TBI REHAB TEAM

TRAUMATIC BRAIN INJURY REHAB TEAM

     Welcome to the Traumatic Brain Injury manual -- TBI for short. This manual is designed to provide you with the rehabilitation treatment you need to help you reach your physical, cognitive, psychological, social, and vocational potential. Your TBI Rehab Team will be working with you and your family to help you become independent and understand the effects of your injury. Prior to your admission, you had a thorough pre-admission evaluation and screening to make sure you are an appropriate candidate for rehab and to help your TBI Rehab Team determine the best possible individualized plan of care for you.

     You are the most important member of the TBI Rehab Team. If you have any questions or problems, do not hesitate to talk with the other members of your team. They exist for one reason- to help you succeed and reach your optimum level of wellness and independence.

(M.D.) - The Physiatrist is a physician who is a specialist in physical medicine and rehabilitation. The physiatrist is the Team Leader who directs your care.

(RN) - Your Nurse is also a very important person. She/he will:

  • Assess you physically and obtain pertinent information necessary to design your personal care plan
  • Take care of you and instruct you and your family so that you will be as independent as possible. The concept of independence is very important for you and your family to understand, as nursing care is based on this goal. Your nurse will encourage you to do as much for yourself as possible - and then some!
  • Follow through with your other therapists' recommendations for your care.  After the first few days, you will be given a daily therapy schedule. You will be expected to keep your therapy appointments on your own whenever possible. If you are unable to get to your therapy appointments independently, a transporter will assist you.

(OT) - The Occupational Therapist will help you:

  • Improve your well being and prepare to return to a meaningful "occupation" or routine of day-to-day activities. These activities can include work, leisure, school, and social responsibilities. Daily activities, such as getting dressed, eating, preparing a meal, and bathing or using the toilet are often difficult to manage following a brain injury. The occupational therapist will help you relearn the skills necessary to perform these activities of daily living (ADLs) as independently as possible
  • Learn to function with changes in your thinking and physical abilities by teaching you other techniques and the use of adaptive equipment. For patients in a coma, the occupational therapist works with other members of the Rehab team to provide a structured program of multi-sensory stimulation
  • Increase your overall endurance and the strength and function of your upper body and arms, with splints or positioning aids when necessary
  • Evaluate changes in your visual and perceptual skills and the impact of these changes on your functioning at school, work, and in the community, including driving, thinking, managing money, memory, etc.
  • Design a treatment plan based on your injury and needs. The primary goal is for you to improve and relearn the skills necessary for living as independently as possible.

- The Physical Therapist is often thought of as a specialist in walking. However, for patients with a brain injury, physical therapy encompasses many aspects of function. Although walking is often a realistic goal, the physical therapist will:

  • Help you meet other goals as well, such as:
    • Increasing the structure of your day
    • Increasing your upper and lower body strength
    • Improving function in all activities
    • Increasing your balance
    • Obtaining maximum endurance and independence in mobility
  • Instruct you in a variety of activities that you can perform to help you reach your goals, such as range of motion, strength, coordination, balance, mobility, and safety activities, and design a treatment plan to suit your rehabilitative needs, which may include a brace, orthotic device, or walker
  • Review any precautions your physician may have ordered, such as cardiac, safety, or orthopedic precautions, and instruct you how to incorporate them into your daily functional activities, such as using a cardiac monitor
  • Instruct you and a family member in a home exercise program or other activities that let you continue your strengthening program, and may recommend home therapy, day treatment, outpatient therapy, special equipment, or community resources following your discharge from the hospital

- The Speech/Language Pathologist addresses a variety of issues in brain injury rehabilitation, including speech quality (articulation), understanding and expressing the spoken and written (language/communication), thinking (cognitive skills), and swallowing problems. The speech therapist will:

  • Thoroughly evaluate changes in communication and cognitive skills due to the brain injuryand the impact of these changes on day-to-day activities. For some problems, the therapist may recommend evaluation by a hearing specialist (audiologist) or an ear, nose, and throat doctor (otolaryngologist)
  • Emphasize the relearning of cognitive skills which are affected by the brain injury, such as attention, memory, sequencing, planning, reasoning/problem-solving, judgment, and self-monitoring of thoughts and behaviors, and the ability to use the relearned skills in other settings and situations. The therapist works with other members of the Rehab Team to help the patient address cognitive skills in all daily activities
  • Evaluate the skills necessary for effective school, work, and community functioning and focus on relearning those tasks that are specific to the individual's previous work or school responsibilities when possible. The therapist may consult with a vocational counselor for optimal assistance and may evaluate additional (augmentative) communication needs for patients who may require an alternative system to help them communicate needs and thoughts, such as a letter or word board or an electronic or computer system
  • Evaluate and manage swallowing (dysphagia) problems

- The Recreational Therapist will focus on leisure activities, hobbies, and crafts that integrate goals and functional tasks begun in other therapies. An integral part of therapeutic recreation is the community re-entry program, which consists of outings into the community, movies, shopping malls, etc. These outings provide an opportunity for you to apply techniques learned during therapy sessions and reach your maximum level of independence in the "real world." Family members are invited and encouraged to participate in the community re-entry program.

- The Psychology Department provides assessment and therapeutic services to you and members of your family who are learning to cope with the effects of your disability, whether temporary or long term. When illness or trauma causes changes in levels of function and lifestyles, support and positive motivation are crucial to a successful adjustment by you and your family. You may meet with a member of the psychology department several times a week, in individual or group sessions. Services provided by the psychology department include:

  • Initial cognitive and emotional evaluation, as well as neuropsychological testing
  • Individual and/or group psychotherapy to facilitate your involvement in the rehabilitationprocess, your adjustment to your injury or disability, and the alteration in your physical, cognitive, and emotional functioning.
  • Marital and family therapy that focuses on changes in family dynamics caused by illness, trauma, and/or disability, as well as sexual counseling
  • Biofeedback and relaxation techniques

- The Case Manager is a vital member of your rehabilitation team. She/he will assist you with many aspects of your care, such as preparing and implementing your discharge plan, arranging meetings with you and your family, arranging a schedule for family observation and training days, working with other interdisciplinary team members, and working with your insurance carrier to communicate the rehab team's short and long term goals. Your case manager will also arrange any equipment and/or home modifications that may be necessary.

TEAM AND FAMILY CONFERENCES

     The Rehab Team will meet routinely to discuss your treatment plan and progress. In addition, the Team will meet with you and your family after your admission to report on your progress and answer any questions.

Based on Brain Injury Patient Care and Education Manual, by Pinecrest Rehabilitation Hospital; Neuro section of the Trauma Manual, Jackson Memorial Hospital; and Recovering from Head Injury; a Guide for Patients, by Nova University Neuropsychology Service, and edited for PoinTIS by the Louis Calder Memorial Library of the University of Miami School of Medicine and the PoinTIS Advisory Committee, and on Rehabilitation of Persons with Traumatic Brain Injury, NIH Consensus Statement 1998 Oct. 26-28.