Cognitive Rehabilitation Therapy for Traumatic Brain Injury Evaluating the Evidence (2011) / Chapter Skim
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5 State of Practice and Providersof Cognitive Rehabilitation Therapy
5 State of Practice and Providersof Cognitive Rehabilitation Therapy
Pages 89-112
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From page 89... ...
or by the method or provider delivering the therapy. For practical purposes, CRT does not differ from occupational therapy, speech-language-pathology, and physical therapy when these treatments intend to reduce or compensate for an underlying cognitive disorder.
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From page 90... ...
Emotional stress, perceived burdens of caretaking, and disrupted family functioning as well as unmet needs of other members of the family may contribute to unhealthy family communication or functioning. Because rising health care costs and the costly nature of neurorehabilitation have led to shorter inpatient stays, outpatient rehabilitation is an important component of therapy, one that relies on a support person for the injured individual (Harrison-Felix et al.
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From page 91... ...
Treatment approaches may include comprehensive inpatient or outpatient CRT programs, outpatient CRT delivered by a sole practitioner, or comprehensive CRT programs with multiple providers working together on a team. The individual treatment ingredients of comprehensive, interdisciplinary rehabilitation programs are not typically recorded.
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From page 92... ...
It is common for this early phase of CRT to aim to increase attention, learning, and basic communication skills, while at the same time reduce disorientation, confusion, and even agitation. Also during this phase, physiatry and rehabilitation nursing provide important medical care to patients, while social workers and psychologists provide support as families and friends plan for discharge to the patient's home or another facility.
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From page 93... ...
Individuals who have a combination of cognitive, psychological, or behavioral issues after TBI may participate in a comprehensive, interdisciplinary outpatient program that "includes individual and group cognitive rehabilitation, psychotherapy, psycho-education, and family therapy" (Tsaousides and Gordon 2009)
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From page 94... ...
When contextualized therapy becomes possible, individuals typically become more aware of how their cognitive impairments may impact return to work, school, and community. Delivery of CRT for Mild TBI The delivery of CRT to patients with mild TBI may differ from the CRT provided to those with moderate or severe TBI, based on when the diagnosis is made and the specificity of symptoms expressed.
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From page 95... ...
Professional associations, such as the American Occupational Therapy Association, the American Physical Therapy Association, and the American Speech-Language-Hearing Association, determine the required education and training for providers to become credentialed.
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From page 96... ...
settings • Designs and implements integral part of graduate Requirements vary by state, • Private offices behavior modification study and are necessary to and generally include passing • Hospitals programs complete the dissertation. a standardized test and may • Universities and • An approved internship include continuing education medical schools Neuropsychology is a • 1 to 2 years of post- for license renewal.
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From page 97... ...
Registered Nurse • Assesses, plans, implements, • Education levels vary Rehabilitation nurses • Acute care and evaluates the care of a among registered nurses are credentialed as a • Assisted living > 10,000 hospitalized patient (RNs) Certified Rehabilitation facilities rehabilitation • Promotes optimal • Education includes courses Registered Nurse (CRRN)
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From page 98... ...
U.S. states regulate the licensing for registered nurses (RNs)
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From page 99... ...
states regulate the • Facilitates education to licensing of physiatrists, and patients and families about requirements vary by state. impairments Licensing requires physicians pass the U.S.
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From page 100... ...
of physical therapy. with a variety of other • Clinically based courses Requirements vary by professionals, such as (medical screening, state, but typically include physicians, nurses, social examination tests and graduation from an workers, occupational measures, diagnostic accredited physical therapy therapists, and speech- process, therapeutic education program; passing language pathologists interventions, outcomes the National Physical assessment, and practice Therapy Examination; management)
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From page 101... ...
services activities, incorporating • Supervised fieldwork U.S. states regulate licensing • Hospitals knowledge of neurology criteria for OTs, and • Nursing care and neuro-anatomy requirements vary by state.
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From page 102... ...
Board-certified physiatrists in the United States are trained to diagnose, treat, and direct a rehabilitation plan to achieve optimal patient outcomes. The physiatrist provides leadership for an interdisciplinary rehabilitation team that may include occupational therapists, physical therapists, recreational therapists, rehabilitation nurses, psychologists, social workers, and speech-language pathologists.
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From page 103... ...
For example, the RN's role in cognitive rehabilitation includes working with physicians (e.g., physiatrist or neurologist) to obtain detailed patient history and a comprehensive neurological evaluation.
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From page 104... ...
. Throughout treatment, OTs evaluate patient outcomes to ensure goals are being met and change the intervention plan as appropriate (American Occupational Therapy Association 2002, 2011)
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From page 105... ...
Physical therapists practice in hospitals, outpatient clinics, and private offices that have specially equipped facilities (American Physical Therapy Association 2003)
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From page 106... ...
SLP graduate students may also learn to evaluate and treat speech, language, and swallowing disorders as part of a curriculum in supervised clinical practice (U.S. Department of Labor 2011c)
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From page 107... ...
In long-term and residential care facilities, recreational therapists use leisure activities -- specially structured group programs -- to improve and maintain patients' general health and quality of life. Community-based recreational therapists may work in park and recreation departments; special education programs within school districts; or assisted living, adult day care, and substance abuse rehabilitation centers.
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From page 108... ...
Most states require 2 years or 3,000 hours of supervised clinical experience for licensure of clinical social workers (U.S. Department of Labor 2011e)
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From page 109... ...
Kinesiotherapist A kinesiotherapist can recommend a cardiovascular conditioning program that promotes wellness and reduces the risk of injury or further disability, generally to improve extended periods of physical exertion. The American Kinesiotherapy Association defines kinesiotherapy as "the application of scientifically based exercise principles adapted to enhance the strength, endurance, and mobility of individuals with functional limitations or those requiring extended physical conditioning" (American Kinesiotherapy Association 2011)
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From page 110... ...
Because U.S. states regulate the licensure requirements for each profession, and a variety of professional organizations determine accrediting standards, a unified brain injury rehabilitation specialty or related requirements do not exist for most professions.
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From page 111... ...
2003. Cognitive rehabilitation for traumatic brain injury: A survey of clinical practice.
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From page 112... ...
2009. Cognitive rehabilitation following traumatic brain injury: Assessment to treatment.
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