolina Department of Health & Human Services. References: Report of the Panel for Consensus Development Conference on the Rehabilitation of Persons with TBI, October 26-28, 1998.
Cope, Nathan, ‘‘The Effectiveness of Traumatic Brain Injury Rehabilitation, a Review’’ ‘Brain Injury’, Volume 9, No. 7 1995, pages 649-670. Additional copies of the TBI Toolkit can be downloaded at http://www.aasa.dshs.wa.gov/Library/tbitoolkitpro.pdf.
 

Comments

As with any service for hire out there- there are good ones and bad ones! There are a variety of rehabilitation hospitals out there- a survivor of TBI needs to shop around! Too often in the medical world, patients don't think they have a choice- a TBI survivor should look for a facility that specializes in brain injury- from neurologically specialized therapy staff to rehab nurses. I always tell families to ask staff who they are seeing that particular day... did the PT just finish with a brain injury survivor or just work out a total knee patient?!?! Are the nurses on the floor engaged in patient's rooms, assisting with movement, cognitive exercises, or family education or are they holed-up at the nurses stations with patients alone in their rooms?? SHOP, SHOP, SHOP like you would with any other service!
I am a successful TBI survivor who urges that this claim about necessity of rehabilitation be taken with a large grain of salt. As with all types of health care in the US now, obtaining long-term, high-quality rehabilitation following a brain injury may be impossible for a large number of survivors. One should NOT be led to believe that chances for recovery are poor without access to such services. Most recovery comes from the brain's own natural and amazing abilities to heal and reconnect broken pathways (plasticity). In any TBI support group, you can meet survivors who will swear that things they did on their own were the key to success -- not any particular expensive doctor or therapy. "Research" touting the great advantages of rehab often can be found to be self-serving advertisements by the medical and rehab industry.

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