Traumatic Brain Injury (TBI) rehabilitation has changed over the last 40 years. Patients with TBI are living longer than before and rehabilitation techniques have been well studied and developed. In particular, we have a better understanding of outcomes-based on rehabilitation. As insurance coverage broadened for people with TBI, however, the length of stay has also decreased. Acute rehabilitation for people with TBI ranges from 10 to 14 days, when it was almost 30 in the 1990s. Perhaps better treatment methods have decreased the need for a longer LOS, but overall, patients are being discharged earlier than before in history for this population.
TBI will most likely impact multiple systems compared to other conditions. Not only will it impact the immediate individual, but their family members and those involved in their life. Therefore, evaluation of people with TBI should be a comprehensive, multidisciplinary, and involve continual discharge planning. Many caregivers are unaware of the resources available to people who have sustained TBIs.
Discontinuation planning should be proactive and consider the long term outcome instead of being focused only on the immediate needs of the individual. For example, in an acute care setting, occupational therapists should be considering if they are eligible candidate for acute rehabilitation to discharge home, or if they are eligible for a long term outpatient TBI program such as Centre for Neuro Skills (CNS). Skilled nursing facilities are also an option. Overall, patients should discharge to facilities with experience in providing rehabilitation to patients with TBI.
In addition to the complexity of the TBI, patient’s background, family, insurance, other details should not be overlooked. Demographic information, race, culture, productivity, religion, location (of residence and availability of services, e.g., rural can be more difficult), and patient’s own input if appropriate. As an occupational therapist, one thing to be mindful is the consideration to the advice provided and the availability of services. While much of this responsibility falls on the case manager, the team should be on the same page to provide a comprehensive and patient-centered plan of care at every setting and stage of the rehabilitation process.
Important considerations for general occupational rehabilitation
- The purpose of the evaluation
- Who requested the evaluation
- Expectations from the evaluation
- How the evaluation information will be used
- Who it is shared with
- Is PT involved? What information will they gather (to avoid redundancy)
- Patient and caregiver interview
- Observation if possible
- Range of motion
- Sensation, proprioception, stereognosis
- Naming difficulties of body parts
- Language in relation to function
- Object manipulation
- Crossing midline
- Gross and fine motor skills
- Transfers for function
- Gait for function
- Vestibular system and symptoms
- ADLs (vs. baseline)
- IADLs (vs. baseline), driving
- Cognition (attention, memory, communication, planning, safety)
- Awareness of time, Routines
- Symptoms (seizures, light sensitivity)