Initial Expectations at the Hospital
After the onset of injury, the first course of treatment will be at the hospital. Imaging studies will examine the brain to look for trauma or dysfunction. A CT (computerized tomography) scan examines the brain structures. This imaging study will reveal an area of injury/dysfunction due to stroke or other brain injury. Other imaging studies that are typically performed include MRI (magnetic resonance imaging) and sometimes X-rays (radiographs) if there is suspicion of any fracture. The individual will receive care from nursing staff and physicians to ensure vital signs are stable and there is no risk of further injury or damage.
The Medical Team
The main physician that will oversee the plan of care is the neurologist. Neurologists are physicians that specialize in the systems of the brain and nervous system. The neurologist will examine the function of the nervous system, identifying the area of damage to the brain and classifying extent of physical ramifications. Other physicians may be brought into the plan of care such as a cardiologist to oversee the monitoring of heart function, as well as a trauma doctor in case of injury. A physiatrist is a physician that specializes in rehabilitation. A physiatrist will oversee the care and progression during rehabilitation.
While in the hospital and at extended care, the patient will be cared for by nurses, nurse assistants, respiratory therapists, phlebotomists, nutritionists, case workers, psychologists, and (of course) physical, occupational and speech therapists. The three types of rehabilitation therapists have some overlapping roles, but three distinct specialties. The physical therapist specializes in functional movement training. The occupational therapist specializes in self-care training. The speech therapist specializes in speech and swallowing. Working with all three specialties is essential for rehabilitation progression.
During the recovery process, individuals are typically seen in a hospital setting, rehabilitation setting, home health setting and eventually outpatient clinic settings. The patient and family meet with a large number of healthcare providers for a comprehensive rehabilitation journey. Functional independence and safety are the main factors in determining where a patient will be placed after hospitalization.
Rehabilitation After Brain Injury - What To Expect
During the hospital stay
The first task that the skilled therapist will teach and assist with is the ability to get up from lying down in bed. If the individual needs assistance, the therapist will provide that assistance and note how much assistance is needed. Then, the therapist will assess and instruct in moving from sitting to standing and getting up to sit in a chair. These tasks are called transfers. Standing balance and stability is assessed to determine level of independence and risk for falling. If there is a need for use of an assistive device for mobility, the therapist will instruct the individual in use of a walker, cane or wheelchair. The main goal of the rehabilitation in the hospital setting is to determine current level of dependence, teach basic skills for mobility (getting in/out of bed, walking), and set up the appropriate treatment course upon discharge from the hospital.
After the acute care stay at the hospital, which typically lasts less than one week, most individuals move to an inpatient rehabilitation setting or a skilled nursing facility. These facilities serve to provide care for the individual's basic needs, such as getting in and out of bed, showering, dressing, nursing care and meals. In addition, the rehabilitation team will continue the care for teaching functional mobility training, as well as working to improve and restore balance and muscle strength. In the inpatient setting, the therapists help to order any necessary adaptive equipment, such as long handled reachers or ankle foot orthoses (AFOs). The stay in an inpatient setting can be anywhere from one week to several months. These facilities have nursing care, rehab care and visiting doctor oversight. The clients are provided with rooms (some private, some shared rooms) for sleeping and basic necessities. This setting serves as a transition point for individuals that need further care before return home. In addition, for individuals that are not able to return home, skilled nursing facilities offer long term care. In long term care, the individual is cared for by the skilled nursing team. This situation is for people that are dependent for basic needs, unable to care for themselves, and without others to care for them.
Outpatient physical therapy clinics are intended to continue rehabilitation after an individual has completed their initial rehabilitation stay after injury or stroke. Typically, individuals attend outpatient therapy sessions 2-3 days per week and complete their own exercises on non-therapy days.
Outpatient therapy treatment cases are designed to further improve specific components of functional loss, and further improve safety with balance and mobility. Occupational therapy can be done in an outpatient setting, focusing on improving the use of the hand and upper extremity. In addition, outpatient occupational therapy works to improve self-care strategies. Speech therapy is often utilized in an outpatient setting to improve speech, articulation and swallowing.
Longer term rehabilitation need to continue as a primarily at home exercise program The physical therapists will recommend specific exercises. These can include general exercises that can be performed at home for muscle weaknesses, dropfoot , spasticity and more. Sure, there a different levels of recovery and the point of ongoing exercise in many cases is to maintain the recovery or even partial recovery. Without ongoing exercise at home or in the gym or pool, a step back in physical condition can too easily occur.
In general, remember, an impact to ones brain through injury or illness can drastically affect cognitive performance. In particular, thought processing can be slower, it can be difficult to concentrate or focus, and memory can deteriorate significantly. A brain injury can also have an impact on social skills. Concentration and focus , attention are primary traits or more likely developed skills that can be improved in time.
The effectiveness of treatments , exercises available will depend on extent of one's injuries and personal physicians would have the best specific advice .