Brain injury rehabilitation following moderate to severe traumatic brain injury is integral to your friend or family member’s recovery. It will help them rebuild physical and mental abilities and increase both their independence and their confidence. Rehabilitation plans are tailored to the individual for optimal results. Rehabilitation will often be multi-disciplinary: there will be multiple professionals helping with cognitive, behavioural, psychosocial and physical needs.
Topics in this section include:
- Tracking rehabilitation
- Factors that impact rehabilitation and recovery
- Inpatient, outpatient, community and virtual rehabilitation
- Caregiver role in rehabilitation
- Public vs. private rehabilitation services and their costs
- Types of rehabilitation
- Rehabilitation tips for caregivers
- Long-term care planning
Continuity of care will play an important role in rehabilitation and recovery after brain injury. Continuity of care comes from working directly with the same doctors, rehabilitation specialists and additional healthcare providers. By developing a strong relationship, patients and their families experience a better quality of care, better care coordination/scheduling, and in many cases better health . You should also keep a detailed tracker of appointments and their outcomes to help you track care of your friend or family member.
Depending on their specific needs, a brain injury survivor could be in rehabilitation for a few months to a few years. Some people continue some form of rehabilitation for the remainder of their lives. The survivor may also depend on someone to help them with their rehabilitation. If that’s the case, make sure to talk to the therapists and figure out what assistance they need.
Factors that impact rehabilitation and recovery include:
- The participant’s willingness and dedication to completing the rehabilitation activities
- The severity of the brain injury
- Physical capabilities - these can be impacted if the person sustained physical injuries to other parts of their body
- Access to services
- A person’s feelings
- How soon rehabilitation starts after a brain injury
Some studies have shown that people with less severe injuries can start rehabilitation sooner. Rehabilitation will start when the physician has determined the time is appropriate.
There are three main places rehabilitation can take place.
- Inpatient rehabilitation
Inpatient rehabilitation is when your friend or family member stays in a rehabilitation centre full-time. Inpatient rehabilitation centres are often run through hospitals, but there are also private rehabilitation centres. Public inpatient rehabilitation is subsidized by the government, while private rehabilitation services are paid for out of pocket by the client or the client’s family.
The doctor may recommend inpatient rehabilitation if:
- The client isn’t able to live at home or with a family member
- Rehabilitation is required frequently or for a long period of time
- Mobility is restricted
- The home isn’t equipped with the necessary accessibility features the client needs
- Caregivers are not able to help with transportation multiple times a week
They could be in inpatient rehabilitation for anywhere from a few days to a few months depending on their needs. The opportunity to do inpatient rehabilitation is beneficial because it allows the person to get the professional help they need in a safe, comfortable environment while reducing the stress associated with transportation and scheduling. If you have questions about whether it is possible for your friend and family member to complete inpatient rehabilitation, ask the primary physician making the referrals/recommendations.
During inpatient rehabilitation
While a person is in inpatient rehabilitation, all of their basic needs are being taken care of by the rehabilitation centre staff. Caregivers can support their friend or family member during this time by:
- Get to know the team members caring for your friend or family member
- Ask when and how you can participate in therapy sessions
- Help you keep track of information and progress
- Visit and socialize with your friend and family member
- Ask the centre staff about personal items or outside food - personal things can improve a person's mood and make their space feel more familiar
- Ask about and discuss the discharge process
Questions to ask about inpatient rehabilitation
- How long will my friend/family member be staying? How is this determined?
- What are the safety features of rooms/safety procedures of the centre?
- When can I visit? Am I able to sleep in the room with them?
- Can we bring things in to decorate their room/make it feel more like home?
- What is the bathing schedule?
- Do you accommodate diets and food preferences?
- Can we bring in outside food?
- What is the nighttime work schedule?
- Can we meet the staff?
- What will my friend or family member be doing when not in rehabilitation therapy sessions?
- Will there be entertainment, socialization, etc.?
- Are home visits allowed during inpatient stays?
- Are there any post-discharge services?
- Outpatient rehabilitation
Outpatient therapy means instead of living at a rehabilitation centre, the client will visit the centre, hospital, or private clinics for their appointments. Depending on the types of therapy and how often they need them, you may have to make appointments for different times with different therapists. This will involve a lot of driving around and waiting on your part, so it’s important to be prepared for that.
Caregiver tip: try using a weekly or monthly planner to organize rehabilitation appointments. This could be a paper copy or an app on your phone. Having the appointments, including travel time, clearly laid out will help you stay organized and minimize stress.
Rehabilitation therapists will complete the appointment and may invite you to be a part of it. A big part of successful rehabilitation is repetition and consistency of the activities and exercises. This means you may have to take the lead at home and help your loved one complete their rehab homework. Here are some rehabilitation tips for caregivers.
Many outpatient rehabilitation centres all offer day programs with pre-planned schedules. This can help cut down on scheduling and time delays, as well as encourage socializing as the programs are generally designed for groups.
- Community rehabilitation
Community rehabilitation (sometimes known as home-based) means that therapists and rehabilitation specialists come to the house for the appointments. Not only is community-based rehabilitation meant to help your loved one with recovery, but it’s meant to help your family and community as well. You are more involved in the rehabilitation process and become a huge part of them achieving more self-reliance.
- Virtual rehabilitation/virtual care
Virtual rehabilitation is when rehabilitation is offered to the person in the comfort of their home through a virtual platform on a computer, tablet, or phone. Virtual rehabilitation is part of a growing virtual care sector of medicine. Virtual rehabilitation has a lot of benefits. A person who is not able to easily leave their home can do rehabilitation in their own space; they are not restricted to services available in their geographical area; and it ensures people can still access essential rehabilitation services in cases where in-person appointments are not possible (such as the 2020 COVID-19 pandemic).
Virtual rehabilitation and virtual care is a developing sector of medicine and as such not all services are available – particularly rehabilitation programs that require specific equipment. This form of rehabilitation may not be as effective for your friend or family member if they are not able to look at screens for long periods of time, require specialized equipment or need a therapist to physically help them with rehabilitation exercises. It’s important to ask questions about virtual rehabilitation, how it would work, and what supports could be put in place to make it an option for your friend or family member.
The caregiver role is one of support for the person with a brain injury. You can provide encouragement, support, and out-of-rehab assistance that will help the person reach their personal goals. Friends and family members are not only able to provide support for the person with the brain injury, but they have insight into their personality and background that could help guide the rehabilitative program .
Emotional toll of rehabilitation on caregivers
Assisting a survivor with rehabilitation is rewarding but can also be physically, mentally and emotionally demanding. It’s important to take care of your own well-being while helping a survivor through rehabilitation.
Questions to ask about brain injury rehabilitation
Doctors will provide you with recommendations and referrals for appropriate rehabilitation for your friend or family member. Even with help from doctors, there are still some questions you should ask to make sure you and other caregivers have all available information .
Tip: use a notebook to write down answers to all your questions. This will help you keep track and share information to other family members or friends later on.
- How long has the rehabilitation program been operational?
- What is the staff-to-patient ratio?
- How flexible is the program?
- Are we able to do both inpatient and outpatient therapy here?
- Are there any services not provided?
- Will we have access to the doctors' contact information?
- Can I meet each member of the team?
- Am I or other family members able to attend sessions?
- What are the safety features?
- Are the staff trained in behavioural problems?
- How often are neuropsychological tests performed to monitor progress?
- Is there a way for us to give feedback on the program, people, and our experience?
- Who can we talk to if we need to make changes or have concerns about our loved ones' care?
- Does the centre specialize in acquired brain injury rehabilitation, or have it as a specialized service?
- What is the daily/weekly rehabilitation schedule going to look like?
- Are counselling services available?
- Is there a family/caregiver education program?
- Do you have accessible parking?
- Do you have a waiting area for people accompanying them to appointments?
- Are there special clothes they will need for their appointments?
- Will accommodations be made to observe religion?
The most common questions people have about rehabilitation and costs are:
1. How much is rehabilitation going to cost?
The cost of rehabilitation is dependent on the province/territory and the kind/amount of rehabilitation needed. It also depends on whether a person chooses public or private rehabilitation. Public rehabilitation centres are funded by the government. As such, public centres often have longer wait times because they are the more affordable option for Canadians. Private rehabilitation centres do not receive any government funding, so the cost of the treatment is the responsibility of the patient.
2. How much of the cost will be covered by insurance?
The kinds of insurance that could help cover rehabilitation costs include:
- Private health/disability insurance
- Workplace health insurance
- Automobile insurance - if rehabilitation is needed as a result of an automobile accident
- Provincial health plans
For specific information about what is covered by personal/private insurance plans, you will need to review your own policies and talk to your insurance provider.
Provincial and Territorial health plans
Rehabilitation may or may not be covered in your province/territory. To be sure, contact your provincial health care service.
3.How much will be paid out-of-pocket?
Out-of-pocket expenses are dependent on the amount of money insurance will cover. It’s also dependent on whether you choose public or private rehabilitation.
Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:
- The product or service promises a quick fix
- Sound too good to be true
- Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
- Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
- The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
- Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based
Always proceed with caution and with the advice of your medical team.