Rehabilitation

A brain injury can affect just about everything -- including the way you walk, talk, and think. That's why there are a number of treatments available that attempt to restore the parts of life that have been affected by a brain injury. The term "brain injury rehabilitation" refers to the many different kinds of specialized supports and services that are offered following the emergency and early phases of brain injury treatment.

Some brain injury rehabilitation is offered as a program within a hospital or other clinical setting; other types of brain injury rehabilitation might occur on an outpatient basis. While most everyone benefits from rehabilitation following a brain injury, the specific type of rehabilitation depends on the unique needs of the person and the challenges they face.

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Selecting the Right Rehabilitation Facility After Brain Injury

Selecting the Right Rehabilitation Facility After Brain Injury
To find the right rehab, you have to ask a lot of questions and you have to also kind of get an understanding of the fact that there are a large number of brain injury rehabs, and all of them have their own specialties. So, if your loved one has more physical problems--you know--maybe their balance is off or their motor control is a little off, then they are going to need a place that really works on physical therapy. But on the other hand, if, say, there are a lot of challenging behaviors that come up after the injury but the person seems physically fine, then you might be looking for more of a neuro-behavioral program where they concentrate more on environmental changes and positive coping strategies for dealing with these behavioral episodes. This kind of therapy kind of runs the gamut. Unfortunately, very many states have very few comprehensive rehab facilities, and so many people are forced to find services hundreds of miles away from home.

What Could We Have Done Better for Our Patients with Brain Injury?

What Could We Have Done Better for Our Patients with Brain Injury?
One success story that is very close to my heart was a person I worked with one time who had significant self-injurious behavior, and to the extent that that behavior would jeopardize their life. And they came to us and had significant neurobehavioral issues-- aggression, self-injurious behavior-- and after roughly a year and a half this person was able to move forward, get a GED, go to a lower level of care, and resume pretty much a "normal" life, so that's a very successful event. The flip side of that is sometimes we don't always have the victories, sometimes we have the losses, and another patient that came to us one time-- the same kind of neurobehavioral issues, self-injurious behavior-- and unfortunately they'd been through a lot of different treatment at a lot of different places and they were harboring that ugly word called "institutionalization" within them. And when it came time to move to a lower level of care, they chose to actually act out and re-create the negative behaviors that would prevent them from moving to the lower level of care, and ultimately chose to go back to prison on a previous charge instead of staying in treatment. And so those are the ones that kind of tug at your heart the other way, that you go back and you question yourself and you wonder, What could I have done better, what didn't I do, what should I have done-- that's my goal for all of our therapists and all of our nurses and doctors and all of our team, is rather than fall into a scenario where we blame the patient, let's take a look at what we did ourselves and what we could have done better. Not to the extent that it hurts us internally, but it doesn't ever hurt to go back and just kind of re-evaluate what happened and what you can do better and move forward from that. My advice to families would probably be search out a place that is open and honest with you and that doesn't sit back and pull punches and try to gloss over the issues. at the same time being gentle and kind to what you're going through, but as I said earlier, not glossing over everything and telling you how wonderful everything's going to be, just come to our program. Watch out for the hard sell as opposed to the dedicated facility or individual.

What Is TBI Rehabilitation Really Like?

What Is TBI Rehabilitation Really Like?
The question I put forth with what is TBI rehabilitation really like has to do from my perspective of what really goes on on the front lines day in and day out. In other words, like at Brookhaven, the day-to-day floor decisions by the professionals, the nursing staff, the Milieu staff, and in light of the day to day interactions and decisions that we make with patients, what are we really doing? Are we allowing them to be a partner in their treatment or are we still adhering to a treatment regimen that we believe through our own beneficent intent is going to work best for them, and who truly knows what works best for them? I would like to think that we have some of the knowledge as professionals, at the same time as professionals I don't think we want to rule out the knowledge that the patient themselves have. We also don't want to rule out the knowledge that the family also has when there's family involvement. And so I think again, it's a large participatory model of everyone involved and that's what I mean by what is it really like. And I'm looking to try to spur thought among professionals to think in these terms of patient autonomy, patient capacity, and questioning our own treatment decisions from an ethical standpoint and our own beneficent intent as opposed to the actual reality of what the patient sees, and experiences, and perceives as our intent. And what I am trying to address there, and have concern for, is moving away from a general standardized model of treatment opposed to a more individualized treatment. I think the profession talks about individualized treatment quite a bit, at the same time I think the reality is we all have standard operating procedures that we go through with everyone.

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