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California Traumatic Brain Injury Attorneys

Rehabilitation After Traumatic Brain Injury

Therapy and medical care following a traumatic brain injury are often required if a head-injury victim is to return to pre-accident condition - or get as close to that state as is possible. Of course, the severity of the brain damage caused by a traumatic head injury will determine to a great extent the prospects for recovery.

What is the Prognosis for the Head Injury Victim's Recovery?

One head-injury patient may show signs of recovery quickly after a brain injury, while others will never recover, or will take much more time to do so. Still, a closed-head-injury victim who takes longer to show progress soon after the head injury may in the end outstrip the recovery of another traumatic-brain-injury patient who came out of a comatose state sooner. Each brain injury is different, and each patient with a head injury is unique, so predicting outcomes after a head injury is difficult.

Medical science has nonetheless come up with several techniques to categorize the severity of traumatic brain injuries, chart the recovery progress of head-injury sufferers and tailor rehabilitative services to each brain-damage victim's unique needs. Some of the techniques currently used are:

• The Glasgow Outcome Scale: One of the first brain damage recovery forecast tools was the Glasgow Outcome Scale (GOS). Using this scale, a number is assigned to the patient's prognosis, with the number "1" being "dead" and the number "5" standing for "good recovery," meaning that the brain-damaged patient will recover enough from his accident to take up normal social and work activities. The head-injured patient given a "2" rating is in a vegetative state (unable to interact with others or the environment); the closed-head-injury patient with a "3" rating is able to follow commands but is unable to live independently; and the brain-damaged person with a "4" rating can live independently but cannot return to work or school.

• The Disability Rating Scale: The Disability Rating Scale (DRS) was developed in an attempt to improve on the accuracy of the Glasgow Outcome Scale. DRS assessments may be made at several times, including when the brain-damaged patient enters a rehabilitation facility, when he is discharged, or even five years later. The highest score on the DRS is 29; a brain-damage sufferer with a score of 29 is in a severe vegetative state. The closed-head-injury victim whose score is zero is perfectly fine, despite having suffered a traumatic brain injury. A head-injury patient's total score is compiled by adding together scores for:

For example, to obtain the brain-injured patient's score for the fourth criteria - psychosocial adaptability - the head-injury victim would be given a score of zero if his brain injury left him with no limitations on employability. If he could only work in a non-competitive environment, such as a workshop for the disabled, the brain-damage sufferer would receive a score of 2 in this category. If he were unable to work at all, his score would be a 3.

• The Craig Handicap Assessment and Reporting Technique: The Craig Handicap Assessment and Reporting Technique (CHART) was devised in 1992 to measure how great were handicaps following injuries to the spine. It was later found that the system worked for other types of injured patients, including brain-damage sufferers. CHART originally measured the severity of five handicap aspects:

A sixth aspect, Orientation (ability of the injured party to orient himself to his surroundings), was added later. A head-injury victim who scores a 100 (the maximum score) in each of these aspects is on a level with the average person who has not suffered brain damage. CHART tests can be given at any time, from soon after injury to years later.

• The Rancho Levels of Cognitive Functioning System: The Rancho Levels of Cognitive Functioning evaluation was developed at the Rancho Los Amigos National Rehabilitation Center to help rehabilitation teams assess the level of brain functioning in brain-damaged patients and tailor a rehabilitation plan to meet that person's needs. It puts patients into one of eight "Cognitive Level" categories; a closed-head injury patient in Cognitive Level I would give no response to stimuli and a patient in Cognitive Level VIII would be described as a person whose actions are purposeful and appropriate to the situation, even though because of the brain damage suffered he might not be functioning as he had before the traumatic brain injury. At each level, the system describes appropriate ways for family and friends to interact with the brain-damaged victim.

Many other systems for measuring the severity of brain damage and making a prognosis for recovery have been formulated and used throughout the United States and internationally. However, truly reliable predictors of how far a patient will recover after traumatic brain injury are hard to come by. In the end, many medical practitioners, when asked when or how much a brain-injury victim will recover lost skills and abilities, will answer something along the lines of, "It is hard to say; each case is unique. We will try various therapies and hope for the best." Although this is hardly the concrete answer that was hoped for, it may indeed be the most accurate assessment of the head-injury victim's prognosis for recovery.

Recovery and Rehabilitation Services for Brain Damaged Patients

Several types of rehabilitative services will likely be considered when lingering brain damage from a head injury impacts the traumatic-brain-injury victim's life. In addition to individual therapies, the brain damage sufferer, his physicians and family might consider the value of group therapy sessions, community-based reintegration programs and home care services. The choice of services needed to help the head injury victim will be dictated by the unique needs of the person with lingering brain damage, his physician's and other medical care providers' recommendations, the limits of his insurance and other available funds and personal or family preferences.

Some of the possible types of recovery and rehabilitative specialists who may be needed to help the open- or closed-head injury victim are:

• Medical care providers - The most universal need of traumatic brain injury sufferers is continuing medical care to monitor changing conditions, alleviate pain and avoid infection. Doctors, nurses, nurse practitioners and others may provide this care in a hospital, on an outpatient basis, in the doctor's office or in the brain-damage sufferer's home.

• Neuropsychologist - Neuropsychologists are licensed professionals with doctorate degrees in psychology who treat and work to prevent mental and emotional disorders.

• Occupational therapist - An occupational therapist helps the brain-injury victim regain skills necessary to obtain current and future employment, as well as regain skills needed for functioning in the home, school and community.

• Respiratory therapist - If brain damage has diminished the head-injury victim's ability to breath - a common problem for brain-damage victims - the services of a respiratory therapist may be needed.

• Physical therapist - Physical therapists are brought in to help brain-damaged patients recover bodily functions through exercises and other therapies that will strengthen their muscles. They can help the head-injury sufferer to get stronger, increase coordination and mobility and decrease balance problems.

• Vocational specialist - The brain injury sufferer may no longer be able to perform the job he once held following the head injury, but he may still be capable of employment of another kind. How to find the right job? Some traumatic-brain-injury sufferers may be able to work independently while others will need a more supervised work situation - the vocational specialist can help with these job placement decisions. Vocational specialists can help by evaluating the capabilities of the brain-damaged person and by counseling him in the types of jobs that are available.

• Dietician - These professionals may add to the brain-damage sufferer's recovery by helping him to get the proper nutrition necessary for optimum health. With the help of a good diet, the brain-injury victim will be better able to work toward regaining optimum strength, coordinaiton and concentration.

• Kinesiologist - Kinesiologists are experts in the movements of the human body. The services they can provide to the brain-damaged patient might include creation of an exercise program and organization of the head-injury victim's home or office so that he will be better able to navigate around furniture and other obstacles. The goal of the kinesiologist is to help the brain-injured person perform as many normal functions in the home and workplace as is possible under the circumstances.

• Speech Pathologist - A speech or language pathologist can help the open- or closed-head injury sufferer with impaired speech or other linguistic problems to maximize and often regain these functionalities. A speech pathologist can even help traumatic-brain-injury sufferers overcome swallowing difficulties, a common problem for brain-damage victims.

• Social workers - Social workers may be needed to help the head-injured person to get services needed for living, including counseling, publicly-funded health services and transportation.

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