Brain Injury Team Members and their roles:
Case Manager
The case manager serves as a primary contact for the patient and family. He/she
is a professional whose role on the team is to direct the patient’s rehabilitation
and coordinate with everyone involved in the patient’s care. In addition, the case
manager communicates updates to insurance companies, and identifies available resources
for post discharge care. The case manager coordinates communication between the
team and the family regarding patient goals, progress, expected length of stay,
and discharge plans.
Physiatrist
The physiatrist is the main medical doctor in rehabilitation. He/she is an M.D.
(Medical Doctor) or D.O. (Doctor of Osteopathic Medicine) with a specialty in physical
medicine and rehabilitation. The physiatrist will assess the patient at admission,
treat medical problems, and maintain stable medical status. The physiatrist will
direct the rehabilitation team, establish goals, and monitor the course of rehabilitation towards
functional goals for discharge. He/she stays in contact with your other physician
consultants to address special issues and keep them updated on rehabilitation progress. The
physiatrist makes contact with all patients daily and meets with families, as needed,
during the rehabilitation stay.
Nursing Team
Nursing staff provide comprehensive rehabilitation care 24 hours a day. Nursing
staff work with the physician to provide medical care.
Nursing specifically works on bathing, dressing, grooming, feeding, elimination,
skin care, respiratory, safety, mobility and nutrition needs. Nursing provides consistent
care and uses a team approach.
Patients learn techniques in therapy and in the nursing unit. Nursing staff encourage
the patient to use techniques learned in therapy. They also will encourage patients
to do as much of their own care as functionally possible, since the goal is to teach
independence and challenge each patient to achieve their maximum potential.
The rehabilitation team encourages family to assist with care. They welcome any
questions from patients and family. Please feel free to ask questions.
Speech-Language Pathologist
The speech-language pathologist is concerned with the brain injured patient’s speech,
language, cognitive, pragmatic and swallowing abilities. The speech process may
be affected due to weakness/paralysis and/or incoordination of the speech musculature.
The brain injured patient may show difficulty in many areas of expressive language
(talking, naming, writing) and receptive language (understanding and reading). Closely
related to communication is cognitive functioning. This has to do with an individual’s
ability to attend to their surroundings, use memory skills, organize their thoughts,
reason/problem-solve through situations, and show good judgement.
It is also the role of the speech-language pathologist to assess the function of
the patient’s swallowing to ensure the patient is eating/drinking the appropriate
diet consistency safely. Speech-language pathologists provide swallowing therapy,
as needed.
Occupational Therapist
The role of the occupational therapist with the brain injured patient is to facilitate
appropriate responses related to functional daily activities. During the early stages
of the patient’s therapy program, the therapist provides daily orientation and sensory
stimulation, familiarizing the patient to their environment. Also, physical limitation
such as decreased head control and imbalanced muscle tone may require the fabrication
of adaptive equipment (such as splints and head control bands) designed to increase
current and future functioning.
As the patient’s responsiveness increases, follow-through with functional tasks
(such as, car/toilet/tub transfers with equipment assessment), plus participation
in self care (such as, feeding, bathing, dressing), will become the treatment emphasis.
Often the building blocks of these tasks, such as visual perceptual abilities, problem-solving,
orientation, memory and motor planning must be addressed. Activities related to
independent functioning such as cooking, household, and job-related tasks also are
emphasized. Driver evaluation and training may be indicated at the last stages of
cognitive recovery.
Physical Therapist
The role of the physical therapist in the treatment of a person with brain injury
is to address overall mobility with attention to any cognitive problems. Specific
areas that are important for mobility are muscle strength, muscle tone, balance
and range of motion, all combined with cognition. The types of mobility range from
movement within the bed, to moving/transferring from one surface to another, to
walking.
The physical therapist assesses the areas mentioned above on each individual patient
to determine which are problem areas. Usually, many or all areas need to be addressed.
