By Michael Samogala, RN, CRRN, CBIS, Director of Education, NeuLife Rehab
In light of the recent and continuing focus regarding brain injury, as well as the specialized care and post-acute rehabilitation that may be required, a brief discussion describing an outcome-based neurorehabilitation/neurobehavioral rehabilitation program’s components and process may be beneficial to the workers’ compensation provider.
Acquired Brain Injury (ABI) by definition may be traumatic, such as caused by excessive motion or a delivery of force/impact or velocity to the head, or non-traumatic including stroke, hypoxia, or chemo toxic exposure such as from chemotherapy treatment or even post substance abuse. ABI is always an “individual” injury and never exactly the same for any two individuals, as we all utilize our brains in a unique fashion with areas of dominance and various degrees of compensation and/or plasticity.
ABI may result in short or long term deficits involving cognitive function (problem solving, attention and memory), motor function (extremity weakness, impaired ambulation, coordination and balance), sensation (hearing, vision, smell, impaired perception and touch) and behavior (emotional regulation, depression, anxiety, aggression, impairments in behavioral control, personality changes). The effect and final outcome of the ABI may depend on many factors, along with the type and quality of not only the timely and accurate identification and treatment of the injury, but also the type and quality of the post-acute rehabilitation the individual may receive.
Post-acute rehabilitation for an individual with ABI should, in its simplest form, be based on an outcome-focused neurorehabilitation process, including a neurobehavioral program which focuses on the patient achieving the maximum possible level of function and independence. The program itself involves the individual and significant others, through a systemic, comprehensive, multidisciplinary assessment in the development of realistic, measurable, functional goals which directly influence each individual’s progression towards their maximum potential, leading to successful community re-entry and a sustained successful outcome.
This being stated, the neurobehavioral component of the program must be dynamic, as to begin with the pre-admission assessment information, which is confirmed by a medical records review conducted by a licensed Clinical Liaison and a recommendation for admission presented to a specialized brain injury credentialed multi/intradisciplinary team.
The team itself should optimally include:
- Rehabilitation Specific Case Managers (Nurses and Social Workers)
- Board Certified Physiatry services (Rehabilitation Specific MD), Psychiatrist, Neuropsychologist and Registered Nurses (CRRN)
- Board Certified Brain Injury Specialist
- Neurology services (Individual or Accessible)
- Cognitive, Dysphagia and Speech Therapy (MS, CCC-SLP)
- Registered Clinical Dietician Services
- Neurobehavioral and Behavior Program with supports as needed
- Physical Therapy
- Occupational Therapy/Functional Independence Team (Community Re-Entry)
- Licensed Mental Health Counselor (Certified Substance Abuse Counselor) and support – clients and family members
- Client/Family Support Team
Ideally upon post- acute rehabilitation admission, a Board-Certified Physiatrist and Psychiatrist lead the multi/intradisciplinary team members which assess, identify, describe and intervene using a personalized fluid approach to each clients’ strengths and barriers relating to their maximum potential for independence and community re-entry.
The Board-Certified Psychiatrist, Neuropsychologist and Licensed Mental Health Counselor develop ongoing and dynamic behavioral and therapy plans based on assessment criteria, subjective observable behaviors and identifiable triggers and consequences. As indicated, the therapy consists of scheduled individual sessions as well as group interaction under the headings of anxiety and worry, self-help and empowerment, success and productivity.
The Purpose and Intent of the optimal neurobehavioral component of the neurorehabilitation program is to assist the client in managing their own behavior using a structured behavior plan and process that:
- Defines behavior as response to stimuli, observable, perceivable or inert and with a purpose or meaning.
- Responds to the client’s behavioral, cognitive and physical needs.
- Presents a positive, consistent therapeutic approach to self-behavior management
- Incorporates medical, nursing and therapy services which are supported by a facility inclusive environment to promote positive behavioral management techniques.
- The behavior plan from initial to full intervention are communicated and consistently available to all significant others, caregivers and staff as appropriate and applicable
- Provides ongoing education and training for the individual and significant others. Program behavioral techniques are taught and reinforced in order to support long-term goals of achieving the most successful and productive discharge outcome.
As community reintegration and return to work remains the primary goal for these individuals, a vocational rehabilitation component within the total program structure should encompass both direct and non-direct assessment, evaluation and access to both in-facility and community based vocational experiences.
In summary, the success and final outcome of the individual with an acquired brain injury from a traumatic or non-traumatic source will depend on many factors; one of the most influential being the type and quality of the post-acute neurorehabilitation/neurobehavioral program the individual completed.
About Michael Samogala
Michael Samogala RN, CRRN CBIS has been directly involved in providing professional nursing and education services to the healthcare community for over 40 years. Most notably receiving board certification in rehabilitation nursing and as a brain injury specialist, he continues to provide professional credited continuing education programs to multiple professionals across the country, and remains in the position of Director of Corporate Education, NeuLife Neurological Services. Michael continues as an active member of The American Nurses Association, The American Association of Rehabilitation Nurses, The Academy of Spinal Cord Injury Professionals, The Academy of Brain Injury Specialists.
About NeuLife Rehab
NeuLife Rehab provides care and specialized neurorehabilitation services, combined with community re-integration, education and training, all within a beautiful homelike environment. We offer an outcome focused neurorehabilitation program with a comprehensive neurobehavioral component that results in approximately 80% of our clients returning to home or to the community.
NeuLife is ideally located in Central Florida and admits clients from across the United States and abroad as one of the nation’s largest and highly respected CARF accredited brain injury specialty residential post-acute rehabilitation facilities.