CEMM Virtual Library

Moderate to Severe TBI

TBI Providers


Clinical neuropsychology is a sub-specialty of clinical psychology that specializes in diagnosing and treating TBI patients, among other things. In terms of TBI rehabilitation, the goal of the neuropsychologist is to understand how the brain injury affects the patient’s thoughts and behaviors.

Typical areas of assessment include:

  • Memory
  • Attention and concentration
  • Decision making
  • Impulsivity
  • Disorientation
  • Language and communication abilities

The neuropsychologist communicates with the patient and their family to help them understand the nature of the injury, the recovery process and barriers to recovery. They also can help assess when or if a patient is capable of making important decisions on their own. The neuropsychologist will often suggest tips to help the patient and family cope, along with memory exercises to improve cognitive function.

Nursing Care

Rehabilitation nurses are essential in maximizing a TBI patient’s health and in helping them to adapt to an altered lifestyle. Nursing care focuses on such things as:

  • Health maintenance
  • Nutrition
  • Swallowing problems
  • Skin problems
  • Bowel and bladder incontinence
  • Impaired physical mobility
  • Impaired or limited ability for self care 
  • Breathing challenges
  • Sleep pattern disturbance
  • Chronic pain
  • Impaired cognition
  • Impaired verbal communication and comprehension
  • Sexual dysfunction

Speech Therapy

Speech therapy following a brain injury usually addresses a variety of issues including speech quality, and understanding and expressing the spoken and written word. Speech therapists also assist patients with cognitive issues, and swallowing problems. The speech therapist will often:

  • Thoroughly evaluate changes in communication and cognitive skills due to the brain injury and the impact of these changes on day-to-day activities. For some problems, the therapist may recommend evaluation by a hearing specialist (audiologist) or an ear, nose, and throat doctor (otolaryngologist).
  • Emphasize the relearning of cognitive skills that are affected by the brain injury. Those skills include attention, memory, sequencing, planning, reasoning/problem solving, judgment, self-monitoring of thoughts and behaviors, and the ability to use the relearned skills in other settings and situations. The therapist works with other members of the rehab team to help the patient address cognitive skills in all daily activities.
  • Evaluate the skills necessary for effective duty, school, work, and community functioning. They focus on relearning those tasks that are specific to the patient’s previous work or school responsibilities when possible.
  • The therapist may also help the patient and family explore specific devices to maximize the patient’s ability to communicate, for example a letter or word board, an electronic communication device, or a computer system.
  • Evaluate and manage swallowing problems called dysphagia.

Physical Therapy

During rehabilitation after TBI, the job of the physical therapist is to minimize or overcome any debilitating physical conditions. Physical therapists specialize in the examination and treatment of musculoskeletal and neuromuscular problems that affect the patient’s ability to move and function in daily life.

As part of the rehabilitation process, the physical therapist will assess:

  • Balance
  • Posture
  • Strength
  • Need for a wheelchair, brace or cane
  • Quality of movement
  • Spontaneous movement
  • Coordination of movement
  • Increased sensation of sensory-motor activities
  • Pain management

After conducting the assessment, the physical therapist will design a therapy program to maximize the physical functioning of the patient. The therapist may also help the patient and family explore specific prosthetics or motorized devices to improve the patient’s ability to function. There have been huge technological advances in recent years, allowing patients with handicaps to achieve a greater degree of independence than ever before.

Occupational Therapy

As part of the TBI rehabilitation process, occupational therapy is designed to assess functions and potential complications related to the movement of upper extremities, daily living skills, cognition, vision and perception. Together with the patient and family, the occupational therapist will help determine the best ways to perform daily living skills including showering, dressing and personal hygiene. The therapist will identify equipment that can help the patient when eating, dressing and bathing.

The occupational therapist will also address specific skills to prepare the patient for their return home. These skills may include activities for daily living, such as:

  • Brushing teeth
  • Getting dressed
  • Eating and using utensils
  • Personal hygiene
  • Cooking
  • Grocery shopping
  • Banking
  • Budgeting
  • Readiness for returning to work by assessing prevocational and vocational skills

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