The Continuum of Rehabilitation for Persons with Traumatic Brain Injury
Initial Intervention continued...
There can also be lack of conclusive physical evidence of the injury on standard imaging such as CT and MRI scans, especially in mild TBI, since microscopic damage after TBI is often not visible on standard neuroradiological assessment tools. In mild TBI, physical symptoms may also resolve quickly or never develop despite cognitive and behavioral problems existing, thus the need for comprehensive evaluation including clinical history, neurologic and mental status exam, and neuropsychological testing. However, these assessment tools are rarely utilized in the emergency or acute care setting, and the person with mild TBI is often not diagnosed and sent home. Even in the scenario of severe TBI, the life threatening medical issues (such as the hemorrhaging or increased pressure on the brain mentioned above) and/or trauma to other areas of the body, may minimize or obscure diagnosis and treatment of non-physical aspects of TBI. Although efforts are being made to inform physicians and the public of the spectrum of TBI symptoms, more awareness is still needed since it is impossible to appropriately treat TBI if the TBI is not recognized.
Inpatient rehabilitation generally begins following the medical stabilization of the injury at which time the rehabilitation team assesses the individual’s condition, designs and implements rehabilitation interventions and develops a discharge plan. Inpatient rehabilitation is provided while the individual remains in a hospital or other healthcare facility.
For individuals with identified TBI (usually more moderate or severe), a period of acute care stabilization occurs within the hospital. Confusion and fatigue are common, and a broad array of specialists may participate in the evaluation and treatment process. Individuals who continue to have significant complex health needs or are in a coma, may transition to long term acute care hospitals (LTACs). LTACs specialize in medically complex care, such as ventilator weaning and wound care. More often, those with TBI are referred to inpatient or outpatient rehabilitation services depending on the nature and extent of services needed.
Rehabilitation settings are typically characterized by a treatment team approach to meet the complex needs of the person recovering from TBI. The team is usually directed by both a physician specializing in rehabilitation medicine, and a case manager or care coordinator who ensures communication with family members, funders and across the various treatment providers. The rehabilitation team approach allows for focused services delivered by specially trained professionals with knowledge of interventions for TBI related issues. Further, this approach facilitates communication among team members and allows for rapid sharing of goals for treatment that are tailored to each person’s unique rehabilitation needs. Most importantly, the person with TBI and their circle of support is the hub of the team. Although every rehabilitation setting has its own specific structure and team organization, the roles of some of the more common team members in both inpatient and outpatient settings are outlined below.