Brain Injury Program - Definitions

Conditions We Treat

Traumatic Brain Injury: A brain injury caused by an external mechanical force such as a blow to the head, concussive forces, acceleration-deceleration forces, or a projectile missile such as a bullet. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.

Acquired Brain Injury: A brain injury caused by a neurological event that originates within the head such as a stroke, an aneurysm, or an infection. 

Stroke: A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or when there is sudden bleeding into or around the brain.

Aneurysms: A cerebral aneurysm (also known as an intracranial or intracerebral aneurysm) is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood.  The bulging aneurysm can put pressure on a nerve or surrounding brain tissue.  It may also leak or rupture, spilling blood into the surrounding tissue (called a hemorrhage).

Brain Hemorrhage/Hematoma: A brain hemorrhage occurs when a blood vessel in the brain bursts, spilling blood into and/or around the brain.

Brain Tumors: A brain tumor is a mass of unnecessary cells growing in the brain. There are two basic kinds of brain tumors: primary brain tumors and metastatic brain tumors.  Primary brain tumors start, and tend to stay, in the brain. Metastatic brain tumors begin as cancer elsewhere in the body and spread to the brain.

Anoxic Encephalopathy: Anoxic encephalopathy occurs when oxygen is not being delivered to the brain for a prolonged period of time. If the condition does not involve total oxygen deprivation, it is often called hypoxia, although the two terms have been used interchangeably.

Hydrocephalus: The term hydrocephalus is derived from the Greek words "hydro" meaning water and "cephalus" meaning head. As its name implies, it is a condition in which the primary characteristic is excessive accumulation of cerebrospinal fluid (CSF) in the skull.  CSF is a clear fluid surrounding the brain and spinal cord. The excessive accumulation of CSF results in an abnormal dilation of the spaces in the brain called ventricles. This dilation causes potentially harmful pressure on the tissues of the brain.

Coma: A coma is a profound or deep state of unconsciousness. An individual in a state of coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as head trauma.

Multiple Sclerosis: Multiple Sclerosis (MS) is thought to be an autoimmune disease that affects the central nervous system (CNS). The CNS consists of the brain and spinal cord. Surrounding and protecting the nerve fibers of the CNS is a fatty tissue called myelin, which helps nerve fibers conduct electrical impulses. In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. These damaged areas are also known as plaques or lesions. Sometimes the nerve fiber itself is damaged or broken.

Parkinson’s Disease: Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks.)

Program Overview

Stimulation Program: The goal of this program is to improve arousal and responsiveness of an individual emerging from a coma through sensory stimulation.  The goal of sensory stimulation is to facilitate purposeful goal-directed responses.  The JFK- Coma Recovery Scale, a standardized instrument for grading progress, is utilized.  The individual’s physical, emotional and functional potential are maximized.  Family and/or caregiver education are provided.

Behavioral Management Program: The goal of this program is to aid an individual’s progression through a period of behaviors related to loss of self-control due to a brain injury, in which a person becomes confused, agitated, combative, and/or aggressive.  Neurobehavioral scales are used to determine an individual’s need for intervention such as the Agitated Behavior Scale and the Rancho Los Amigos Scale.  Specific behavior management techniques are utilized to reduce the frequency of such behaviors such as environmental management, low stimulation precautions, de-escalation, re-direction, and positive feedback.  Physical and chemical restraints are utilized as a last resort.  Family and/or caregiver involvement and education are emphasized.

Orientation Program: The goals of this program are to provide a structured daily treatment routine aimed at increasing awareness and participation in activities of daily living.  Emphasis is placed on helping the patient to adjust to their medical condition, new physical and cognitive status, and rehabilitation environment.  The program will assist the patient to improve attention and participation in group sessions, to improve behavioral and emotional control, and work on communication skills.  Education is provided to the individual, family and caregivers.)

Cognitive-Linguistic Program: The goal of this program is to assist the individual’s cognitive (thinking) and linguistic (speaking and language) skills, physical mobility, and emotional functioning through individual and groups therapies.  Emphasis is placed on increasing independence in activities of daily living.  The individual and his or her caregivers participate in ongoing education and counseling about his orher neurological condition and what can be typically be expected from the course of rehabilitation. The individual and his or her caregivers are considered to be important members of the rehabilitation team.

