Traumatic Brain Injury

At Swanson, the rehabilitation program for traumatic brain injuries utilizes a functional team approach. This approach recognizes the importance of learning compensatory techniques for functional tasks, but also promotes remediation of cognitive skills. As metacognition and cognitive skills develop, functional or real-life activities related to the individual’s life roles are incorporated in therapy. Both adult and paediatric intervention is provided for all levels of severity of brain injury.

The core treatment team consists of case management, occupational therapy, physiotherapy, psychology and speech language pathology, while additional services are introduced during the recovery process as required. Close liaison is maintained with the hospital prior to discharge to facilitate the transition to the community. If consultation with specialists outside of the core team is required, our case managers are adept at facilitating the process. Our clients are usually followed by the Brain Injury Program at The Rehabilitation Centre under Dr. Shawn Marshall, with whom there is regular consultation.

Researched methods of cognitive rehabilitation, including the Dynamic Interactional Model by Joan Toglia, are implemented from the onset of community based therapy. Initially therapies are primarily home-based; as the client progresses in the return to pre-injury life roles, therapies move into the community, school or workplace. Rehabilitation assistants provide reinforcement of strategies in daily activities. Therapy directed at work and educational reintegration is generally introduced after home based therapy and community reintegration.

Top

Spinal Cord

Learning to live with spinal cord injury can be very stressful as it affects so many areas of a person’s life. Our occupational therapists, physiotherapists and case managers have the training and required skills necessary to optimize the client’s independence. Our team has experience with bowel and bladder management, skincare management and attendant care management, as well as solutions to more practical issues such as: home modifications, wheelchair prescriptions and adaptive transportation. As with all of our programs, our approach is a holistic one and all of the client’s needs and goals are considered and addressed.

The case manager commences involvement during the inpatient rehabilitation phase of treatment in order to facilitate a smooth transition and develop an appropriate community based team. This team includes, but is not limited to: physiotherapy, psychology and occupational therapy. Early intervention allows the case manager to develop rapport and support the client and family through each stage of the rehabilitation process. Work and educational reintegration generally follows home based therapy and community reintegration.

If consultation with specialists outside of the core team is required, our case managers are adept at facilitating the process. There is regular consultation with the medical specialists at the Spinal Cord Program in The Rehabilitation Centre.

Top

Musculoskeletal

The most common form of injury following a motor vehicle accident is the musculoskeletal injury. Under Section 24, occupational therapy intervention, rather than just assessment, co-ordinated with physiotherapy, facilitates the client’s return to function. Occupational therapy and physiotherapy can both be provided in the home, clinic, workplace, school, or in the community, as the need dictates. We also provide intervention to facilitate recovery and resumption of re-injury life roles. If a more extensive team is required, we are also able to facilitate this.

Top

Chronic Pain Management

Our community-based chronic pain management program utilizes guidelines from the International Association for the Study of Pain (IASP) and review of existing pain management research. Where funding allows, a case manager coordinates the program as well as providing support and education. The need for a high level of communication between team members is recognized and supported. Many clients with chronic pain following a motor vehicle accident also have related psychological dysfunction, e.g. anxiety, fear of movement or re-injury, depression and/or phobias. This may contribute to maladaptive coping methods, reduced participation in pre-injury roles and functions and social withdrawal. The occupational therapist works closely with the psychologist and physiotherapist to facilitate adjustment to pain, participation in meaningful activities and improved self management, active physical activity and coping and improved overall functional ability.

Goals of the program include relaxation, sleep hygiene, problem solving, basic compensatory memory techniques, social skills, daily exercise. Improving physical condition also enables greater participation in activities of daily living with reduced risk of re-injury. Interest in purposeful activity is developed and participation encouraged through training in body mechanics, pacing, task modification and use of assistive devices. As well, pain is addressed through pacing, mindfulness, relaxation, body mechanics, addressing sense of self and values. The services of occupational- and physical therapist assistants supplement therapies and facilitate the generalization of skills learned in all therapies, to daily living. The importance of activity is emphasized in order to break the cycle of inactivity and resultant deconditioning.

Top

Complex Injury

Complex injuries refer both to multiple injuries such as orthopaedic, amputations, brain injury and internal injuries, and to injury to an individual with an existing diagnosis, for example, mild brain injury to a person with schizophrenia. Knowledge and experience in multiple areas is therefore required by the service providers in order to provide adequate care, even if every diagnosis is not directly treated. It is well known that not all complex injury files are designated catastrophic according the insurance regulations. Nevertheless, many require extensive therapeutic intervention by a variety of disciplines and close liaison with speciality clinics at The Rehabilitation Centre. The files therefore also require team communication and problem solving to facilitate progress. Community, Work and educational reintegration may be required.

Top

Paediatrics

Children are not little adults and as such they have different life roles. Whatever the diagnosis, normal development must be taken into consideration as well as the components of function impacted by the motor vehicle accident. At Swanson we have an extensive battery of paediatric assessment tools standardized to evaluate cognitive, perceptual, sensory, motor, and school function. As with all programs, clinical observations and functional assessment compliment the assessment. Cognitive, physical and sensory motor rehabilitation is provided as required. Supported educational and community reintegration follows home-based therapy to facilitate return to pre-injury function.

Top

Vocational Programs

Vocational programming and intervention is provided for both catastrophic and non-catastrophic injuries. With catastrophic injuries, preparation for return to work may commence early on in the rehabilitation process, with the introduction of pre-vocational activities in therapy sessions. As with the educational reintegration program, vocational rehabilitation often requires team support. Therapeutic intervention may include:

  • Skill and strategy development
  • Cognitive or physical work hardening
  • Simulated work programs
  • Consultation with employers, vocational counsellors and other team members
  • Developing, monitoring and modifying a graduated return to work plan
  • Volunteer placements
  • Work trials
  • Developing and implementing job modifications
  • Job coaching

Every attempt is made to reintegrate the individual in his/her pre-injury job, however, sometimes the job analysis, work capacity assessment may reveal the need for a new direction. In such cases, vocational and aptitude testing can be conducted.

Top

Rehabilitation Components

Cognitive Rehabilitation:
A team approach is promoted in all rehabilitation, however, the focus may lie with a specific discipline, depending on the nature of the client’s deficits. The occupational therapists utilize the Functional Model of Cognitive Rehabilitation in Occupational Therapy providing remediation as well as training in the use of compensatory strategies within functional activities. Cognitive linguistic intervention is provided by the speech language pathologist. Individualized treatment programs accommodate the individual’s style of learning, experience with technology, developmental level and level of cognitive impairment. Psychology addresses adjustment issues to facilitate overall progress in rehabilitation. All team members reinforce strategies introduced by any discipline to facilitate the generalization process.

Community reintegration:
This incorporates facilitating physical access through environmental modifications, mobility devices and/or mobility training; use of public or other transportation; and social ability within the community. Social communication and generalization of strategies is encouraged through involvement in community social programs, interest groups, educational courses and/or fitness programs.

Educational Reintegration:
Our program facilitates a smooth transition in the process of returning to school, college or university. Communication with educators is streamlined through one primary contact person, however, a successful return to school process requires a team approach. Cognitive, physical and psycho-social factors can impact school participation and performance. Therapeutic interventions may include:

  • Individualized study strategies
  • Modifications to program content, evaluation, method of presentation and classroom setup
  • Accessibility evaluation and recommendations
  • Training of the educational assistant
  • Liaison with school resource departments and post-secondary Centres for Student Disabilities
  • Education for the school staff regarding the client’s diagnosis and the impact thereof on school performance
Top