Core Rehabilitation Activities
Intruduction
Individually and collectively these core activities are the key enablers of optimal brain injury rehabilitation.
Core Activities
Individually and collectively these core activities are the key enablers of optimal brain injury rehabilitation.
a) Person centred care & goal directed synergistic team
- Person centred care, engagement with family & enabling self-management
- Goal directed synergistic team work where the Team includes the person, family/carers, rehabilitation specialist, clinicians, other services.
While person centred care is a principle in all good practice health care and community services, in TBI rehabilitation it is especially important as it is carrying the added significance that the injury, impairments and impacts are unique to the person and their rehabilitation pathway will also be unique.
Assessment incorporates the discovery of what is important to the person (their values – valued activities, people, places and beliefs) along with the biological, psychological and social aspects of the person. Brain injury rehabilitation must be informed by the person’s values when addressing the biopsychosocial aspects of care. Brain injury rehabilitation is optimised when all of these aspects are addressed within a teaching and learning framework. Services and information provided must be culturally appropriate (including for Aboriginal clients and their extended families).
Families/carers are recognised as important members of the rehabilitation team, and can influence rehabilitation and community outcomes when providing emotional, practical and social support.
Families are provided with education and support to maximise client outcomes and sustain positive family relationships. [Ideally this includes access to accommodation close to services (particularly for Aboriginal clients in hospitals distant from their family/communities).]
The rehabilitation team’s teamwork draws on the strengths, skills and expertise of all members of the rehabilitation team by engaging in respectful relationships to maximise the outcomes valued by the person. By working synergistically in this way the team produces something greater than the sum of its parts. The rehabilitation team includes but is not limited to the client, their family/carers, and clinicians.
Self-management is enabled through a range of mechanisms which may include the provision of education and information, peer support, the development of problem solving skills, cognitive approaches, and coaching.
Intervention is not dependent on initial injury severity, but rather on the nature and degree of disablement and impact on the person. BIRP case management is provided in a flexible manner and the duration of intervention is based on continuing need rather than having a pre-determined time limited program.
Person centred care requires staff to be able to bring their own person into person centred work with the client.
Consumer engagement and feedback in built into the way the program is designed/works.
Core Activities (contd)
Individually and collectively these core activities are the key enablers of optimal brain injury rehabilitation.
b) Supportive environment
- Providing a facilitatory and supportive environment
The environment can facilitate the process and outcomes of brain injury rehabilitation. The physical, social, and attitudinal aspects of the environment must be considered for this to occur18.
c) Therapeutic interventions
Therapeutic interventions promoting recovery, adaption, compensation and prevention:
- Sub-acute rehabilitation
- Community reintegration & rehabilitation (incl Transitional Living Program)
- Schooling and further education & rehabilitation
- Vocational rehabilitation
Brain injury rehabilitation is optimised when the full range of treatment approaches are considered for each and every client. This includes therapeutic interventions promoting recovery, adaptation, compensation and prevention.
Recovery refers to the process of returning towards pre-morbid state or better.
Adaptation includes changing what or how we do things to complete a task or process successfully, as well as psychosocial adjustment.
Compensation refers to using an alternate strategy to achieve the same outcome.
Prevention has a key role in minimising the risk of adverse event or poor outcome.
Where possible, intervention is contextually based and conducted within the environment in which the person lives, learns, plays, works and socialises.
The approach is holistic and is informed by biomedical, neuropsychological, neurobehavioural and community participation paradigms involving a range of medical, clinical and support staff operating together to maximise client outcomes
d) Managing disorders of consciousness and associated behaviours
- Managing challenging behaviours caused by cognitive impairments
- Managing cognitive impairments impacts in rehabilitation
- Managing PTA
- Managing suicide risk, sexuality
Many people with TBI have challenging behaviours at some time during rehabilitation. The most common challenging behaviours are inappropriate social behaviour, verbal aggression and adynamia (lack of strength or vigor). Many people with severe TBI display more than one type of challenging behaviour.
All staff require the skills for working constructively with challenging behaviours.
e) Managing life and service transitions
- Managing life transitions well - e.g. child to young person, young person to adult, employed to retired
- Managing transitions from one service to another well including child to adult services
f) Case Management
Case management is an essential (for many clients) core activity because of the individual nature of each person’s rehabilitation process and the complexity of weaving together this with services and funding while engaging with the family/carers and dealing with all the unique individual, family and social impacts.
g) Children
- Child development
- Family centred care
When working with children staff work in ways that take into account the child’s brain development and psycho-social development.
They also work with families in ways that are family centred care. Every family and child is unique and that families know their child better than anyone else and that families must be part of the care of children.
Work with children also involves working with other services and settings (e.g. schools, justice system, mental health, accommodation and other health services, etc) relevant for the child.
Transitions include transition into and between education settings (to preschool, to kindergarten, to primary school, to secondary school etc) and transition to employment.
Child protection issues are also considered and addressed.
h) Collaborations, Partnerships & Funding
- Managing icare and other insurance funding
- Collaboration with private clinicians
- Collaboration with other health services (e.g. mental health, drug and alcohol)
Systems and processes are in place to ensure all relevant collaborations, partnerships and coordination of services are in place.
Systems and processes are in place to ensure all relevant stakeholders have up to date information about brain injury rehabilitation services.
i) Statewide network of services
- Seamless service network with shared expertise across the network
This involves staff:
Participating in state wide brain injury rehabilitation network activities
Building effective ways of sharing expertise across the network
Building agreed policies and process to ensure client access and equity of services across NSW
