Traumatic Brain Injury Rehabilitation

The goal of brain injury rehabilitation is to help the impaired individual to progress to the most independent level of functioning possible.

Brain injury rehabilitation involves two essential processes: restoration of functions that can be restored and learning how to do things differently when functions cannot be restored to pre-injury level. Cognitive stimulation therapy plays a key role in the rehabilitation process. Brain injury rehabilitation is based on the nature and scope of neuropsychological symptoms identified during an assessment following brain injury.

Brain injury rehabilitation must be designed taking into account a broad range of neuro-functional strengths and weaknesses of the brain injured patient. Basic skills (e.g. specifically attention, focus, perception skills) must be strengthened before more complex skills are added (e.g. problem solving, strategic analysis, etc.). This pattern of identifying functional strengths and weaknesses along with focused stimulation of the deficit areas becomes the foundation for designing a program of brain rehabilitation.

Brain injury rehabilitation follows patterns of brain development. Gross or large-scale systems must develop (or be retrained) before fine systems. Attention, focus, and perceptual skills develop (or are retrained) before complex intellectual activity can be successful.

What Cognitive Problems Can Result From Traumatic Brain Injury?

Cognitive problems that result from traumatic brain injury vary widely from person to person. These problems depend on many factors which include an individual's personality, pre-injury abilities, and the severity of the brain damage and other influencing factors.

So long as the executive functions (logic, problem solving, etc.) are intact, a person can likely sustain considerable cognitive loss and still continue to be independent, constructively self-serving, and productive. When these higher order and more complex executive functions are impaired, they tend to show up globally, affecting all aspects of behavior. Executive functions consist of those capacities that enable a person to engage in independent, purposive, self-serving behavior successfully. They differ from basic cognitive functions in a number of ways.  Questions about executive functions ask how or whether a person goes about doing something (e.g., Will s/he do it, and, if so, how?)

Cognitive improvements can occur as other areas of the brain learn to take over the function of the damaged areas. This “learning” process is the key process by which the brain’s neuro-plasticity is leveraged to regenerate existing neural pathways to find neural network detours around permanently damaged areas.

In some individuals, cognitive impairments often include problems with

• Attention
  • Focused Attention
  • Divided Attention
• Concentration
• Memory
  • Short Term memory
  • Long Term memory
• Comprehension
  • Interpreting instructions 
  • Learning new information
• Language
  • Reading
  • Writing
  • Difficulty finding words
  • Forming sentences correctly
  • Describing things or situations
• Simple and complex math
• Executive Function
  • Problem solving
  • Decision making
  • Planning
  • Judgment 
  • Organizing thoughts

Individuals with traumatic brain injuries are often unaware of their cognitive deficits and can become frustrated or angry.

How Are these Cognitive Problems Treated?

The rehabilitation of cognitive and communication problems is a continual, ongoing process. Once the physicians, speech-language pathologists, neuropsychologists, occupational therapists and other professionals have assessed the extent of the cognitive loss, communication skills, behavioral abilities, active daily living (ADL) capability, hearing ability, a treatment plan can be created. The cognitive and communication problems of traumatic brain injury are best treated early, often beginning while the individual is still in the hospital. This early therapy will frequently center on increasing skills of alertness and attention. They may focus on improving orientation to person, place, time, and situation, and stimulating speech understanding.

Longer term rehabilitation may be performed individually, in groups, or both, depending upon the needs of the individual. This therapy often occurs in a rehabilitation facility designed specifically for the treatment of individuals with traumatic brain injury. Therapies can be supplemented by activities at home. The rehab facility setting allows for intensive therapy by speech-language pathologists, physical therapists, occupational therapists, and neuropsychologists at a time when the individual can best benefit from such intensive therapy.  Other individuals may receive therapy at home by visiting therapists or on an outpatient basis at a hospital, medical center, or rehabilitation facility.

The goal of rehabilitation is to help the individual progress to the most independent level of functioning possible. Therapy will focus on regaining lost skills as well as learning ways to compensate for abilities that have been permanently changed because of the brain injury. Most individuals respond best to programs tailored to their backgrounds and interests. The most effective therapy programs involve family members who can best provide this information and support the rehabilitation process.

USA Social & Health Services TBI Fact Sheet for Professionals: Click Here