The TBI rehabilitation process helps activate the brain’s natural healing process so that you can recover as quickly as possible.
Every brain injury is unique, so the rehabilitation process will look a little different for everyone. Some patients will require intensive rehab from an inpatient facility, while others will only need to visit an outpatient center a few times a week.
Below, you will learn the different stages of TBI rehabilitation you might take part in, plus how to promote a successful recovery.
Part 1: Acute TBI Rehabilitation
TBI rehabilitation can be divided into three distinct stages (although, as mentioned above, not all patients will go through the inpatient rehab stage):
- Acute rehabilitation
- Inpatient rehab at a skilled facility
- Individual outpatient rehabilitation
Acute rehabilitation typically starts immediately after the person’s injuries are stabilized, when they are still in the hospital (possibly even in the ICU). If the patient is in a coma, therapists may begin performing range-of-motion exercises, stretching and massaging their arms and legs to prevent muscle tightness. Therapists at this stage may also be assisting with/educating on proper positioning for the patient.
When the person emerges from their coma, treatment will usually focus on helping them regain basic cognitive and physical skills, also known as activities of daily living. These include actions such as dressing, eating, walking, speaking, and using the bathroom.
Once they improve their abilities and no longer require complex medical care, some patients will continue their recovery at an inpatient rehab facility.
Part 2: Inpatient Rehabilitation Facilities
Patients strong enough to tolerate intensive therapy but not well enough to return home may be transferred to an inpatient rehab center.
At the inpatient facility, therapy will be designed to address your specific needs. You will receive at least 3 hours of therapy throughout the day, 5-7 days a week. The therapies you will receive include speech, physical, and occupational therapy. (see the section below for more info)
Inpatient clinics encourage intensive therapy because of the brain’s heightened plasticity after an injury.
Plasticity refers to the brain’s ability to rewire itself and repair neural connections. This allows people to regain functions even after a devastating injury.
This ability can only be activated through intensive exercise though. That’s why doctors require so much therapy in the early stages of recovery
Your TBI Rehabilitation Team
At the inpatient facility, your care will be provided by a team of medical professionals, called your “rehab team”, who will work together every day to build the best program for your recovery.
- While there are other professionals you may work with during rehab, the following will be core members of your rehab team:
- Physiatrist. The physiatrist is a physician who specializes in rehabilitation medicine. They are in charge of overall treatment and direct the rest of your team on how to best care for you.
- Physical therapist. Their role is to help you restore normal muscle function and to teach you to be safe in your environment.
- Occupational therapist. The occupational therapist’s goal is to help you regain functional independence. They do this by teaching you how to relearn an activity or by finding creative ways for you to adapt.
- Speech pathologist. Speech therapists focus on treating communication and cognitive problems. This can involve helping improve your swallowing and speech abilities or your cognitive skills such as memory and word recall.
- Social worker. The social worker provides you and your family with information about community resources and disability benefits to help make your transition home smoother.
When your rehab team agrees that you are well enough to continue treatment without their supervision, you will be discharged and sent home.
Part 3. Outpatient Rehabilitation
After you are discharged from either the hospital or an inpatient facility, it is absolutely critical that you continue with therapy.
As explained above, your brain is in a heightened state of plasticity after an injury, which means you need to make the most of this time. The more you exercise, the more you increase your chances of achieving a full recovery.
The best way to do that is to train at an outpatient rehab clinic. At an outpatient clinic, you can do the same therapies you were taught at the inpatient facility, except you can go home when you finish.
Some of the most important therapies you should take part in include:
The main goal of physical therapy during TBI rehabilitation is to retrain the nervous system to control normal muscle movement.
After a brain injury, the connection between the brain and muscles can become damaged or destroyed. Fortunately, engaging the brain’s neuroplasticity allows you to rebuild those neural connections.
There are a number of interventions a physical therapist might use to accomplish this, such as:
- Passive range-of-motion exercises. If your muscles are too weak or stiff to move on their own, your PT can move them for you. Just having someone else do the motion can stimulate the brain and rekindle the neural networks that help you move.
- Electrical stimulation. E-stim sends electrical impulses directly into the targeted muscle through electrodes placed on top of the skin. These impulses can stimulate the nerves to assist with the neural repair process.
- Task-specific exercises. These exercises are the best way to engage neuroplasticity. All it really means is that, if you want to improve an ability, you must practice that action directly. For example, to improve your walking skills, therapists will have you practice proper walking motions (or break the skill down into more manageable components if you’re not ready for walking yet).
The more you activate your muscles through physical therapy, the more skills you can hope to recover.
While physical therapy is concerned with teaching you how to rebuild your physical strength, occupational therapy looks at what specific skills you might need to regain independence.
During an OT session, you will practice many important activities that will directly improve your independence. Some areas of your life an occupational therapist can help you with include:
- Home management
- Social skills
- Cognitive functioning
To help you regain these skills, an occupational therapist will teach you both restorative and compensatory strategies:
- Restorative techniques help you relearn how to perform an activity the way you did before your brain injury.
- Compensatory tactics, on the other hand, help you find a new way of doing something if it’s not yet possible for you to do it the way you were doing it before your injury.
Of the two, restorative techniques typically require more muscular effort on the part of the patient, and tend to address the root of the problem more directly. Therefore, occupational therapists prefer to focus on restorative techniques whenever possible, however there are definitely scenarios where compensatory strategies are necessary and beneficial.
If your traumatic brain injury caused cognitive deficits, aphasia, or any other TBI communication disorders, begin speech therapy right away. The sooner you get treatment, the less likely it is that those disorders will last.
A speech therapist can walk you through the various TBI speech therapy activities available, and show you exactly what you need to do to retrain your brain and regain language and thinking skills.
Even if you have no noticeable speech impediments, speech therapy can also help you with the more delicate aspects of communication that you might struggle with after a TBI.
For example, you might need to relearn how to match your voice pitch and volume with others, which a therapist can teach you. They can also help you with cognitive-communication skills such as the ability to listen, pay attention, and respond appropriately.
All of this makes speech therapy a vital part of TBI rehabilitation.
Continuing TBI Rehabilitation at Home
Going to an outpatient clinic two or three times per week will simply serve as a guide for your continuing rehabilitation at this point.
To ensure the best recovery possible, you must practice at home every day the exercises you learn at therapy. If you struggle with memory problems, have your therapist write you a home exercise sheet to help you remember exactly how to do them.
There are also home therapy devices, such as FitMi, which walk you through exercises in a fun and engaging way. Many patients find that these devices help them stay motivated in a way that hand-out sheets do not.
Practicing your exercises every day will keep your brain stimulated and can help you recover from brain injury much quicker.
Dealing with Lack of Motivation at Home
Sometimes lack of motivation can impede the TBI rehabilitation process. Particularly, when the frontal lobe has been damaged, it can result in a condition called adynamia, which involves impaired motivation and initiation after TBI.
Although it can look like the person is just acting lazy, they actually cannot help it. Unfortunately, if the person does not stay active, their brain injury symptoms can worsen.
Therefore, family members may need to gently prod their loved one to do their daily home exercises, especially at the beginning of their recovery.
What to Expect from Traumatic Brain Injury Rehabilitation
The above are the most common treatments you might encounter during TBI rehabilitation.
Patients with mild to moderate brain injuries may not require intensive therapy in an inpatient facility as described here. But they will most likely need to take part in outpatient and home therapy programs.
Finally, the most important aspect of the rehab process is perseverance. No matter how severe your injury is, if you continue with your therapy, you can have a real hope of making your brain injury rehabilitation a success.
Featured Image: iStock/kzenon