The rehabilitation team
In a specialist rehabilitation setting, a ‘multidisciplinary’ team of professionals will work closely with the person with a brain injury.
Initially, each therapist will carry out detailed assessments to explore the extent of the difficulties caused by the brain injury, including physical, cognitive, emotional, behavioural and social difficulties.
Following the assessment process, the team will discuss with the client and the family what their priorities and goals for the period ahead might be and what they hope to achieve. Based on this, the rehabilitation goals – both short and long-term – will be agreed and the rehabilitation programme will be planned. In devising the rehabilitation programme, the team will want to set goals that take into account each patient’s individual views and needs, their cultural background, and pre-injury lifestyle and interests.
The different therapists who may be involved in the rehabilitation process, and their areas of expertise, are
A clinical neuropsychologist is a psychologist who specialises in the assessment and treatment of behavioural, emotional and cognitive (thinking) problems following brain injury. A neuropsychologist can advise on how to build upon the person’s existing skills and abilities and how to reduce some of their difficulties.
Occupational therapist (OT)
OTs help people to develop independence in carrying out daily tasks such as dressing, washing, cooking and leisure activities. An OT will also help the person to develop the skills that underlie these activities, such as budgeting and planning, and help to find ways around any remaining problems. At a later stage, the OT may help and advise on difficulties that may be encountered in the home environment and advise on any adaptations that may need to be made. They will also be involved in planning for returning to work. There are OTs working within both the NHS and social services.
Speech and language therapist
A speech and language therapist (sometimes referred to as a SALT or SLT) helps people to improve their communication skills. This may include understanding and expressing both written and spoken language and improving speech clarity. The speech and language therapist will work with family members to help the person to communicate as best they can in their daily life and will identify any communication aids that may be helpful. They may also be required to assess swallowing difficulties and provide guidance on how this should be managed safely.
A physiotherapist helps people to regain the use of their muscles and joints after injury and helps with balance and movement problems. A ‘physio’ will, for example, suggest exercises to help the person improve their physical ability and enable them to become as mobile and independent as possible.
Nurses help the therapists to implement many of the rehabilitation strategies. In many in-patient rehabilitation units the care provided by the nursing team is the foundation for the rehabilitation programme provided by the multidisciplinary team. On in-patient units and in the community there may be specialist nurses who take on specific roles, such as the management of epilepsy or behavioural programmes.
Social workers provide practical advice on issues such as benefits, housing, transport and assistance at home. They are also trained to offer emotional support to individuals and their families.
A case manager is responsible for overseeing and managing the overall care of the person with a brain injury. They will prepare an individually-tailored care plan or treatment programme for each client, which is designed to meet the person’s specific health, social and emotional needs. Case managers can come from a variety of professional backgrounds, such as social work, occupational therapy, or nursing. Brain injury case managers are usually only available through private referrals and interim compensation payments.
Family members have a very important role to play in helping the survivor make as full a recovery as possible. A good working relationship between the family and the rehabilitation team is essential in making sure that rehabilitation programmes are followed correctly. Research suggests that the patients who make the best recovery are those whose family is actively involved and can maintain the skills learned in rehabilitation once the patient has gone home.
Sometimes relatives will need to learn new skills so that they can help to provide the best support. However, it is important that the family member does not become a ‘therapist’ and that they are encouraged to focus primarily on their role as somebody who provides love and affection. Family members are usually invited to participate in formal meetings with staff members to keep them informed of their relative’s progress. Sometimes the family will need to act as an advocate for the survivor when the survivor lacks the capacity to make decisions for themselves.
There are many rehabilitation professionals working in private practice. If little or no rehabilitation has been provided by the NHS or social services then one option can be to contact professionals independently. It may still be possible to obtain an NHS or social services referral, or it may be necessary to pay privately.
For more detailed information on brain injury rehabilitation see the Headway booklet Rehabilitation after brain injury.