What Kinds of Rehabilitation Should a TBI Patient Receive?

National Institute of Neurological Disorders and Stroke
¿Qué tipos de rehabilitación debe recibir un paciente con traumatismo cerebral?

Rehabilitation is an important part of the recovery process for a TBI patient. During the acute stage, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital. Once stable, the patient may be transferred to a subacute unit of the medical center or to an independent rehabilitation hospital. At this point, patients follow many diverse paths toward recovery because there are a wide variety of options for rehabilitation.

In 1998, the NIH held a Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury. The Consensus Development Panel recommended that TBI patients receive an individualized rehabilitation program based upon the patient's strengths and capacities and that rehabilitation services should be modified over time to adapt to the patient's changing needs.* The panel also recommended that moderately to severely injured patients receive rehabilitation treatment that draws on the skills of many specialists. This involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support. Medical personnel who provide this care include rehabilitation specialists, such as rehabilitation nurses, psychologists, speech/language pathologists, physical and occupational therapists, physiatrists (physical medicine specialists), social workers, and a team coordinator or administrator.

The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient's living space, called environmental modification, to make everyday activities easier.

Some patients may need medication for psychiatric and physical problems resulting from the TBI. Great care must be taken in prescribing medications because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents. It is important for the family to provide social support for the patient by being involved in the rehabilitation program. Family members may also benefit from psychotherapy.

It is important for TBI patients and their families to select the most appropriate setting for rehabilitation. There are several options, including home-based rehabilitation, hospital outpatient rehabilitation, inpatient rehabilitation centers, comprehensive day programs at rehabilitation centers, supportive living programs, independent living centers, club-house programs, school based programs for children, and others. The TBI patient, the family, and the rehabilitation team members should work together to find the best place for the patient to recover.

* National Institutes of Health Consensus Development Conference Statement, October 26-28, 1998. Rehabilitation of Persons with Traumatic Brain Injury. Bethesda, MD, September 1999

-----------

NIH Publication No. 02-2478

Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

Posted on BrainLine May 17, 2013.

Source: Traumatic Brain Injury: Hope Through Research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov

Comments (9)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

As a 64 year old female brain tumor and stroke survivor, 18 years post brain surgery with Short Term Memory Loss, headaches, fatigue challenges, divorcing after 43 years, I would very much appreciate support for coping strategies, it’s impact on family adjustment dynamics, refreshing and learning cell phone and internet technologies.

Your cooperation would be greatly appreciated.

Thank you very much.

Cherlyn Bell-Wilson

Dear Cherlyn, I can empathize. I divorced after a stroke - was together with her for 27 years. After returning home from the rehab hospital, She informed me," I don't want sex with anybody especially you! If you want affection- get a girlfriend? So, I moved to Mexico both physically and emotionally - great rehab learning another language and adapting to a new environment. Mexico is pretty awesome too.

Looking for the next chapter, but all they care about is my money. Do you see the problem with a for profit rehab?

I suffered a tbi in a car accident in 1999. Doctor just wanted to label me depressed and nearly killed me with meds for that. Two more car accidents worsened the problems. I have learned of a condition called auditory processing disorder and been evaluated for that. Yes, that is what I have and it is caused by a tbi (or born with it, which I was not). I cannot get a doctor to understand I have a tbi. I understand it will show up on an eeg and I have been trying to get an eeg to prove the tbi. As horrible as this is, I am taking comfort that I am not alone in what I can only call abuse by the medical industry. I also have ptsd from the car accidents and resulting legal abuse (my job was taken from me and I know it is false info in medical records, but can't get any help with this). Would be great if enough of us with tbi and no treatment or accommodations could form a group and get some attention on the problem and hopefully some true help instead of mental health diagnosis for a physical injury like this.

Ohh my god bless this message that I've just read. I had a TBI in Feb 2013 and my life now is unrecognisable as it was before but possibly the biggest impact upon me has been every body's lack of understanding and attitude towards me. I'm glad that I was born with resilience as I've needed every drop of it. Gary.. Gary.Prowse. Gp@Gmail.com

I don't know if its me or that our story is unique that I am finding it difficult to find the right information to help my husband. Overwhelming is an understatement for what we have been going through. The first frustration is the medical profession understanding what we need.

My husband as a late teenager had a motorcycle accident that he was in a coma for 6 moths. As soon as he could he left the hospital and fled the state. Never did he get any type of rehab. 30 plus years later he has coped with his anxiety and anger with alcohol. He and I have been married for 2 years. His first marriage ended because of complications of his TBI. I did not know he had this problem I did know about the drinking. Moving ahead when ever I told our doctor he needed medication for anxiety and he learned of his alcohol abuse that was the only thing the doctor wanted to focus on his drinking.

I was able to get him up the dose of his anxiety medicine but thats all he will do.

Thanks for letting me vent here. One more note my husband is currently going through getting his license back and they want him to undergo counseling for alcohol but he is not one to benefit from this as this is not the underlying cause of his drinking. I wish I could get these professionals to help me. You would think they would have this education.

Michelle

ogmichelle45@gmail.com

My TBI was September 13, 1999. To this day I still suffer with the short term and long term memory issues. I am very fatigued, very depressed and suffer much anger issues. I did check into a mental institution one time but long-term, it had no answers for my problems. No one understands and even the medical world does not understand symptoms of a 19-year-old TBI. It’s literally driving me crazy and I’m driving everyone else crazy. I am a very depressed and anxious Christian man. It must be believe it is that no one believes that the TBI issues can exist as long as mine half., But my symptoms are very real! If there is Who knows of treatment for that old of a TBI issue please contact me. Michelle best of luck to you and your problems I pray God will help you.

I recently had my first experience with a TBI patient. He suffered severe head trauma at age 25 and now, 3 years later, he has still not received any kind of intensive TBI rehab. He has partial paralysis and can’t speak. He uses his iPad to communicate. When I inquired why he never got TBI rehab like his doctor recommended, I was told you have to be 21 or younger to receive TBI rehab?! How can this possibly be true? This young man is suffering greatly with depression and decreased function. I am trying to find a way to help him. Does anyone have any answers?

Melanie, I understand your pain for this young man......my son (51yrs old) suffered a TBI 3 years ago also and he was offered NO REHAB!!! All doctors at the hospital and rehab/nursing facilities gave up an said "he'll never be able" to do anything!! (His injury was to the very top/center of his head) I've been with him every day since the accident......I worked with him, entertained him, encouraged him....even in these institutions, I was his primary caregiver and the staff at the institutions allowed and welcomed me!! He was sent home for me (75yrs. old) to continue his care......none of his doctors seem to care, they always ask "what do you think is wrong"? Now my son has fallen into a state of depression, showing a lack of interest in LIFE, he is now 100% disabled!! All that I had taught him is now gone...….he won't eat (G-tube fed), he won't talk, he won't pray or sing anymore nor will he help me with his care!!! If anyone has suggestions or answers, please, please let me know!! Thanks in advance!