Life Skills Program: The goals of this program are to address the physical, emotional, psychosocial and functional problems of individuals through individual and group treatment sessions.  Emphasis is placed on re-integration into the community and regaining skill for return to home, work, family and leisure interests.  Education of family and caregivers is an important part of the program.)

The Team

Neurologists: The neurologist is responsible for the continuous coordination and management of the patient’s medical condition. The medical specialist will work closely with the Team to closely monitor recovery according to the unique circumstances of the medical condition, and will consult with other specialists as necessary.

Neuropsychologists: The Neuropsychologist is specially trained to evaluate and treat the ways in which alteration in brain functioning may affect the patient’s thinking processes, behavior, or emotions. The Neuropsychologist is also concerned with the special issues of adjusting to the physical and cognitive changes brought about by the patient’s neurological condition. During the course of treatment, the Neuropsychologist sees the individual for an evaluation and assists with adjustment and progress.  The Neuropsychologist may also provide the patient and family with educational materials.

Rehab Psychologists: The Psychologist is available to provide emotional support and to help the patient derive the maximum benefit from the treatment in the hospital. The psychologist works to develop coping skills and strategies that address the psychological and social impact of the condition and helps to improve overall well being. The Psychologist also works with the individual and family to discover internal resources for creating balance, control and improve quality of life.

Physical Medicine and Rehabilitation Specialists: The physiatrist is in charge of coordinating medical care and communicates regularly with the patient and family regarding medical needs. This medical specialist works closely with the Rehabilitation Team to monitor recovery according to the unique circumstances of the medical condition, and will consult with other physician specialists as necessary.

Physical Therapists: The physical therapist works to improve the patient’s strength, flexibility, balance and coordination. An individual program will be developed to address specific needs. The goal of physical therapy is to help to improve mobility and independence. Physical therapy sessions, exercises and activities are used to remove obstacles to movement and provide instruction on how to move safely around the environment.  The therapist works with the doctor and nurse to manage pain so the patient receives the most benefit from therapy time. At discharge the physical therapist provides an exercise program, and recommends equipment and/or orthotics so that the individual continues to work on his or her mobility.)

Occupational Therapists : The Occupational Therapist will evaluate how the neurological condition may affect ability to perform daily activities such as eating, dressing, bathing, personal grooming and hygiene, preparing meals, managing household chores and/or child care responsibilities. The occupational therapist will design a program to address any limitations the patient has in self-care, the ability to return to work and to participate in leisure interests.   In addition, the therapist will design specific problem-solving strategies to help ensure independence in day-to-day activities. This may include recommendations of adaptive devices, equipment or ways to better manage energy.

Speech/Language Pathologists: The Speech-Language Pathologist evaluates both communication and cognitive (thinking) skills. She or he will assist the patient in improving the ability to understand language (spoken or written), express thoughts (verbally, gesturally or in writing) and participate in conversations. In addition, if the neurological condition has affected the individual’s ability to chew or swallow safely, the speech-language pathologist will evaluate swallowing function and assist in swallowing rehab.

Recreation Therapists: The Recreation Therapist assesses areas of interest and ability in order to provide opportunities for leisure and social activities. She or he will use these areas to prepare for the patient’s return to the community. He or she will also provide activities and special events for the patient and family in the evenings and on weekends.)

Social Workers: Our Social Worker is specially trained in the needs of rehabilitation patients and their families, and serves as the link between the patient and the community. The Social Worker may help to resolve financial concerns, provide emotional support, and assist with discharge plans. The Social Worker also works with insurance carriers and community resources to ensure the smooth delivery of health care services.

Rehabilitation Nurses: Nursing is responsible for general care on a 24-hour basis. The nurses will assess and monitor physical needs with special emphasis placed on skin care and bladder and bowel management. The nurses help coordinate care to ensure that goals are achieved and that daily needs are met. Nurses will help the patient to follow the Rehabilitation Team’s recommendations for bed positioning, wheelchair use, mobility and eating.

Registered Dietician: Nutrition plays an essential role in restoring and retaining health during the brain injury rehabilitation process.  Brain injury may result in physical/metabolic changes, swallowing problems, or eating disorders.  Our registered dietitians will work closely with the attending physicians, nurses, and therapists to assess the patient’s nutritional status and formulate a program to meet specific nutritional needs, which may include tube feedings and/or specialized diets.  Ongoing nutrition education is also provided to promote wellness following discharge.)