Types of rehabilitation

Please note: not all of the therapies listed below are available publicly and may not be covered by insurance providers. This means that there may be out of pocket costs, depending on the type of therapy you do.

There are several types of rehabilitation that individuals with brain injuries may find helpful in their recovery. We have included the most common and recognized rehabilitation therapies. Different rehabilitation therapies will be recommended for different people. Not every rehabilitation therapy will be available in every area. Speak with your medical team about rehabilitations available to you, and ways you can access them. In some cases, there may be online rehabilitation services that can make getting support even easier.

You can also reach out to your local brain injury association about available public groups.

Occupational therapy
Occupational therapy (OT) assists with activities of daily living (ADLs) and creating a home environment that is designed for the person with a brain injury to be as independent as possible. This includes things like:

  • Cooking
  • Eating
  • Bathing
  • Cleaning
  • Getting dressed
  • Going to the bus stop

After a brain injury, these everyday activities can be more challenging. If you’re experiencing problems with your fine motor skills, having trouble with memory or processing instructions, or have issues with vision, hearing, or touch, occupational therapy will be a big help.

An occupational therapist will perform a functional assessment of you, your family, and your environment. They identify impairments and environmental barriers and create a treatment plan designed specifically for you. Part of the plan is developing specific goals you want to achieve, and using tools and strategies to help you do so. An occupational therapist helps you re-learn self-care, work, and leisure skills. This includes teaching you new ways to do things if your capabilities have changed. Their job is to help you with your ADLs, and help you reach a place where you can do them as independently as possible. They’ll do this using tools, new processes, and activities. They’ll even complete an assessment of your home environment so it can be set up in a way that works best for you. This includes making recommendations for furniture placement and how to remove tripping hazards and prevent further injuries.

Physiotherapy
Physiotherapy focuses on improving movement and mobility. This is done through carefully monitored stretching and exercises. This is one of the most common therapies – most people recovering from physical injuries need it. A physiotherapist is a rehabilitation professional who will perform an assessment of your physical capabilities and create a treatment plan to improve strength, muscle tone, or mobility. Exercises and activities can include range of motion exercises (ROM), strengthening exercises focused on building endurance and muscle, balance exercises which will target areas of deficit, and gait training to improve posture and walking.

Physiotherapy can be short or long-term. You may also be given activities or exercises that you have to do between appointments. As you meet physiotherapy goals, your abilities and needs will be reassessed, and your plan adapted to make sure you continue making positive progress.

Psychological therapy
Psychological therapy – which can also be called counselling – is an excellent way to take care of your mental health and understand more about your emotions, behaviours, and thoughts. It’s also a great way to unburden yourself and receive considerate, thoughtful feedback from a professional. Counselling can be done by either a psychiatrist or a psychologist – both are licensed mental health professionals. The main difference is that a psychiatrist has a medical degree and is able to prescribe medication.

The health professional providing the treatment will first complete an assessment to help identify what you need and what goals you would like to reach.

Speech and language therapy
Possible effects of brain injury include cognitive communication challenges. You may not be able to process your thoughts, have difficulty organizing your speech, or struggle with reading/writing. A speech language pathologist (SLP) can help with relearning communication skills and new adaptive techniques.

A person may also experience difficulty speaking or trouble swallowing. These challenges are connected to the throat and mouth muscles. Not only can it be difficult to talk, but it can be challenging to eat or drink, causing further problems with nutrition and safe eating. An SLP will perform tests in the early (acute care) stages of recovery if a person is experiencing any of these issues. It may be recommended that the person continue to work with a speech language pathologist to improve speaking and swallowing abilities. This can be a long process that requires patience, and treatment will be updated on an ongoing basis.

Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy is rehabilitation that focuses on creating programs and activities that will help you engage in positive and productive behaviour. Cognitive behavioural therapy covers a lot of symptoms of brain injury, including neural feedback, appropriate behaviour, memory, and information processing. Since no two brain injuries are the same, cognitive behavioural therapy doesn’t have a set program of exercises and activities. Your therapist will perform an initial assessment and set goals with you that you will then work towards. Once those goals are met, new goals will be set, and the treatment plan will evolve to include activities that will help you reach those goals.

