Rehabilitation Following Brain Injury: Techniques for Working with Post-MTBI Patients

According to the CDC, an estimated 1.7 million people sustain a traumatic brain injury (TBI) annually, resulting in more than 50,000 deaths and 275,000 hospitalizations. About 75 percent of TBIs are concussions or other forms of mild TBI, also called MTBI. MTBIs are defined by the Mild Traumatic Brain Injury Work Group as: an injury to the head as a result of blunt trauma or acceleration or deceleration forces that result in one or more of the following conditions:

Any period of observed or self-reported:

• Transient confusion, disorientation, or impaired consciousness;
• Dysfunction of memory around the time of injury;
• Loss of consciousness lasting less than 30 minutes. 

Observed signs of neurological or neuropsychological dysfunction, such as:

•  Seizures acutely following injury to the head;
• Among infants and very young children: irritability, lethargy, or vomiting following head injury;
• Symptoms among older children and adults: headache, dizziness, irritability, fatigue or poor concentration which, when identified soon after injury, can be used to support the diagnosis of mild TBI, but cannot be used to make the diagnosis in the absence of loss of consciousness or altered consciousness.
  

The high occurrence of MTBIs means therapy professionals must be acutely aware of the differences in head injuries—as well as the unique characteristics of each patient—in order to provide the highest level of care. Because there are several key factors that can impact the rehabilitation process, a number of questions must be asked before rehabilitation goals are set. For example, will the patient live alone or with others? Is he able to function independently? Have the patient’s social skills changed, and would they interfere with his desire to return to work?

MTBI Rehab: Not One Size Fits All

There is no one rehabilitation program that fits all brain injury victims, as similar injuries can produce different results in different people. Typically, rehabilitation goals are set in the first few weeks after a traumatic brain injury to maximize positive outcomes, and goal-setting is based on the unique functional status of each individual patient.

Essentially, every human being is different and learns new information and new skills differently. Post-brain injury patients typically need help in most areas of learning; one question to ask an individual is what his or her preferred mode of learning was before the injury. You can then assess whether that method still remains the same. Following are just a few examples of techniques to use with post-MTBI patients:

• Speech therapy to increase communication skills
• Occupational therapy to regulate sensory information
• Physical therapy to improve coordination and gross motor skills
•  Individual and/or small group activities to model and practice social skills
• Establish structure and routine to maintain focus and time organization skills
•  Break down training and/or activities into several discrete steps to ensure understanding
• Realize that difficulty with communication, sensory integration, and change may cause frustration and/or behavioral changes
• Keep instructions short and concrete
• Utilize positive reinforcement

Ensuring Positive Outcomes

When working with patients who have suffered a mild traumatic brain injury, it is important to remember that every individual is unique. Successful rehabilitation begins with first analyzing the patient’s functional status and assessing his or her ability to function independently. From there, therapists can establish a personalized rehabilitation program and take the first step toward recovery.

For more information about the neuropsychological evaluation and treatment of patients with mild traumatic brain injuries, including proven rehab techniques and the key factors that can affect successful rehabilitation, view our comprehensive course Brain Injury Treatment: A Neuropsychological Approach.

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