The Continuum of Rehabilitation for Persons with Traumatic Brain Injury
When individuals with TBI do not need or meet the requirements for acute inpatient rehabilitation or are not able to participate in acute inpatient rehabilitation for financial reasons, but still have needs requiring 24-hour skilled nursing and rehabilitation care, subacute inpatient rehabilitation is an option. This is also a viable option for those who are making progress toward recovery but still have significant deficits requiring inpatient care at a less intense level. As opposed to a typical nursing home, subacute inpatient rehabilitation settings offer a rehabilitation program along with medical care, and the expectation is for the person with TBI to make functional gains toward a safe discharge. These facilities tend to have less physician and nursing coverage per patient and offer less hours and intensity of rehabilitation therapy than acute inpatient rehabilitation facilities, while having longer lengths of stay. As there are TBI acute inpatient rehabilitation programs, there are also TBI specific subacute inpatient rehabilitation programs which are have greater expertise in addressing medical, cognitive, psychosocial, and behavioral issues associated with TBI.
Once a person with TBI is medically stable and has progressed toa level where they are safe in the community (either able to live independently and safely in the community or has an adequate support network to provide the assistance needed at that time to return to the community safely), they are ready for discharge from inpatient rehabilitation care. Options for community integration services may include: independent living, group home, personal assistant services, vocational rehabilitation, etc. Careful education about discharge plans and needed follow-up appointments are important for the person with TBI and their family.
Many individuals who sustain TBI return to productive work, social roles, family responsibilities and their pre-morbid lifestyle. However, some TBI survivors live with residual disability, have unmet care needs, and/or are initially unsuccessful in community re-entry. Those individuals with TBI at risk for unsatisfactory outcomes or with continued rehabilitation needs are candidates for community-integrated rehabilitation.
Lifetime of Care: Community Integrated Rehabilitation
Community integrated rehabilitation (CIR) is a broad term encompassing various approaches and contexts for treatment, with a gradually evolving body of supporting scientific evidence.