Specialized Rehabilitation Care for Brain Injuries of All Levels

SuAnn Chen, MD

For many physicians, the immediate treatment and stabilization of severe head trauma and a resultant brain injury are the easy part. The focus shifts once patients are medically stable. Patients with brain injuries – and their loved ones – face the monumental tasks of accepting loss and then beginning the often long journey of recovery.

Individuals, their family members and medical providers must work as a team to deal with the residual symptoms and deficits that can occur following traumatic brain injury (TBI). Best practices in rehabilitation are often out of the scope of those physicians and practitioners involved in the initial management of a patient with a TBI, and he or she may feel paralyzed by the task at hand. That’s when a physical medicine and rehabilitation (PM&R) physician should become part of the recovery team.

For patients suffering from TBI, hypoxic/anoxic injury, brain tumors, ADEM, encephalitis or hemorrhage stroke, specialized rehabilitation care by physicians certified by the American Board of Physical Medicine and Rehabilitation and those fellowship trained in brain injury puts the patient on track to maximize long-term recovery, functional outcomes and quality of life. PM&R brain injury providers are specially trained to see the potential for recovery in all stages of TBI, regardless of whether patients have suffered a focal neurologic deficit or seemingly global losses in vegetative or minimally conscious states. For all degrees of injury, meaningful gains are possible.

At Good Shepherd Rehabilitation Network, brain injury rehabilitation is not just physical therapy offered in the inpatient or outpatient setting. Patient care is medically optimized with neurostimulatory agents like amantadine to maximize therapy participation. Rehabilitation is an integrated multimodal therapy of attention, goal focus, movement and procedural memory. For the comatose, minimally conscious orpatient in a persistent vegetative state, treatment of post-traumatic amnesia uses individual capacity for habitual and procedural memory through repetition to master trunk control, reorientation and work through issues of aphasia, tone and word forming.  Gains are monitored using standardized assessment tools for tracking recovery like the Galveston Orientation and Amnesia Test, giving providers the ability to objectively quantify improvement over time. These assessments also are used in family education, because for all Good Shepherd patients, being discharged to home is the goal. To be successful, this requires multimodal family education and support.

Good Shepherd also is a resource for patients at the other end of the clinical spectrum, those dealing with the long-term functional, cognitive and emotional impact of concussion and mild brain injury. Current research has shown that the sequelae can include fatigue, insomnia, dizziness, chronic headache, personality change, irritability, anxiety, depression, as well as impaired memory and concentration. The outpatient clinics and therapy services provided at Good Shepherd work with this group to address long-term problems with cognition, depression, headache, vision and other post-concussive symptoms.

Good Shepherd’s PM&R physicians work with directed pharmacology, as well as neuropsychological, cognitive, physical, occupational, speech, vision and vestibular therapy and headache management. I am pleased to belong to a team that includes the region’s largest number of therapy staff certified as brain injury specialists (CBIS) and the largest number of nurses certified in rehabilitation nursing (CRRN). In addition, Good Shepherd is nationally recognized for being a leader in the use of rehabilitation technology and is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) for brain injury specialized rehabilitation.

At Good Shepherd, our integrated team works toward the common goal of helping patients recover from all levels of brain injuries – physically, mentally and emotionally.