Cognitive behavioural therapy is becoming more and more common, but it is still a growing part of rehabilitation for brain injury and is not as widely available as other types of rehabilitation.

Vocational rehabilitation therapy
It can be challenging after a brain injury to go back to a job. Depending on your injury, you might not be able to return to your former workplace or you may have to come up with new strategies to help you complete work-related tasks. Vocational rehabilitation therapy focuses on helping you prepare to re-enter the workforce. They give you the tools and skills needed to find a part-time or full-time position. In partnership with the Vocational Rehabilitation Association of Canada, we have developed a guidebook to help you understand the return to work process.

Art therapy
Art therapy is a more experimental therapy. Patients complete art projects in a personalized program. When someone is working on a creative art project, it can stimulate multiple parts of the brain at the same time and encourage neural pathways to form. Art therapy can also improve fine motor skills, help with other cognitive challenges such as memory and attention, and improve mental health and moods. Art therapy is conducted by licensed art therapists and is normally an out-of-pocket expense.
Mindful meditation and yoga
Mindful meditation and yoga have become popular forms of therapy after brain injury. Both focus on the concept of quieting the mind, limiting outside distractions, and focusing on deep breathing and relaxing. Meditation can reduce stress and anxiety and allows for emotional self-check-ins and is a great technique for calming down.

Yoga also reduces stress and anxiety but adds an element of physical movement. Yoga moves are designed to be adapted and taken at the person’s pace. There are special classes and movements designed specifically for people who need adaptations.

Music therapy
Music therapy uses music to help people with functional goals, improve mental health and cognition, and promote self-awareness and reflection. Music can be used to help with speech problems through musical vocals, motor skills through instruments, and cognition through composing. Music therapists are licensed professionals who undergo several years of training. Music therapy is an out-of-pocket rehabilitation expense.

More information on music therapy

Recreational therapy
Recreational therapy uses leisure activities that a person would normally do to meet rehabilitation goals. The goal of this therapy is to help the person become as independent as possible when doing those activities. This could include walking, outdoor activities, arts and crafts, dancing – anything someone would normally do in their leisure time. Certified recreational therapists will use these activities to help with cognition, mental health, and even physical health if the activities are exercise-based.

Additional rehabilitation specialists

Depending on your rehabilitation needs, you may work with additional rehabilitation specialists who will help you with recovery. Please note: you may not need to work with every kind of rehabilitation specialist. Doctors will make recommendations and referrals based on your needs.

Audiologist
An audiologist is a healthcare professional with a focus in hearing loss related to the inner ear and vestibular system. They can diagnose and recommend treatment for people with brain injury who are experiencing hearing loss.
Behaviour therapist
A behavioural therapist is a professional that uses professional training to help people with behaviour challenges understand good vs. bad behaviour. The therapist will identify the problem behaviours, then outline a treatment plan based on what the person wants to achieve. While there are many different types of behavioural therapy, the therapist will help reinforce positive behaviours.
Case manager
A case manager is someone who can help you coordinate appointments and other daily activities after your brain injury, particularly if you are experiencing cognitive challenges that make planning and going to appointments difficult. They can also help you by going to appointments with you and assisting you with post-appointment activities.

Case managers are not available everywhere in Canada and may be an out-of-pocket expense. You should speak with your physician about available rehabilitation specialists in your area and what would be right for you.

Chiropractor
Chiropractors focus on treating neuromuscular (nerve and muscle) conditions by physically working on the person’s spine. Their focus is on improving muscle and skeletal structure and reducing pain in the back and related joints. Chiropractor services can be helpful for people with lingering pain from physical injuries.
Dietitian
A dietitian is a medical professional with a degree in nutrition science. They are able to understand how food impacts health and well-being, and work with individuals to create comprehensive diet plans that treat nutritional problems. Treating nutritional problems can aid in treating other conditions, such as brain injury.

