The families of traumatic brain injury (TBI) victims often have many questions when their loved one is transferred to a rehabilitative care center.
What happens in rehabilitation?
Similar to the acute care facility, the TBI patient will be cared for by a team of professionals who specialize in the care of trauma victims.
Their goals are to:
- Stabilize the medical and rehabilitation issues related to brain injury and the other injuries.
- Prevent secondary complications. Complications could include pressure sores, pneumonia and contractures.
- Restore lost functional abilities. Functional changes could include limited ability to move, use the bathroom, talk, eat and think.
- The staff will also provide adaptive devices or strategies to enhance functional independence.
- The staff will begin to analyze with the family and the patient what changes might be required when the person goes home.
Each day, the patient will participate in therapy. Initially, the patient may require staff assistance for even the most simple activities: brushing teeth, getting out of bed and eating. The patient also may require staff for safety because there is a risk of falling, eloping (trying to get out of the hospital to go home) or getting hurt. The patient may be confused and forgetful.
The Rehabilitation Team
The Physiatrist is the team leader in the rehabilitation program. The physiatrist is a physician specializing in physical medicine and rehabilitation. Physiatrists treat a wide range of problems, including the changes after brain injury. The physiatrist will assess and prescribe the treatment and direct the team.
The Neuropsychologist is a key member of the rehabilitation team. The neuropsychologist will assess the patient’s changes in thinking and behavior. Changes could include:
- Poor memory
- Poor attention and concentration
- Poor decision-making
- Language and communication abilities
- Inability to speak
- Inability to understand when spoken to
Many patients are unaware of the changes in the brain and how those changes affect their daily lives. A patient may not understand what has happened and may be distraught by being away from home. Through education and counseling, the neuropsychologist can help assure the patient and the patient’s family.
The Rehabilitation Nurse assists patients with brain injury and chronic illness in attaining maximum optimal health, and adapting to an altered lifestyle. The Rehabilitation Nurse provides care for the patient on the nursing unit. The focus of nursing care is on:
- Health maintenance
- Potential for aspiration
- Impaired skin integrity
- Bowel and bladder incontinence
- Impaired physical mobility
- Impaired or limited ability to take care of self
- Ineffective airway
- Sleep pattern disturbance
- Chronic pain
- Impaired cognition
- Impaired verbal communication and comprehension
- Sexual dysfunction
The Physical Therapist works with people with orthopedic problems, such as low back pain, knee injuries or pain reduction. With traumatic brain injury, the PT’s job is to minimize or overcome paralyzing effects related to the brain injury. Physical therapists are experts in the examination and treatment of musculoskeletal and neuromuscular problems that affect the abilities to move and function in daily life.
Physical therapists help with transfers to and from the bed when a patient cannot walk alone. They train a person to begin to walk and move more normally. PTs will assess:
- Need for a wheelchair, brace or cane
- Quality of movement
- Spontaneous movement
- Coordination of movement
- Increased sensation of sensory-motor activities
- Pain management
The Occupational Therapist assesses functions and potential complications related to the movement of upper extremities, daily living skills, cognition, vision and perception. OTS help determine, with the patient, the best ways to perform daily living skills including showering, dressing and personal hygiene. The OT will identify equipment for eating, dressing and bathing.
The OT also will look at skills to prepare the patient for a return to the home. These skills include:
- Grocery shopping
- Readiness for returning to work by assessing prevocational and vocational skills
The following sections explain: