Rehabilitation - also known as rehab or therapy - means building back up physical and cognitive abilities through activities and therapies with trained healthcare professionals following a moderate to severe brain injury. 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. Depending on the situation, rehabilitation can last a few months to a few years. Some people continue it for the rest of their lives.
Rehabilitation for brain injury commonly requires a referral from a healthcare professional such as a physician or a neurologist. This can be a lengthy process depending on factors such as where you live and the availability of rehabilitation in your area - particularly if you are using public rehabilitation services. It’s important not to get discouraged by wait times and stay in regular contact with your healthcare team and caregivers to make sure that your recovery is moving forward. You can also become a self-advocate for rehabilitation services.
Topics in this section include:
- Tracking rehabilitation
- Inpatient, outpatient, community and virtual rehabilitation
- How long will I be doing rehabilitation?
- Public vs. private rehabilitation
- Types of rehabilitation
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 outcomes to monitor your care and appointments.
Factors that impact rehabilitation and recovery
Depending on your specific needs, you 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.
You may also depend on someone to help you with your rehabilitation. If that’s the case, make sure to talk to the therapists and figure out what assistance you need.
Additional factors that impact rehabilitation and recovery include:
- Your willingness and dedication to completing the rehabilitation activities
- The severity of the brain injury
- Physical capabilities - these can be impacted if you sustained physical injuries to other parts of your body
- Access to services
- Your feelings
- How soon rehabilitation starts after a brain injury. Studies on early rehabilitation have shown it is beneficial to a person’s recovery after a brain injury but is highly dependent on other factors (such as severity of injury). Rehabilitation will start when the physician has determined the time is appropriate
- Inpatient rehabilitation
If you have complex medical needs and require intensive rehabilitation and can’t live at home or with a family member at the time, your doctor may recommend inpatient rehabilitation. Inpatient rehabilitation is when you stay in the hospital or rehabilitation centre full-time. This ensures you get the therapies and care you need after your brain injury. You could be in inpatient rehabilitation for anywhere from a few days to a few months depending on your needs. Inpatient rehabilitation centres are often run through hospitals. There are also private rehabilitation centres not associated with specific medical centres.
The opportunity to do inpatient rehabilitation is beneficial because it allows you to get the professional help you 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 you to complete inpatient rehabilitation, ask the primary physician making the referrals/recommendations.
During inpatient rehabilitation
While you’re in inpatient rehabilitation, all of your basic needs are being taken care of by the rehabilitation centre staff. You and your family and friends can make the process as smooth as possible by asking questions like the following:
How long will I be staying? How is this determined? What are the safety features of rooms/safety procedures of the centre? When can my friends/family members visit? Are they able to sleep in the room with me? Can we bring things in to decorate the 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 I meet the staff on both shifts? What will I 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
If you’re ready to live at home or with a family member and are able to leave the house, you’ll participate in outpatient therapy. Outpatient therapy means you visit rehabilitation centres or therapist offices for appointments. Your therapists will complete your appointment with you, and often give you exercises/activities to do at home until your next appointment. A big part of successful rehabilitation is repetition and consistency of the activities and exercises. This means you may have exercises and activities to complete at home as well.
- Community rehabilitation
Many outpatient rehabilitation centres 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 (sometimes known as home-based) means that you have therapists and rehabilitation specialists come to you at your house. Not only is community-based rehabilitation meant to help you in your recovery, but it’s meant to help your family and community as well. It teaches them how to assist you in your activities of daily living (ADLs), and gives you more convenience and independence.
- 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. If you are not able to easily leave your home, you can do rehabilitation in your own space; you are not restricted to services available in your geographical area; and it ensures you 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 you if you are not able to look at screens for long periods of time, require specialized equipment or need a therapist to physically help 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 you.
Brain injury recovery varies from person to person, which means rehabilitation is different as well. Doctors and rehabilitation specialists will monitor your progress and make updates to the recovery plan as needed. There is no timeline for how long recovery will take, how long you’ll be doing rehabilitation, or the extent to which you will recover. The main factors that dictate recovery are the extent of the injury, time, and progress made in rehabilitation appointments.
Questions to ask about brain injury rehabilitation
Doctors will provide you with recommendations and referrals for appropriate rehabilitation. Even with help from doctors, there are still some questions you should ask to make sure you have all the available information.
Tip: Use a notebook to write down answers to all your questions. This will help you keep track and share information later on.
- How long has the rehabilitation program been operational?
- What is the staff-to-patient ratio?
- How flexible is the program?
- Am I able to do both inpatient and outpatient therapy here?
- Are there any services not provided?
- Will I have access to the doctors' contact information?
- Can I meet each member of my rehabilitation team?
- Are my family members able to attend therapy sessions?
- What are the safety features of the centre?
- How often are neuropsychological tests performed to monitor progress?
- Is there a way to give feedback on the program, people, and my experience?
- Who can I talk to if I need to make changes or have concerns?
- 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 information about returning home with brain injury?
- Do you have accessible parking?
- Do you have a waiting area for people accompanying me to appointments?
- Are there special clothes I will need for my appointments?
- Will accommodations be made to observe religion?
How much is rehabilitation going to cost?
The cost of rehabilitation depends on the type of rehabilitation, its availability, and whether it’s public or private.
Public rehabilitation is funded by the government. Physicians and medical professionals at hospitals will commonly provide referrals for rehabilitation. It’s more affordable, but also has much longer waitlists due to limited availability. Not every therapy is available through government funding. Physiotherapy is widely available, and in many provinces/territories occupational therapy is covered in part by the government and by insurance. Other, more specific or experimental therapies are not covered.
Private rehabilitation services are ones paid for out of pocket by the patient and are not subsidized by the government. This is a more expensive option. Private rehabilitation services have shorter waitlists and a greater variety of therapies, which is good if you’re looking for something specific.
There are both public and private outpatient rehabilitation services in Canada, but not for every therapy.
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.
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.