Please note: There is a difference between a dietitian and nutritionist. Dietitian is a protected term in Canada, which means they need to have professional certification. Nutritionist is only a protected term in Alberta, Quebec and Nova Scotia. This means that someone may be a nutritionist in British Columbia but not have the same credentials as someone in Alberta. Dietitians of Canada has an explanation and a chart of protected titles by province/territory that can help you identify what kind of health professional to consult for dietary needs.

Ear, nose and throat doctor (ENT)
An ear, nose and throat doctor (ENT) – officially called an otolaryngologist – is a doctor that specializes in the connected systems in the head. An ENT can diagnose and provide treatment recommendations for conditions such as hearing loss, tinnitus, sinus issues, balance problems, and swallowing difficulties.
Life care planner
A certified life care planner is someone who can help you create a plan after a life-altering event such as a brain injury. This plan can include services, supports, and costs necessary from that point on. A life care planner will perform an in-person assessment and develop a plan that will help map out future needs. This is incredibly helpful, especially if a person’s abilities to plan are compromised, or their family is worried about care, finances, and emergency planning for the future.
Life skills planner
A life skills planner is someone who is trained to teach other people how to develop and improve life skills. Life skills is a broad term used to describe any skills that are helpful in activities of daily living (ADLs). Examples of life skills include communication skills, interpersonal skills, decision-making, and taking care of a home.
Personal support worker
A personal support worker is someone who helps you with your activities of daily living (ADLs) and self-care, and is either with you full or part-time in your home or at a treatment centre. Their role is to help make your day-to-day routine more manageable.
Neurologist
A neurologist is a medical health professional that specializes in treating the nervous system, which includes the brain. A neurologist is one of the physicians that would be able to make a diagnosis of brain injury and address symptoms. They also help with management of brain injury and its symptoms through treatment and referrals to other treatment options.
Neuropsychologist
A neuropsychologist specializes in understanding how the brain and behaviours are linked. For someone with an acquired brain injury, a neuropsychologist can help determine how the injury will affect their cognitive abilities and behaviours and make recommendations for what rehabilitations could be helpful in your recovery.
Physiatrist
A physiatrist is someone who specializes in physical medicine and rehabilitation. They can help a person with a brain injury by evaluating physical needs and making rehabilitation/treatment plans. The physiatrist can identify and make recommendations for treatment in relation to physical, cognitive or behaviours problems that can result from brain injury.
Recreational therapist
A recreational therapist is a professional that uses leisure and recreational activities as rehabilitation to build skills. The treatments are assessment-based and can be useful for people with social, cognitive, and behavioural challenges in developing independence and improving quality of life.
Respiratory therapist
A respiratory therapist is a professional that can assist with breathing difficulties. They work alongside doctors at hospitals to provide emergency respiratory care, or they can work in rehabilitation centres or at home to help people with ongoing breathing difficulties. Doctors will provide a recommendation if they think you need to see a respiratory therapist during rehabilitation.
Social worker
A social worker is a healthcare professional that provides ongoing support to the patient and the family by serving as an advocate and assisting with accessing services. They can also provide some levels of counselling. Their primary focus is improving overall well-being. A social worker can be a huge help for someone who is not sure where to find information or resources or needs someone to help support them while they look for services.

Tips for improving mobility

Most physical recovery gains will occur in the first 6-24 months – but that is not a strict rule. Every brain injury is different and will require its own treatment plan and timeline. There are actions you can take to help increase your mobility over time.

Work with physiotherapists, kinesiologists and occupational therapists

The best way to improve mobility is to work with experts. Physiotherapists, kinesiologists and occupational therapists specialize in helping people improve their gross motor skills and fine motor skills. By having the support of professionals and following a tailored rehabilitation plan, you will be able to make progress.

Repeat exercises and activities

Our muscles and body will learn movements the more we repeat them. The more you practice an exercise, the more your body will respond. However, practicing exercises should be spread out over time. This is a long process requiring a lot of patience. You do not want to go too hard or too quickly: that can result in diminished returns. In other words, you probably will not see progress as quickly. This can cause frustration with the process, which also has the potential to impact your progress.

