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What role does rehabilitation play in recovery?
Rehabilitation has been defined by the World Health Organization (WHO) as "a process aimed at enabling persons with disabilities to reach and maintain their optimal . . . functional levels . . . ." Although the exact role rehabilitation plays in the rate of recovery is unclear, research shows that intensive rehabilitation facilitates the recovery rate.
Determining the combination of cognitive, behavioral and physical deficits is an important first step in setting goals for rehabilitation. Prioritizing goals should be undertaken with the assistance of both the person and their family. As with all rehabilitation, the goal is to help the person achieve the maximum degree of return to their previous level of functioning. TBI rehabilitation is best managed by a specialized interdisciplinary team of health professionals. It often consists of two phases—inpatient and community management.
Inpatient management is required for those with more severe and acute physical, cognitive and/or behavioral deficits. The focus is on issues such as PTA monitoring, retraining in activities of daily living, pain management, cognitive and behavioral therapies, pharmacological management, assistive technology (eg, prescription wheelchairs and gait aids), environmental manipulation (eg, installation of lifts, ramps and rails, and bathroom alterations), as well as family education and counseling. Most patients also require rehabilitation for associated trauma (eg, fractures). People with catastrophic injury may need prescription of major equipment (eg, hoists to facilitate patient transfer, modifications to cars such as special seating) and modifications to their home environment (eg, bathroom modifications, grab rails, non-skid flooring). Patients may also require retraining in daily living activities for home and community living (eg, household tasks such as doing the laundry, and community living skills such as crossing roads, banking, etc). This can be done through outpatient programs or through a transitional living unit, where patients are largely self-managing under health professional supervision.
Community rehabilitation follows discharge from an inpatient rehabilitation service. Helping a person with TBI return to maximum independence and participation in the community is an extremely difficult task. Family support, education and counseling are vital and likely to be needed for a prolonged period. The quality and availability of community services can be less than ideal and issues of cost may limit access. This applies particularly to adapted lifestyle-sustaining services.