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The Rehabilitation Stage: begins as soon as the TBI survivor is medically stable and cleared for therapy.
Each brain injury is unique and a rehabilitation program designed specifically around the individual is established early on.
According to the National Institute of Health, brain injury rehabilitation involves two essential components. First, restoration of functions that can be restored and secondly, learning how to do things differently when functions can’t be restored to pre-injury level. The overall goal of rehabilitation is to improve the patient's ability to function at home and in society in the face of the residual effects of the injury, which may be complex and multifaceted.
Therapies are designed to help the TBI survivor either adapt to disabilities or change their living space and conditions to make everyday activities easier and to accommodate residual impairments. Education and training for caregivers who will be involved in assisting the survivor after discharge are also critically important components of the rehabilitation program.
For most families, the rehabilitation process is a mystery. However, a physiatrist led team approach is the most effective. At the very least, three hours per day should include some of the following:
Physical Therapy (PT): Physical therapy includes exercise programs geared toward muscle strengthening and endurance, maintaining range of motion, improving coordination and regaining as much mobility as possible, often with the use of assistive devices.
Occupational Therapy (OT): Occupational therapy helps redevelop fine motor skills. Patients also re-learn techniques for dressing, bathing, self-grooming, preparing food, etc. Families are often taught strategies for safe and effective care giving. With brain injury patients, the occupational therapist also may work on high-level thinking skills necessary to return home and work successfully.
Speech Therapy (ST): Helping someone talk is just one aspect of speech pathology. Speech therapy will also target language and cognitive problems. With a brain injury patient, the speech therapist may work on attention, memory, organization, planning, and sequencing, as well as things like reading comprehension and writing skills. They also specialize in teaching memory strategies.
Recreational Therapy (RT): Recreational therapy encourages patients to build on their abilities so that they can participate in recreational or athletic activities at their level of mobility. Engaging in recreational outlets and athletics helps those with spinal cord injuries achieve a more balanced and normal lifestyle and also provides opportunities for socialization and self-expression.
Respiratory Therapy: Respiratory therapy may be needed to teach ventilator care, if needed; breathing treatments and exercises to promote lung function and prevent pneumonia.
There are many different types of programs that can continue providing the stimulation needed for individuals recovering from traumatic brain injury.
• Home-based programs: Some hospitals and rehabilitation companies provide therapies within the home for persons with brain injuries living at home with caregivers.
• Outpatient: Therapy sessions address functional impairments to maintain or improve recovery
• Day treatment programs: Provide rehabilitation in a structured group setting during the day and allows the person with a brain injury to return home at night.
• Independent Living Program: Provide housing with the goal of regaining the ability to live as independently as possible.
• Community Based Programs: Generally focus on developing higher level motor, social, and cognitive skills in order to prepare the person with a brain injury to return to independent living and potentially to work. Person usually lives at home.
• Neurobehavioral programs: For those individuals having significant agitation or behavioral outbursts.
Sometimes the physical effects of a TBI may require various home modifications to make the home more accessible and more comfortable, while also enabling as much independence as possible for the survivor. Not all modifications have to be extensive and expensive. For example, an appropriately built ramp or well placed grab bar can make the biggest difference in the safety and sense of independence for a person with mobility impairments. Also, before spending a lot of money on modifications, remember function can continue to return and what someone requires in rehab may not be what they end up needing a year or two post-injury. The basics, like ramps, usually top the list of immediate needs after discharge from rehab.
Typical home modifications can often include:
• Entrance/exit ramp
• Wider doors/hallways
• If possible, single floor living
• Levered handles on doors
• Lowered rocker-style light switches
• Roll under sinks
• Hard surface floors (tile, wood, etc.)
• Roll-in showers with rolling shower chairs
• Ceiling lift systems
• Raised toilets
• Side by side style refrigerator
• Cabinets with drawer pull outs or lazy Susans
• Lowered countertops
• Raised front load style washer and dryer
• Purchase of a hospital bed to aid transfers
One of the most serious and difficult traumas that no one ought to face is when dealing with an individual who has had an injury to the brain. Not only can this be life altering for the individual themselves, it can be life altering for those who care for them as well. Having a loved one change to someone whose personality does not resemble the person you knew and who has suddenly become dependent not only for a few weeks in the hospital, but for months to years after can become daunting. In the months and years that it can take to recover, caregivers need to take all the help they can get in the form of support groups, in-house services and counselors.
Counseling for the families of victims involves:
• Making sure that family and loved ones understand the victim’s frame of mind and the need for them to be educated on what to expect from a recovering brain damaged patient.
• Educating families about the need for playing an active role in making the right choices for the their loved one suffering from brain injury as they may not be able to make for themselves the correct decisions that are required during this traumatic period.
• Connecting families with support groups in order to help the victim through a time that is emotionally depressing and physically draining.
• Creating an understanding of the amount of time and work that is involved in the recovery process and the need for patience in this difficult time.
• Helping families not to lose heart and get frustrated as the healing takes time and is often a thankless process. Ultimately, after all the medical procedures are completed, a loving and caring support system provided by the family is the environment that is most conducive towards getting the TBI survivor better.
Counseling for the victims:
Counseling is an important part of the recovery process for brain injury victims, as well. The convalescence period is a long, frustrating, depressing and anxious time for an individual. Counseling is important in this stage of recovery as it will enable them to channel their anger in the right direction.
• Most individuals recovering from brain injuries may have a lot of discomfort and confusion. There is a lot of anger and depression that will be aimed at loved ones, it is important to help them control their anger and channel it towards recovery.
• It is important for these individuals to be able to lead as normal a life as possible outside the hospital and rehabilitation clinics. For this reason, memory-improving activities need to be advised for those suffering from memory loss. Other therapies such as speech and physical therapies need to be recommended based on each individual case.
• Above all the victim needs to have a positive frame of mind through assurances from loved ones and practical help through their counselors.
Families need to understand their loved ones and the emotional needs that they have. It is a difficult time for the victim and they will express their frustration by using their families as more than just a sounding board. This can be an upsetting time for the caregivers, however if families are able to maintain a positive mindset, the victim will hopefully become less agitated and more focused on fighting for ultimate recovery.