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Consumer Guide - Medical Care, Hospital Care and Rehabilitation of Brain Injury
The medical and rehabilitation care needed after a brain injury can be overwhelming to navigate because it is a process, or a journey, not a single event. The brain is complex and there is not a guaranteed straight path from injury to recovery. And it is impossible to predict with any certainty what impact a brain injury will have on a person - both immediately following the brain injury and in the long term.
It is also important to recognize that the severity of the injury largely determines the duration and level of medical care, hospital care and brain injury rehabilitation that is needed. Other factors that influence a person’s recovery from brain injury include:
- Emergency response to the injury
- Age of the person
- Health of the person prior to the injury
- Education, experience and personality of the person prior to the injury
- Family support
- Financial resources and insurance coverage
- Timing and access to medical and rehabilitation services.
The Process of Medical Care
After a brain injury, medical care and evaluation is a process, not an event. In fact, many persons need medical care and evaluation after discharge from the hospital. For example, persons with brain injury may struggle with problems related to memory, cognitive skills, learning new skills, emotional changes, vision and many other aspects of physical and mental health that may not be apparent until after hospital discharge.
The hospital works to create stability in a person's medical condition. After a person is stabilized, they often are discharged. Medical problems are not always identified until some time after an injury occurs. As a result, the responsibility of accessing quality, comprehensive medical care is shifted to the patient. Be sure to stay in communication with your primary care doctor. Many persons with brain injury experience significant changes as they go through the rehabilitation process.
All children and teens with brain injury should have periodic follow-up medical care with their pediatrician and neuropsychological examinations should occur approximately every three to five years. Brain injuries in children and teens are unique because a child’s brain is still developing. As a result, the impact of a brain injury may not be fully understood until the affected part of the brain develops.
Acute vs. Sub-Acute Rehabilitation
Acute rehabilitation addresses skills related to physical health, personal care, cognitive processing, language and communication, movement and mobility, behavior and environmental awareness and responsiveness. Usually, acute rehabilitation happens first. Sub-acute rehabilitation addresses skills relating to community living, employment, school, behavior, recreation and independent living. Occasionally, a person with brain injury may need to enter acute rehabilitation after medical or behavioral issues are resolved.
Physiatrists and Rehabilitation
A physiatrist is a physical medicine and rehabilitation (PM & R) doctor responsible for coordinating the rehabilitative needs of a person with brain injury. The physiatrist often works with a team of other health professionals to develop and implement a comprehensive rehabilitation plan that addresses all aspects of a person's life.
If a physiatrist is working with you or your loved one, she or he should be involved in all aspects of the rehabilitation process.
Rehabilitation specialists work as a team. In addition to the physiatrist and the person with the brain injury, members of the rehabilitation team may include the person with brain injury's loved ones, neurosurgeons, neurologists, nurses, social workers, neuropsychologists, psychologists (explained later in this section), and occupational, recreation, speech, and physical therapists.
Psychotropic Medication and Adjustment
Persons with brain injury who are put on psychotropic medication should find and work with a psychiatrist who has expertise in brain injury. For more information, consult a neuropsychologist or call the Minnesota Brain Injury Alliance at 612-378-2742 or 800-669-6442.
What is Neuropsychology?
Neuropsychology is an area of clinical psychology that deals with cognitive thought and personality as related to the way that the brain functions. Neuropsychology is used in many areas, including rehabilitation, behavior, employment, return to school, relationship building, determining eligibility for government benefits, driving and general treatment planning.
A neuropsychologist is a specialist who evaluates, through comprehensive testing procedures, the mental functions of a person's brain and how the brain injury has impacted those functions. A neuropsychologist will work with a person to plan treatment programs that can help his or her brain return to an optimal level of functioning as quickly as possible.
What is a Neuropsychological Assessment?
Many persons with brain injury should be seen while still in the hospital by a neuropsychologist for a neuropsychological assessment. This assessment is a series of tests that measure a wide range of abilities to determine an individual's strengths and weaknesses. An assessment can determine which functions of the brain have been disrupted and what the changes mean in a person's everyday life.
Once an assessment is complete, it is critical for the person with brain injury and his or her family to request a follow-up meeting with the neuropsychologist to discuss the results. In the session, ask how activities like work, school, relationships and decision making will be affected. After having a neuropsychological assessment, it will be easier to understand the limitations caused by brain injury. A neuropsychologist should also be able to make suggestions in structuring support systems to compensate for the brain injury.
Frequently, abilities change dramatically in the first couple of years following an injury. A follow-up evaluation should be done within two years after the injury occurs.
How to Find a Good Neuropsychologist A neuropsychologist should have a state license to practice psychology and have a Ph.D. in psychology. After receiving a Ph.D., a neuropsychologist should have additional supervised training and experience in the cognitive and behavioral evaluation of individuals with various types of brain injury and disease. Some neuropsychologists are certified by the American Board of Professional Psychology (ABPP). However, the certification is fairly new; several qualified neuropsychologists do not have ABPP certification. To find a good neuropsychologist you should ask the same questions that you would ask of any professional.