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Rehabilitation Following TBI

  • Mel B. GlennEmail author
  • Shirley L. Shih
Chapter

Abstract

Traumatic brain injury (TBI) can cause a wide variety of motor, cognitive, behavioral, emotional, and medical problems. Rehabilitation following TBI is, therefore, a complex endeavor requiring a team approach involving physicians, nurses, neuropsychologists, psychotherapists (e.g., psychologists, social workers, or mental health counselors), speech and language pathologists (SLPs), occupational therapists (OTs), physical therapists (PTs), vocational counselors, recreational therapists, and case managers. This entails the need for strong communication among team members and considerable flexibility on the part of the team. Therapists often have to take roles that may not be required in other settings. For instance, physical therapists will treat the physical mobility issues, including community navigation skills and safety. However, they have to be tuned into how cognitive dysfunction will affect mobility and how best to address it. They will also be confronted with the behavioral disorders that are prominent among people with TBI: disinhibited behavior, including aggression, but also apathy. OTs will work on activities of daily living (ADLs) and upper limb mobility, but will do so in the context of cognitive disability as well. Home and community skills, such as balancing a checkbook, meal preparation, and shopping, will take on greater importance in the rehabilitation of people with TBI because of the cognitive dimension. OTs, too, will have to treat behavioral disorders. SLPs will treat not only language, swallowing, and speech deficits among people with TBI but also cognitively based communication deficits. They will also treat problems with memory, attention, and executive skills and may overlap with OTs in the areas of home and community skills, such as scheduling and money management. Of course, SLPs will have to know how to manage behavioral issues as well. Nurses and the nurses’ aides will have to deal with every dimension: medical, mobility, cognitive, and behavioral. Most TBI programs have neuropsychologists and/or behavioral psychologists who do neuropsychological assessments; guide the team with respect to cognitive, emotional, and behavioral treatments; and sometimes do counseling. The neuropsychologist has to apply his or her understanding of the cognitive and behavioral issues to pharmacology, mobility, ADLs, and home and community rehabilitation. Although important in all areas of rehabilitation, in rehabilitation following TBI, it is crucial that the physician listens to all team members, as well as family members. The physician is not going to learn all the details of what a patient is doing and saying with respect to emotional, behavioral, and cognitive status directly from the patient. The therapy and nursing staff, as well as family, will be the ones who observe the intricacies of the patient’s inattention, disinhibition, and apathy and hear about the patient’s despairing thoughts and so forth. At the same time, if the physician starts the patient on a medication for a cognitive, emotional, or behavioral issue, he or she will get a more complete perspective on the patient’s response by hearing from other team members.

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Brain Injury Division, Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalCharlestownUSA
  2. 2.NeuroRestorative (The MENTOR Network),—Massachusetts, Rhode IslandBostonUSA
  3. 3.Community Rehab CareWatertownUSA
  4. 4.Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalCharlestownUSA

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