Professional Services

Because of the breadth and complexity of problems following TBI, many different types of medical and professionals often become involved in the direct care of a particular individual. These professionals may be involved at all levels of care in the recovery process. The common types of professionals who directly care for individuals with severe TBI are listed on the following pages:

Physician - Initially, emergency room and trauma physicians may be involved and then neurosurgeons and neurologists become the primary care physicians in the hospital. In the rehabilitation unit, a physiatrist will usually be the physician directing treatment. Consultants can include psychiatrists, neuro-opthamologists, internists, urologists, and other medical specialists, as needed. Physicians are usually charged with the overall care of the individual from a legal standpoint.

Nurse - Nurses provide direct care to the individual throughout the hospitalization and inpatient rehabilitation stays. Emergency, ICU, surgical, and neurological nurses may be involved in treatment in the hospital setting and rehabilitation nurses in the rehabilitation unit. Later on, home health care nurses may provide home care and treatment. Nursing care includes assistance in bowel and bladder programs, administration of medications, skin care, and health management.

Physical therapist (PT) - Physical therapists do comprehensive assessments of physical body functioning and provide movement and exercise therapy, for the lower extremities (legs) in particular, to facilitate recovery of strength, coordination, and speed of muscular activity. Therapy includes passive range of motion, guided, active range of motion, strengthening exercises, and assistance in walking.

Occupational therapist (OT) - Occupational therapists do comprehensive assessments of physical body functioning, but focus largely on the upper extremities (arms and hands) and perceptual (visual) skills. Occupational therapists also provide crucial assessment and training in doing activities of daily living such as eating, meal preparation, and driving.

Speech therapist - Speech therapists focus on the treatment of speech, language, and cognitive disorders. Treatment for speech disorders includes assessment and therapy for impaired swallowing and articulation of speech sounds. Treatment for acquired language disorders, called aphasias, consists of structured exercises to increase the level of expression and/or comprehension of language, including listening, reading, speaking, and writing, as well as doing calculations.

Recreation therapist (RT) - Recreation therapists help the individual plan, organize, and carry out leisure and recreational pursuits.

Vocational rehabilitation specialist - This individual administers assessments to determine the ability of the individual to work and then provides specialized training aimed at increasing the work capacities and abilities of the person.

Respiratory therapist - A respiratory therapist provides assistance in maintaining the airway and breathing after severe TBI, including monitoring any assistive breathing devices like tracheostomies and respirators.

Psychologist - Psychologists provide assessment and behavioral treatment for non-organic, cognitive and emotional disorders. Treatments are provided through counseling and group therapy. Neuropsychologists assess cognitive and emotional problems resulting from brain injury, as well as other causes, and provide treatment through cognitive retraining, counseling, and group therapy.

Counselor - Counselors work at many tasks, including family, individual, and group counseling.

Case manager/Clinical supervisor - Case managers provide coordination of the treatment process through the levels of care, and integrate ongoing rehabilitation activities with input from family and funding sources. The goal of case management is to provide overall management of the individual throughout the rehabilitation process.

Rehabilitation Paraprofessionals - Rehabilitation Paraprofessionals supervise and directly assist with and teache activities of daily living (ADL's), and Therapeutic Home Programs (THP's) assigned by the clinical therapists in a residential environment. The rehabilitation paraprofessional monitors and supervises clients in social, recreational, shopping, and entertainment activities in community settings, as well as teaching appropriate behavior in the home and community environment.

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