The physical therapist then uses various treatments to address these areas and promote
patient mobility and function.
Neuropsychologist
Neuropsychologists are clinical psychologists who specialize in studying brain behavior
relationships. The role of the neuropsychologist on the brain injury team includes
three aspects, generally:
- Assessment
- Treatment
- Consultation and Education
The neuropsychologist leads the team in addressing psychological changes following
brain injury, and provides neuropsychological and other assessment services, which
may include:
- Assisting in the monitoring in the level of consciousness.
- Repeated brief assessments to measure individual cognitive strengths and limitations,
as well as progress.
- Comprehensive neuropsychological assessments of higher cognitive function in order
to help with cognitive treatment/remediation and academic, vocational or other future
planning. These services contribute to the process of informed clinical decision-making.
Treatments offered include psychotherapy, including individual and group psychotherapy,
as well as behavioral management (when the head injured person’s behavior interferes
with his/her ability to progress in rehabilitation). The specific approach to treatment
is determined by the assessment process and takes into consideration such factors
at the person’s cognitive and emotional functioning and the requirements of the
anticipated post-discharge setting. The goals of the clinical psychologist’s treatments
include:
- Addressing such issues as adjustment to losses, recognition of deficits and their
implications, sexuality, and relationships to others;
- Management of behavioral problems (including, for example, agitation, apathy, and
impulsivity); and
- Enhancing interpersonal skills and awareness of impact upon others, self esteem
and self acceptance, and effective goal setting.
The assessment and treatment services of the clinical psychologist/neuropsychologist
are offered in consultation with the other members of the treatment team, including
the family. Such consultations help answer questions such as “Why is he/she acting
that way?” and “How can we best respond?” Such consultation emphasizes ready availability
of the neuropsychologist, serves to enhance understanding, and contributes to a
coordinated approach to rehabilitation following brain injury.
Registered Dietitian
The role of the dietitian is integral to the care of brain injury patients and relies
heavily on the coordination with all team members. Because brain injury patients
are often dependent upon the total provision of nutrients through tube feedings,
the patient is nutritionally assessed to determine caloric needs and method of feeding.
Constant monitoring is performed to evaluate tolerance, and recommendations are
made for any necessary progression or changes.
As the patient’s awareness level and physical ability increases, oral intake usually
progresses and is monitored until the patient is safe and independent in self feeding.
The rate of progress each patient makes is individual. A great deal of stimulation
and encouragement is provided. Communication between all team members is essential
in assuring the nutritional adequacy and the rate of progress made.
Pastoral Care
Pastoral Care staff focus attention primarily on the spiritual well-being of the
patient and family. The Pastoral Care staff will make an initial visit to each patient/family
on admission. Subsequent visits are made regularly depending on the patient’s/family’s
needs.
When visiting with patients and families, the chaplain seeks to bring strength and
a healing presence by:
- Assisting the patient/family to express their beliefs and concerns at critical moments
through compassionate listening.
- Helping the patient/family to realize that a time of crisis can be an opportunity
to grow and mature in their beliefs.
- Helping persons who have been devastated by disability to grieve and thereby regain
their peace of mind and ability to move on with their life.
- Fostering a holistic view of patient care.
- Providing for the celebrations of the Sacraments, and other rituals, ecumenical
services, etc.
- Praying with the patient/family, as requested.
Ministers of all faiths are encouraged to visit at any time during the patient’s
stay at SSM Rehabilitation Hospital.
Respiratory Therapist
Respiratory therapy may be a service provided, depending on the needs of the patient.
A respiratory therapist specializes in airway care and breathing and is involved
when the individual has the need for oxygen, has a tracheostomy, or has other breathing
problems that necessitate specific respiratory treatments. Different methods of
treatment can deliver medicine or humidity to the lungs to restore a patient’s cough
and keep their airway clear of secretions. It is important to maintain adequate
breathing to prevent pneumonia and keep the lungs strong to maintain sufficient
oxygen supply to the body.
