Traumatic brain injury rehabilitation
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Rehabilitation
Rehabilitation is a critical part of recovery from TBI. During the acute stage, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital followed by movement to a step-down unit or to a neurosurgical ward. Once medically stable, the patient may be transferred to a subacute unit of the medical center, to a long-term acute care (LTAC) facility, to a rehabilitation inpatient treatment unit contained within the acute trauma center, or to an independent off-site rehabilitation hospital. Some inpatient treatment units have a specialty focus in brain injury rehabilitation.
Decisions regarding when and where an individual should be treated depend on many different factors including the level to which the person can participate in the rehabilitation process. Moderately to severely injured patients may receive treatment from programs including physical therapy, occupational therapy, speech and language therapy, psychiatry (physical medicine and rehabilitation), psychology, psychiatry, and social work. The services and efforts of this team of healthcare professionals are generally applied to the practical concerns of the survivor. This treatment program is generally provided through a coordinated and self-organized process in the context of a trans disciplinary model of team healthcare delivery. The overall goal of rehabilitation after a TBI is to improve the patient's ability to function independently at home and in society. Therapists help the patient adapt to disabilities or change the patient's living conditions to accommodate impairments. Education and training for caregivers are also critical components of the rehabilitation program.
After discharge from the inpatient rehabilitation treatment unit, the outpatient phase of care begins and goals often will shift from assisting the person to achieve independence in basic routines of daily living to treating broader psychosocial issues associated with long-term adjustment and community reintegration. Patients will often have problems in areas including cognition, social awareness, and behavior and emotional regulation, often complicated by difficulty adjusting to deficits. Other concerns such as post traumatic stress disorder associated with disturbing memories surrounding the injury, may emerge and complicate recovery.
An additional goal of the rehabilitation program is to prevent, or failing that, to diagnose and treat TBI complications that may cause additional morbidity and mortality.
Some patients may need medication for psychiatric and physical problems resulting from the TBI. TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents or may be inordinately sensitive to them, for example, due to a more permeable blood-brain barrier that may result from injury.
It is important for caregivers to assist and encourage the patient by being involved in the rehabilitation program. Family members may also benefit from psychotherapy and social support services. Caretakers often feel a great deal of emotional stress, which can reduce the quality of their care. Support for caregivers becomes particularly important during the outpatient phase of care when behavioral and cognitive problems may complicate patients' relationships, particularly in marriage. Respite care such as supported living and residential holidays, with supported days out, offers relief for caregivers and a new area of brain stimulation for the patient.
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