Brain Injury Rehab: Are we thinking long-term?
Written by Dan Harren
TBI rehab is hard stuff. 10-plus years in, and I still find myself failing, learning, and moving forward. I’ve been thinking about success a lot lately, and what it means to be successful in rehab – from a client’s perspective (and thus from the treatment provider’s perspective). Here’s a bit of what I’ve been thinking on…
I have worked with some truly amazing rehab professionals, and I’ve found that the very best of them plan their treatment around what the best achievable outcome might be for the patient. The focus is not only on what is being provided now, but what must be provided now to achieve the client’s goals later in life.
What is a positive outcome? I think this is a question only the client can answer:the client decides – not his team. But the team can sure help the client define outcomes by asking questions, listening, and asking more questions; I’ve also found this to be a great way to build trust with my clients.
Brain injury rehab, at its best, is about identity and transferability. How can we help the client become who he or she wants to be? What rehab lessons can we teach? Oh, and can the client take those rehab lessons and apply them to new situations, new environments, and new stressors? If the answer to that last question is, “no,” then this is not a good outcome– it’s that simple.
Are we measuring the outcomes of our treatments? The answer for most is, “yes,” we need to be able to see progress over the course of treatment; but what about the long term durability of these outcomes? How can we be sure that outcomes are, in fact, truly positive outcomes if we don’t have long-term measures of how the client is faring post-rehab? A client that “completes” his rehab and then finds him-or-herself struggling 6 months, 1 year, 5 years later is not a positive outcome.
Personally, I have been a part of teams where the client did very well in treatment, only to learn later that the client was struggling post-rehab with the demands of life, relationships, drugs, etc. It’s important that we learn from these poor long-term outcomes and determine what success means to that client and plan for how to get there. Consider the lifespan of the client; the goal should be for the brain-injured client, in the waning years of his or her life, to be able to look back at a life well-lived.
Good rehab is goal-oriented, durable over time, and transferable. It is also achievable.
In my next post, I’m going to take a look at outcomes-focused rehab, and how durability is achieved.