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What About Rehabilitation?  
 
Rehabilitation & Ongoing Support
      The definition of rehabilitate is "restore to a good condition; make over in a new form"  (Gage Canadian Dictionary, 1983).

    Many people think of rehabilitation as what happens while the brain injury survivor is in the hospital with a team of professionals.  The understanding of rehabilitation can be expanded to include not only the ongoing support that is needed for the survivor, but also the supports for his or her natural support system.  

     That is, support needs to be in place for family, friends, and others in the community whom interact with the survivor on a regular basis.  These people can be considered as part of the rehabilitation team as they are often the ones dealing with the day-to-day issues after the patient comes home and over his or her lifetime.
 
The Medical Model
      The medical model consists of the professional working with the brain injury survivor while he or she is still in hospital.  The rehabilitation team may consist of the following members:

Audiologist:  Professional who evaluates the patient's hearing.

Dietician:  Professional who seeks to meet the nutritional needs of the patient through proper diet.  Careful consideration is taken of pre-trauma weight and eating habits.

Neurologist:  Physician who specializes in disorders of the brain.  He diagnoses the type of injury and makes recommendations for surgery and medications.

Neuropsychiatrist:  Medical doctor who specializes in the relationship between the neurological system and psychiatric or psychological disorders.  He may provide individual and/or family therapy.

Neuropsychologist:  Psychologist with a Ph.D. who specializes in the relationship between the brain and behavior.  He performs tests to determine levels of functioning in the areas of cognition, intelligence, and personality.  He may also provide individual and/or family therapy on an individual or group basis.

Nurse:  Professional who provides daily care.

Occupational Therapist:  Professional who focuses on the patient's physical, cognitive, and perceptual disabilities.  He helps the patient regain function of arms, hands, and fingers and return to the activities of daily living.  He works on fine motor skills, hand-eye coordination, and self-care skills.  He may also provide any necessary special equipment.

Physical Therapist:  Professional who assists the patient return to the highest level of motor functioning as possible.  He helps the patient regain function of the body movements needed for basic actions such as standing, walking, and sitting.  He evaluates the need for special equipment and constructs a program of exercise and movements.

Recreational Therapist:  Professional who evaluates the patient's leisure interests and skills, his ability to initiate leisure activities, group skills and interaction, and skills in the community.  Therapy often takes place in a group setting.

Respiratory Therapist:  Professional who helps with problems breathing when the patient is in the early stages of hospital care.  He is responsible for maintaining the ventilation system and assisting the patient who is unable to cough up secretions.

Social Worker:  Professional who assists the patient to meet his social and psychological needs with planning and counselling.  He acts as a liaison between the professional team and all other parties concerned, including family, funding sources, and past or future facilities.  He also completes various assessments.

Speech-Language Pathologist or Speech Therapist:  Professional who helps the patient regain communication skills, including speech, language, memory, thought processing, reading, and writing.  He evaluates the patient's cognitive functioning and social interaction skills.
 
Ongoing Support
           The aspect of rehabilitation that many people tend to overlook is the ongoing support that is needed over the lifetime of the affected individual.  This involves the issues that arise from time to time after the survivor has left the hospital and adjusts to daily life in the community.
 
Ongoing concerns may include issues with:
 
  • Self-esteem
  • Anger management
  • Conflict management
  • Fatigue
  • Stress
  • Anxiety
  • Assertiveness
  • Relationships
  • Finances
  • Housing
  • Meaningful activity
  • Sense of community
 
    Problems may occur in the areas of problem solving, memory, communication (which includes listening skills, social skills, and reading and writing skills), attention, organization, decision-making, and planning.  Other issues which may or may not have already been addressed in the hospital but which become apparent upon returning home include dealing with household tasks, transportation, money, and leisure time.

     If these issues arise shortly after the injury (typically within a couple years), the survivor may be allowed to return to a rehabilitation facility on an outpatient basis.  Very often, however, these issues do not become apparent until many years later.  In that instance, community resources must be accessed.  Unfortunately, there is a serious lack of these resources and very often there are none available in small communities.  Your local support group may be aware of what is available in your area.

    Returning to work may also lead to difficulties that had not yet become evident.  Vocational Rehabilitation is another area in which an individual may have an interest in exploring job retraining, skills assessments, interest inventories, vocational counselling, volunteer work trials, education, and vocational support.

     The family plays a very important role throughout the recovery process.  They provide useful and insightful information, such as the survivor's pre-trauma personality and learning style.  They provide psychological support for the patient.  They also act as an advocate for him or her.  Support for the family is important and may be offered to the family in the form of counselling, caregiver support groups, or respite care.
 
  References:
Brine, N. 1998. (September). Community Integration for Persons with Brain Injury. Presentation given at Brain Attack - What's New in Stroke Care? Symposium. Edmonton, AB.

Cera, R.M., Vulanich, N.N. & Brady, W.A. (1995). Patients with Brain Injury. Austin: Pro-Ed.

Hawley, L.A. (1989). The Family Guide to the Rehabilitation of the Severely Head-Injured Patient. Austin: Health Care international, Inc.

 
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