The Continuum of Rehabilitation for Persons with Traumatic Brain Injury
Acute Rehabilitation continued...
The person with TBI and their family (defined as those comprising the inner circle of support for that person) are key members of the rehabilitation team as well. Family members provide direct care and emotional support, as well as insight into the unique social history and behavior of the individual with TBI. When the family is invested in the rehabilitation program, the effectiveness of a treatment program can improve greatly. Although it is not always possible to engage the person with TBI actively, especially early in the course of recovery, appropriate family support can reduce stress and anxiety, as well as promote participation in the rehabilitation program. However, it is important to note that unhealthy family interactions can also hinder recovery.
The overall principle of rehabilitation is for individuals with TBI to incorporate compensation strategies into their lives at the same time as they are trying to improve and recover their functions. The team approach, where the treatment team members meet directly and frequently with each other to discuss the care plan, facilitates communication among team members and allows for rapid sharing of specific goals for treatment that are tailored to each person’s unique rehabilitation needs. The needs of the person with TBI and the point along the rehabilitation continuum influence the combination, setting and types of services offered. Ideally, goals are person-centered, reflecting the unique needs, challenges and priorities of the person served. Particularly in post-acute settings, such as community integrated rehabilitation programs, many team members may be working together in a coordinated manner to achieve particular goals. Consistency and structure are often necessary to effectively address cognitive and behavioral issues, thus the need for a well functioning team is paramount in the TBI rehabilitation setting.
In order to be eligible for acute inpatient rehabilitation (which implies close physician supervision, management by experts in rehabilitation, and active therapies) as opposed to subacute inpatient rehabilitation (implies less intensive inpatient rehabilitation and medical care/supervision), medical insurance companies generally require that the individual with TBI must be able to engage in and benefit from three hours of physical and occupational therapy daily versus less daily therapy at subacute rehabilitation centers. In addition, most insurers require the person with TBI to have residual physical impairments that would benefit from continued physical rehabilitation. These conditions have reduced the ability of those who need it to access acute inpatient rehabilitation, as well as diminishing the length of stay to a few weeks. However, many times, acute inpatient TBI rehabilitation facilities are the most suitable place for patients to transition from the acute care setting to later stages of rehabilitation care, especially if they still have significant medical issues, post TBI agitation or behavioral problems, substantial cognitive and physical rehabilitation needs with good potential for recovery, or arousal issues that would benefit from intensive stimulation and monitoring. Unfortunately, many insurers and public funding streams may not cover these components of the later stages of rehabilitation.