Brain injuries can occur in both traumatic and non-traumatic varieties. Traumatic injuries occur from, you guessed it, physical trauma. This can include events such as motor vehicle accidents, assaults or striking the head during a fall. Non-traumatic injuries may involve brain bleeds, cancer diagnosis or brain infections. This list isn’t exhaustive. Severity of brain injury varies and is initially determined by a person’s acute care medical team, but the label given doesn’t always create a clear picture of the impact the injury will have on the person and their life.
The symptoms a person can experience after suffering a brain injury vary drastically depending on the location of brain involvement, the severity of the injury, medical complications and other pre-existing factors. As much as we know about the parts of the brain and what they’re responsible for, it’s crucial to understand that every individual is different, and every brain is different. The symptoms the person experiences, but most importantly the person’s individual goals, will determine which therapy discipline(s) they work with across the continuum of care.
What Does the Brain Injury Rehabilitation Journey Look Like?
The different stops a person makes and the amount of time in each level of care along their rehabilitation journey can be as variable as the injuries themselves. Some common levels of care in the recovery process include:
- Acute care hospital
- Inpatient rehabilitation
- Sub-acute rehabilitation
- Outpatient therapy
- Home and community services
- Transitional living
Brain injury can be a lifelong process, and the team members likely will fluctuate over time. For this article, we’ll focus on three of the primary therapy disciplines—physical therapy, occupational therapy and speech therapy.
What Is Interdisciplinary Rehabilitation for Brain Injury?
Interdisciplinary rehabilitation is a collaborative approach that involves the individual, their family and loved ones, their nurses, doctors, care managers, and therapists to create a shared treatment plan. An interdisciplinary approach differs from a multidisciplinary approach wherein each discipline works on their goals in parallel.
Interdisciplinary teams work together to:
- Improve patient outcomes
- Reduce unwanted therapy overlap
- Enhance communication
Brain injury rehabilitation best serves patients when interdisciplinary teams collaborate with the patient and their family or support system.
What Does a Speech-Language Pathologist Do in Brain Injury Rehabilitation?
The speech-language pathologist’s (SLP) role is to assess, establish or facilitate communication across all language modalities. This includes verbal or written expression, reading and auditory comprehension. SLPs can also facilitate the use of alternative forms of communication beyond verbal communication, if warranted.
The SLP may target breath support and speech clarity to encourage improved efficiency with conversation. However, when it comes to brain injury, we also focus on the cognitive-communication skills we use every day.
Cognitive communication skills include:
- Memory and recall
- Processing information
- Concentration
- Goal-setting and execution
A big part of cognitive-communication therapy is integration with functional activities. For example, how does a person’s memory impact their ability to efficiently complete their job or home duties?
How Does Speech Therapy Help with Swallowing After Brain Injury?
SLPs are also responsible for swallow function and safety. Brain injuries can impact the physical strength, coordination and endurance of swallowing muscles. When there’s an impairment, it can put people at risk for dehydration, reduced nutritional intake or aspiration.
SLPs complete instrumental evaluations to assess swallowing and establish a plan of care. They may also make diet recommendations or provide strategies to encourage safe eating and drinking.
What Does a Physical Therapist Do in Brain Injury Recovery?
Within a neurologic population, physical therapists work to promote neuroplasticity and restore functional independence. The areas addressed often include wheelchair mobility, transfers, stairs and walking.
Care plans often include:
- Working on strength and balance
- Managing spasticity
- Improving coordination
- Increasing tolerance while standing
Physical therapists also incorporate cognition, memory, attention and awareness into their sessions.
What Does an Occupational Therapist Do After a Brain Injury?
Occupational therapists help individuals regain independence in meaningful daily activities. While returning to work may be a goal, occupational therapy focuses on any activity that helps someone live their day-to-day life.
This may include:
- Getting dressed
- Using the bathroom
- Taking a shower
- Cooking or navigating environments
Occupational therapists develop individualized treatment plans to help patients return to the activities that matter most to them.
How Do Therapy Disciplines Work Together in Brain Injury Rehabilitation?
Collaboration within the patient’s care team can be communicated formally or informally depending on the patient’s needs.
Examples of collaboration include:
- Occupational therapists providing visual recommendations
- Speech and occupational therapists working on cognition and memory
- Physical and occupational therapists coordinating mobility strategies
- Speech therapists supporting communication for patient engagement
What Are Cotreatment Sessions in Brain Injury Rehabilitation?
Cotreatment occurs when two therapists work with a patient at the same time to address multiple goals.
Examples include:
- A physical therapist working on standing tolerance while a speech therapist addresses communication
- Occupational and physical therapists working on balance during dressing
- Speech and occupational therapists working on communication while addressing vision or motor skills
Why a Collaborative Brain Injury Rehabilitation Team Matters
The rehabilitation team for any patient after a brain injury is most successful with specialized training and a collaborative mindset. Collaboration between disciplines and with the patient and their support system leads to better outcomes and more comprehensive care.
Advanced training and teamwork allow providers to better understand recovery, make appropriate referrals and support patients throughout their rehabilitation journey.
Meet The Authors
Christina Platko PT, DPT, Board-Certified Neurologic Clinical Specialist, Certified Brain Injury Specialist, Director of Therapy Residencies and Fellowships
Lizbeth Brenneman, MA, CCC-SLP, Certified Brain Injury Specialist
Rachel Daley, MSOT, OTRL, Neurologic Occupational Therapy Fellow