The best way to see results is to follow the program set by therapists and use exercises or activities that mimic actions you enjoy and do in your day-to-day routines. Engaging and interesting activities will produce more dramatic and meaningful recovery as you are more likely to successfully repeat the action.

Medications

Medications may be used for controlling muscle tone, seizures, pain management (headache, central pain), dizziness and nausea. Medications should only be prescribed by and taken on the recommendation of your doctor.

You will benefit from having a good working relationship with your doctor. All aspects of brain injury recovery take time, and this will be a long-term relationship with many check-ins. You should feel comfortable telling them about any changes to your health and well-being throughout your recovery. They will be able to adapt your treatment plan as needed, helping you progress as much as possible.

Use mobility aids as needed

To both improve your mobility and keep yourself safe, you should always use any mobility aids your therapists or healthcare team recommend. Many individuals with brain injury continue to use some sort of aid like sturdy shoes or walking sticks to reduce the risk of further injury.


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Tips to manage fatigue

There are some actions you can take to help manage your fatigue.

Ask for help

Fatigue can make it difficult to complete daily tasks, travel, or go to appointments. A caregiver, family member or personal support worker can assist with tasks that may leave you fatigued, and work with you as you build up your endurance.

Cognitive behaviour therapy (CBT) and occupational therapy (OT)

One of the leading causes of fatigue is the extra mental and physical efforts it takes a person with a brain injury to complete tasks.

Cognitive behaviour therapy is designed to help survivors coping with mental and cognitive changes. For fatigue stemming from cognitive changes, cognitive behaviour therapy can be helpful in building endurance and understanding what’s causing fatigue and how to manage it.

Occupational therapy is available to help people living with brain injury relearn skills or find new ways to complete activities of daily living (ADLs). When you practice these skills consistently, it will take less and less energy for you to complete them – this leads to less instances of fatigue.

Remember: the effects of rehabilitation happen over time and recovery is based on several factors. You won’t notice significant changes right away but that doesn’t mean the rehabilitation isn’t helping you. It’s like tracking fitness goals: you notice changes and improvements week to week, not day to day.

These therapies are available both privately and publicly. Private therapy is paid for by you. Publicly funded therapy is available at no additional cost: however, availability of public therapy is limited and differs from province to province based on the services available. Your doctor will be able to provide you with more accurate local information or recommendations.

Depending on your private or work insurance plan, occupational therapy and cognitive behaviour therapy may be partially or fully covered under psychotherapy services. It is always best to check directly with your insurance provider about your coverage.

Communicate your experience with fatigue

Your loved ones and friends may not understand how deeply fatigue can impact your daily life.  They may see you at a family gathering or event and make comments like “glad to see you are feeling better” or “great to see you back to normal”. They don’t know that you have had to sleep leading up to the event and will have to sleep for hours after it, just so you could have the energy to attend.

It’s okay to tell them you struggle with fatigue and you are always recovering. Openness and honesty will help educate others on the experience of living with a brain injury.

Create schedules to manage your day and your fatigue

Set out a schedule and plan your activities, appointments, and tasks for each day. You only have so much time and energy, and you want to make sure it will get you through the day. Chances are your energy levels before your injury were a lot different than your energy levels now. This means you will have to practice pacing – taking a bit more time and spreading out your schedule.

When building your schedule, try to do it the night before or in the morning after you wake up. When making a schedule, make sure to do the following things:

  • Build in rest periods. One of the best ways to manage fatigue is to give yourself time to rest. Listen to your body and don’t “push through” if you’re feeling fatigued. If you know you need multiple rest periods a day, schedule them before you schedule anything else. Having a schedule with time set aside to rest will help ensure you take the time you need.
  • Schedule activities when you have the most energy. Depending on when you experience fatigue, there will be periods of time during the day that make the most sense to schedule activities. For example, many individuals have the most energy after they wake up in the morning and much less energy in the evenings. By scheduling activities and appointments during the times you have the most energy, you will minimize the risk that fatigue will interfere.

