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| TREATMENTS and REHABILITATION
(Brain) |
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What is the rehabilitation process?
1. The rehabilitation process is different for everyone.
Rehabilitation programs should be individualized, catering
to each person's unique needs. Just as no two people
are exactly alike, no two brain injuries are exactly
alike. The person with a brain injury and his or her
family should always be the most important members of
the treatment team. Cultural, religious, social and
economic backgrounds must always be taken into consideration
when planning a person's rehabilitation program.
2. Rehabilitation channels the body's natural healing
abilities and the brain's relearning processes so than
an individual recovers as quickly and efficiently as
possible. Rehabilitation also involves learning new
ways to compensate for abilities that have permanently
changed due to brain injury. There is much that is still
unknown about the brain and brain injury rehabilitation.
Treatment methods and technology are rapidly advancing
as knowledge of the brain and it's functions increases.
3. The goal of rehabilitation is to help people regain
the most independent level of functioning possible.
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Models of Rehabilitation
In the past, rehabilitation services for people with
brain injury were largely provided in a "medical model,"
located in a medical facility with a cadre of physicians,
nurses, and trained professionals providing services.
While this model still predominates, the trend today
is toward more community-based rehabilitation models,
and more options are available than ever before. Rehabilitation
service delivery and funding are changing rapidly as
managed care continues to replace the traditional fee-for-service
and indemnity insurance plans.
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Medically Based Rehabilitation:
Early intervention is crucial. Rehabilitation should
ideally start in the Intensive Care Unit. At this point,
rehabilitation is generally preventive in nature. Range
of motion, bowel and bladder hygiene (i.e. initiation
of regular bowel program and removing indwelling catheters),
prevention of pressure sores, and orientation are all
very important, right from the beginning. Frequently,
rehabilitation activities initiated in the ICU can reduce
complications and sometimes, the length of hospitalization.
Acute Rehabilitation: Once a person is medically stable,
transfer to an acute rehabilitation facility often occurs.
There, he or she will spend several hours a day in a
structured rehabilitation program. This program usually
includes a team of professionals with training and experience
in brain injury rehabilitation. Additional staff support
the brain injury rehabilitation team's efforts, and
often includes respiratory therapy, pharmacy, lab, nuclear
medicine and radiology and even housekeeping, dietary
and central supply. "Subacute" Rehabilitation: People
who are minimally aroused for a prolonged period often
have limited attention and stamina, and need a less
intensive level of rehabilitation services, over a longer
period of time.
Subacute rehabilitation may be provided in a variety
of settings, but is often in a skilled nursing facility
or nursing home. It is important to note that the services
provided by subacute programs vary widely , as there
is no generally accepted definition of subacute services
at this time.
It is important to recognize that "more therapy" does
not make a person "better", but that "appropriate" therapy
does. Sub-acute rehabilitation programs require the
same appropriately trained professionals as acute rehabilitation
programs do. The goals of sub-acute rehabilitation should
include minimizing morbidity, maintaining functional
positioning, hygiene, nutrition, and medication management,
as well as providing support for the person with a brain
injury and his or her family. Sub-acute rehabilitation
programs may also be designed for persons who have made
progress in the acute rehabilitation setting and are
still progressing, but are not making rapid functional
gains.
Day Treatment/Day Rehab: Day rehab (sometimes called
"Day Hospital") provides intensive rehabilitation in
a structured setting during the day and allows the person
with a brain injury to return home to their family at
night. The treatment team is often made up of a variety
of trained rehabilitation professionals.
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Community - Based Rehabilitation
Outpatient Facilities: Following acute rehabilitation
or sub-acute rehabilitation, a person with a brain injury
may continue to receive outpatient treatment in specific
areas (i.e. ongoing speech pathology to continue to
work on cognition, or occupational therapy to work on
driving, etc.). Often, this treatment can also be provided
in the home by a home-health agency.
Home-based Rehabilitation: There are a few rehabilitation
companies which focus on providing acute rehabilitation
within the home, or community setting. Once medically
stable, some persons with a brain injury may be able
to participate in such a program, if there is such a
program in their community. Community Re-entry:
Community re-entry programs generally focus on developing
higher level motor and cognitive skills in order to
prepare the person with a brain injury to return to
independent living and potentially to work. Treatment
may focus on safety in the community, interacting with
others, initiation and goal setting and money management
skills. Vocational evaluation and training may also
be a component of this type of program. Community Re-entry
programs generally run for part or all of the day, with
participants returning home to sleep and be with their
families. Independent Living Programs:
Independent Living programs provide housing for persons
with brain injury, with the goal of regaining the ability
to live as independently as possible. Usually, independent
living programs will have several different levels,
for people requiring more assistance, to those who are
living independently and being monitored. In addition
to physical, occupational, speech and recreation therapists,
these programs usually have life skills technicians,
who assist the person with a brain injury towards independence.
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