Traumatic Brain Injury A Roadmap for Accelerating Progress (2022) / Chapter Skim
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6 Rehabilitation and Long-Term Care Needs After Traumatic Brain Injury
6 Rehabilitation and Long-Term Care Needs After Traumatic Brain Injury
Pages 107-142
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From page 107... ...
• Barriers to accessing comprehensive inpatient rehabilitation include the need for insurance preauthorization, lack of available beds in rehabilitation facilities, location of a facility far from a person's home and family, inconsistent quality of rehabilitation services, and hesitancy on the part of facilities to take patients who may not be able to be discharged home after rehabilitation. • Lack of access to TBI-informed outpatient physical and mental health services and lack of awareness or resources to address needs among those returning to work and school after TBI can hinder the recovery process for those with less severe TBI.
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From page 108... ...
TARGET GOALS AND OUTCOMES OF CARE When a TBI patient transitions to the post-acute phase of care, clinical outcomes different from those of the acute care phase become important. While the initial focus of TBI care is on sustaining life and minimizing secondary damage to the brain, post-acute care focuses on the optimization of a person's day-to-day function and the ability to return to community living.
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From page 109... ...
For those who start their care pathway with hospital-based treatment, acute rehabilitative services may begin within 24–72 hours of injury. Subsequent stages of the journey can involve referrals to different types of care facilities, including additional inpatient rehabilitation, outpatient rehabilitation, nursing homes, and residential care facilities (see Box 6-2)
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From page 110... ...
Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 30, 2021.
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From page 111... ...
. Care Pathways for Persons with TBI Who Are Able to Care for Themselves at Discharge from Acute Care The return home after brain injury can be complex.
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From page 112... ...
Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021.
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From page 113... ...
Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 16, 2021.
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From page 114... ...
Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021.
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From page 115... ...
• INCOG Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury (Bayley et al., 2014) • Ontario Neurotrauma Foundation and Institut National d'Excellence en Santé et en Services Sociaux's Clinical Practice Guideline for the Rehabilitation of Adults with Moderate to Severe TBI (INESSS-ONF, 2015)
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From page 116... ...
2021. Accelerating Progress in Traumatic Brain Injury Research and Care: Webinar on Rehabilitation Care and Research, June 15, 2021.
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From page 117... ...
Interactions with Physiological Systems A noted previously, TBI patients frequently experience multisystem trauma, complicating their treatment requirements. Because the brain and central nervous system play important roles in other body systems, TBI can lead to metabolic and endocrine dysfunction (Li and Sirko, 2018)
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From page 118... ...
. Research has also investigated the use of rTMS to reduce such symptoms as headache, overall pain, depressive symptoms, and problems with executive function following mild to severe TBI, with mixed results (Anderson et al., 2020)
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From page 119... ...
EXAMPLES OF EDUCATIONAL MATERIALS AND RESOURCES BOX 6-4 ON TBI Selected examples of available resources include the following: • Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans, Back to School: Guide to Academic Success After Traumatic Brain Injury, and other resources pub lished by the military's Traumatic Brain Injury Center of Excellence (https://www.health.mil/ Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-Center-of-Excellence/ Patient-and-Family-Resources) • National Brain Injury Information Center from the Brain Injury Association of America (BIAA)
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From page 120... ...
supports the feasibility and usability of a virtual reality rehabilitation system for cognitive rehabilitation for patients with severe TBI and their caregivers during the patient's hospitalization, suggesting its potential therapeutic use at home. Larger studies using more rigorous designs are beginning to build evidence for the efficacy of telehealth for persons with TBI.
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From page 121... ...
"Return-toLearn" State Laws for Students with Traumatic Brain Injuries (https://www.ncsl.org/research/health/-return-to-learnstate-laws-for-students-with-traumatic-brain-injuries.aspx [accessed November 14, 2021]
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From page 122... ...
The Long-Term Services and Supports Program The range of state-provided services for persons with physical disabilities (including persons with TBI) , older adults, and family caregivers is evaluated by the LTSS State Scorecard (Reinard et al., 2020)
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Under the Traumatic Brain Injury Act, states can apply for grants to improve access to rehabilitation and community services. About 16 states have consistently secured these grants.
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From page 124... ...
. The authors of a study comparing application of chronic care management to cancer survivorship, diabetes management, and chronic TBI care concluded that a separate chronic care management model is needed to address the needs of and resources required by TBI survivors and their family caregivers (Heiden and Caldwell, 2018)
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From page 125... ...
SOURCES: Possin et al., 2019; Miller, B., Comparative Systems of Care: Lessons from Other Disease Systems. Presentation and panel discussion during the virtual workshop on Accelerating Progress in Traumatic Brain Injury Research and Care, March 30, 2021.
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Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 16, 2021.
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From page 127... ...
Presentation and panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 30, 2021.
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From page 128... ...
2021. Disorders of Consciousness After Traumatic Brain Injury: A Virtual Workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, May 24, 2021.
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From page 129... ...
. And in 2019, the Neurocritcal Care Society launched the Curing Coma Campaign to raise awareness of needs among this patient population and develop new treatment strategies (Provencio et al., 2020)
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From page 130... ...
Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 16, 2021. 21 Sander, A
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From page 131... ...
examined the effect of a 12-session cognitive-behavioral intervention that delivered psychoeducation, supportive psychotherapy, stress management, and problem-solving strategies for 20 persons with acquired or traumatic brain injury and their 20 respective family caregivers. Intervention participants showed a significant increase in perceived self-efficacy immediately posttreatment and at the 3-month follow-up compared with controls, but no significant difference in psychological distress.
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From page 132... ...
As discussed in detail in Chapter 3, factors that affect TBI care and outcomes include not only geographic location, but also race and ethnicity and economic circumstances, such as unemployment, lack of health insurance, limitations in coverage, and high financial costs that are difficult for patients and families to bear on their own. Finally, as this chapter has illustrated, while a range of clinical and other care practices are used to support post-TBI rehabilitation and recovery, which of these interventions are most effective for which individuals and at what stage of recovery remains largely unknown.
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From page 133... ...
• Development of a person-centered follow-up and rehabilitation plan with input from the person with TBI and their family and taking account of individual needs, goals, and interests. Given the diverse and multidisciplinary needs that accompany TBI, developing this plan would also require input from fields including physical medicine, occupational therapy, physical therapy, speech therapy, rehabilitation psychology, neuropsychology, nursing, and behavioral health.
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From page 134... ...
2014. INCOG guidelines for cognitive rehabilitation following traumatic brain injury.
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From page 135... ...
2019b. Contextualized treatment in traumatic brain injury inpatient rehabilitation: Effects on outcomes during the first year after discharge.
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2021. Improving transition from inpatient rehabilitation fol lowing traumatic brain injury: Protocol for the BRITE pragmatic comparative effectiveness trial.
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From page 137... ...
2018. Considerations for developing chronic care system for traumatic brain in jury based on comparisons of cancer survivorship and diabetes management care.
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From page 138... ...
1998b. Caregiver burden at 1 year following traumatic brain injury.
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2003. Long-term adjustment of families following traumatic brain injury where comprehensive rehabilitation has been provided.
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From page 140... ...
2008. Problem-solving training for family caregivers of persons with traumatic brain injuries: A randomized controlled trial.
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From page 141... ...
2018. One and five year outcomes after moderate-to-severe traumatic brain injury requiring inpatient rehabilitation: Traumatic brain injury report.
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