The "Whatever It Takes" Model for Brain Injury Recovery
Holistic rehab is like the "whatever it takes" model. Balance issues may need to be treated by a PT and depression by a psychologist, but those therapies overlap for the outcome of the whole person.
Holistic treatment is rehabilitation that's directed at the whole person. You can weave traditional rehabilitation interventions into that. For instance, a person may need help in their mobility, they may need help with their memory, they may need help dealing with their anxiety and anger, and they may need help in independent living and return to work. That set of problems is probably best addressed holistically, all together. But the mobility problems may need traditional physical therapy, and depression may need good ol' psychotherapy and an anti-depressant. However, that all interacts with the goal of getting them back to work and independent living, so it's best to be working on all of that at once and to have the people that are working on that all on the same page. If I want to get the person back to work, and I send them to a job trial-- am I going to plunge them back into a depression if things don't go well? This is, at a very basic level, the concept of holistic rehabilitation. There may be different providers of these various services, but they're interacting in a very regular way to make sure that everything stays on track, and to some degree, can kind of assume each other's roles. So, if the psychologist working on depression sees that the person isn't wearing their foot brace and it's affecting their ambulation, they know enough about what the physical therapist is doing to remind them to get back on track. In the same way, the physical therapist notices that they're starting to do some of the self-talk that perpetuates depression, they can help them stop and move on. The concept of holistic rehabilitation, to some degree, is also a "whatever it takes" model. If meditation, or mindfulness, or Tai Chi-- if this is going to make a difference for a person, this can be part of the treatment plan. And that can be highly individualized. A person who has a background in any of those activities before their injury-- that might really be the preferred mode of treatment. Something familiar will help them manage their behavior and emotions a little more successfully.
Posted on BrainLine November 1, 2012.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.
James Malec, PhD, is professor and research director in the Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and the Rehabilitation Hospital of Indiana. He is a professor emeritus of psychology at the Mayo Clinic.