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The Continuum of Rehabilitation for Persons with Traumatic Brain Injury

Lifetime of Care: Community Integrated Rehabilitation continued...

There are also instances where individuals experience a TBI but do not require inpatient rehabilitation or even an inpatient acute care stay. Most of these individuals are considered to have had a mild TBI and are good candidates for CIR. Mild TBI has been called the “invisible injury” since the majority of individuals present without noticeable physical deficits or obvious cognitive and behavioral issues at first glance. However, upon closer examination, they may have difficulty across cognitive, behavioral, and emotional domains of functioning. Balance deficits and symptoms such as loss of the sense of smell, headaches, nausea, and dizziness may also be seen. Fatigue, mood change and trouble concentrating are common. Often these individuals are able to function independently in the community with minimal support from family or friends, but struggle to resume their former roles as related to work and relationships. Sometimes, cognitive and physical symptoms only emerge after the person with a mild TBI has attempted to return to these former life activities and roles. In many cases, it takes rejection or failure with these former relationships and roles for the person to seek treatment. However, due to the subtlety of their deficits and problems, those with mild TBI may never seek help, struggle to find the right type of help and/or not be able to secure insurance or other funding to cover their specific rehabilitation needs.

There are a substantial number of persons with TBI who have long lasting and even life long difficulties related to their TBI, whether they are cognitive, behavioral, psychosocial, or physical. These individuals may continue using many of the services discussed earlier. Case managers and social workers as well as disability organizations can help obtain further appropriate services such as transportation, financial, and housing assistance. Many states have TBI specific Medicaid waivers and assistance programs to help facilitate provision of appropriate services. In addition, support groups and recreational/community organizations for persons with TBI as well as their families can fill extremely beneficial social and advisory roles. Other non-specific sources of aide such as through local church and community programs can provide valuable assistance including volunteer or financial help.

The structure, level of intensity, and services available for both inpatient and outpatient TBI rehabilitation programs vary widely from one area to another, whether comparing facilities, cities, states, or countries. Unfortunately, socioeconomic and medical insurance status also can limit the types of services available to a particular person. There is no single proven method or course of TBI rehabilitation that works for every person, thus it can be difficult for patients, professionals and families to determine the best course of action in certain circumstances. For instance, individuals with mild TBI may not require inpatient acute medical or rehabilitation services at all and address their TBI management completely at the outpatient level, whereas others who make rapid medical recovery or have great family support after their TBI may transition straight from acute inpatient medical care to outpatient TBI rehabilitation programs, skipping inpatient rehabilitation. Furthermore, considering the various physical, cognitive, behavioral, and psychosocial issues that can develop after a TBI, each person benefits most from a rehabilitation program tailored to their individual needs.

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