Exercise and physical activity

This should be undertaken on doctor recommendations. Exercise and physical activity have all-over health benefits but should be reintroduced slowly and under supervision. Overtime you will build up your skills and endurance, meaning you can do more and feel less fatigued.

Have plans in place for unexpected fatigue

Fatigue can be debilitating and leave a person unable to complete tasks. It can also occur unexpectedly, especially immediately following your injury. For example, you could become fatigued in a public place, at a social event, or at work.

When this happens, having coping strategies can help manage the situation. This could include having hand signals with your caregivers or having an emergency contact come get you. If you’re worried about fatigue catching you off guard, try the following aids:

  • Keep a journal to track when you commonly feel fatigued
  • Speak with your rehabilitation therapists about strategies for coping with fatigue and public outings
  • Share your feelings with caregivers or employers – they can help you come up with a plan

Manage stress

Elevated stress levels can increase fatigue, particularly for individuals with brain injury who have cognitive and problem-solving challenges. When you identify what causes you stress, you can either remove those stressors or start dealing with them on a gradual basis. Giving yourself this time to process and respond to stressors will help manage feelings of fatigue.

Manage your expectations

A brain injury is a major life change, and that means abilities have changed. It’s important during recovery to manage your expectations and focus on what you can do. Don’t always compare where you are today with where you were before the injury. That will lead to negative feelings and fatigue because you’re trying to push yourself to hard. Instead, focus on setting weekly or monthly goals and prioritizing your health and well-being.

Track your fatigue

What causes fatigue for you may not cause fatigue in someone else. It is dependent on the person, their injury, and the environment. While it can be difficult to identify triggers, it’s important that you and your caregivers learn what makes you feel fatigued: if you don’t, you may experience extended periods of fatigue or feel like you have no control over your energy levels.

It can be difficult to track your fatigue through the course of a day, especially if you’re experiencing memory issues. By keeping a journal of your activities and your feelings, you can more accurately identify periods of time where you feel fatigued.

Record all medications you’re taking

Some medications can have increased feelings of fatigue as a side effect. Keep a list of what medications you’re taking, when you’re taking them, and their side effects. This will help you identify when you may feel more tired.

Create a rating system

One way to check in with yourself and how fatigued you’re feeling is to create a rating system. Make a scale from 1-10 and measure your fatigue on that scale. For example, a 1 is not fatigued at all while a 7 or 8 is strong feelings of fatigue.

You should rate your fatigue levels before and after you complete an activity – for example, doing the dishes. If you find that doing the dishes takes you from a 1 to a 5 on your fatigue scale, perhaps take breaks or ask for help with dishes.

This rating system will not only help you identify what makes you feel fatigued; it will help you identify when to take breaks and improvements you make over time [1].

Understand what environments work for you

Some environments can increase a person’s fatigue. This includes places with loud noises, bright lights, overcrowding or that require a lot of travel. By understanding what environments cause fatigue and what environments work best for you, you can more easily participate in activities. Over time, you can reintroduce yourself to other environments for short periods of time. Wear sunglasses if it will help you deal with bright lights and ear plugs to deal with noise if it does not jeopardize your safety. Look for places that offer sensory-friendly settings – for examples, some grocery stores have specific sensory-friendly shopping days.

Remember: take breaks as often as you need. You don’t have to stay out for a full day if you’re experiencing fatigue or other symptoms. It’s important to listen to your body.

Use assistive technology and tools

Assistive technology and tools help individuals with acquired brain injury manage their symptoms and complete activities of daily living [2]. There are ways to use assistive devices to cope with fatigue. For example:

  • Wheelchairs during walking rehabilitation
  • Checklists to help manage tasks and minimize stress
  • A sleep journal to track sleep disturbances

Occupational therapists and cognitive behavioural therapists can assist in developing coping methods or introduce you to tools that manage fatigue.

If you need financial support to obtain assistive devices you can explore this assistive devices program. This program assists adults with physical disabilities who are in financial need to purchase assistive devices that increase their mobility and functional independence.


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