Brain injury rehabilitation refers to the process whereby a specialist multidisciplinary team supports the person to achieve their fullest potential in terms of their physical, psychological, cognitive, communicative, occupational and social functioning. Rehabilitation should be regarded as a continuum, the duration and nature of which will vary considerably depending on the person’s ongoing difficulties and needs. After the initial period of rehabilitation, some people may require further rehabilitation at a later date if they experience a deterioration in their functioning. Deterioration may be precipitated by a number of psychosocial and/or health factors. For example, the person may experience a deterioration in their mental/physical health which may lead to a change in their ability to manage activities of daily living. A change in personal/social circumstances may also result in changes in functioning necessitating further specialist input.
The care pathway for patients with a significant Acquired Brain Injury begins with emergency and acute management (see SIGN 110). This is followed by a period of inpatient and/or community based rehabilitation.
The complex and varied consequences of brain injury necessitates the combined efforts of a team of specialist professionals (e.g. doctors, nurses, therapists, psychologists, social workers and others) i.e. a multidisciplinary team working in a person centred approach. Good communication between team members is essential to the rehabilitation process.
The aims of rehabilitation may include:
Promoting intrinsic recovery: capitalising on the phenomenon of brain plasticity (neuroplasticity). This refers to changes in grey matter and neuronal connections. These changes may contribute to improvements in functioning.- Assisting adaptive recovery: supporting the person to develop ways of compensating for their individual difficulties e.g. using the left hand when the right is impaired. It also includes providing assistance for physical , cognitive, communicative and psychological difficulties.
- Prevention of secondary complications: e.g. physical complications (pressure ulcers, infections, joint contractures etc), chest infections (arising from aspiration), seizures and nutritional issues.
- Maximising participation in all aspects of life: this includes addressing issues such as promoting social interaction, encouraging leisure activities and attending to vocational concerns.
Goal planning is an effective tool to support rehabilitation. There are many different approaches to goal planning but perhaps the most commonly used approach is known as SMART goal planning. SMART refers to goals that are:
Specific
Measurable
Achievable
Realistic
Timed
Utilising a goal planning approach to rehabilitation is helpful in identifying goals for intervention, implementing treatment programmes and measuring outcomes.