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A care worker listens to the instructions regarding a bottle of tablets illustrating the difference between care and rehabilitation

In the course of our business rehabilitating those with acquired brain injury we are often asked if we provide ‘care’, which suggests to us that some of those that engage with our services do not understand that ’care’ and ‘rehabilitation’ are at the opposite ends of a spectrum. In the following few paragraphs, we will take a look at someone that was referred to our service after being diagnosed with a traumatic brain injury, to help illustrate this spectrum and to explore the limits of care and the extents of rehabilitation.

John was hospitalised after being involved in a major road traffic collision from which he incurred severe injuries, including a below the knee amputation, a complex fracture to his dominant arm, a series of lacerations to his body and a frontal lobe brain injury. The brain damage acquired by John had some profound effects on his personality and he experienced problems with his memory, judgement, planning and struggled with the basic day to day problem solving skills that most of us take for granted, which sometimes resulted in emotional outbursts.

As John was being prepared for discharge from hospital, considerations had to be made as to whether or not it was appropriate for him to return to his own home, with primary consideration being the level of care necessary to ensure his safety and the availability of such care in a vocation that was suffering from major staff shortages.

Care does things for and to patients, and the care that John would need included help with his morning routine, food preparation and assistance to ensure he attended the medical appointments that would be a necessity over the coming months. With the passage of time, the lacerations to John’s body would heal and with ongoing physiotherapy he would start to regain function in his arm, but the partial loss of his leg and the brain injury would still be significant hurdles for him to overcome.

At this point in his recovery, ‘care’ was replaced by ‘support’ and would become the main focus for those assisting John, which is probably best described as being a little more about the ‘for’ and a little less about the ‘to’, but it is essentially a prong of the same fork. Support services may provide assistance to John with the things that he couldn’t master which, in the case of his brain injury, was anything that required forward planning, such as cooking and making arrangements to attend appointments. He would also need a lot of help dealing with anxiety of being in a motor vehicle again.

At this point on his recovery, John’s life would have been reframed, with many of the facets of his past life being left behind him and his future being one that was dependent on long-term support and leaving him unable to resume a normal social life. In many patients, the level of psychological dependence on the support services grows and they never fully optimise their ability to regain control over their lives, which perpetuates the need for support. To enable further progress in their recovery, a well-structured, focused rehabilitation programme is required.

The above raises the question of when should care become support and vitally, when should rehabilitation be introduced?

These aspects of the recovery process can be mutually supportive and a daily care regime may enable a patient to return home at the earliest opportunity, which is also the right time to develop an intensive rehabilitation package whilst they are still adjusting to their environment. Clinical studies1 demonstrate overwhelming support for the case of early intervention for neuro-rehabilitation to increase function and increase the potential of positive outcomes and neuro occupational therapists (OT) are pivotal in neuro-rehabilitation.

The real difference between care and support staff and neuro-OTs is that the neuro-OT will be aiming to make themselves redundant. Rehabilitation is a finite process, it serves to help patients achieve their goals and objectives and over the longer term, will experience ever diminishing returns from its inputs.

In John’s case, Reach’s experienced neuro-OTs were involved very soon after he was discharged from hospital. They quickly established rehabilitation priorities with John and his family and discussed how the programme could be structured, so that it best suited their situation and his needs. They focussed on John’s organisational skills, travelling and the anxiety of social interaction. With Reach’s help, John gradually regained skills, learned how to manage his anxiety and eventually returned to work, resumed his love of cooking for his family and started using his football season ticket again, regularly attending home matches with his friends.

You see, recovery is a spectrum that begins with care, but moves through the provision of appropriate support and rehabilitation with the goal of returning someone to as much of the person they were prior to their injury. Once rehabilitation has optimised an individual’s capacity and independence, then is the time to begin assessing any need for ongoing care or support.


About Reach Personal Injury

For 30 years Reach has offered a unique hands-on neurological rehabilitation service for brain injured adults and children within their own homes and local community. Our individually tailored programmes are designed and carried out by experienced Neuro-Occupational Therapists to meet the client’s needs and abilities. We specialise in goal focussed, time-limited rehabilitation programmes for the clients and their families across the UK.

Read more about Reach Personal Injury.


Reference

1 Marsh Königs et al, Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis (ACRM) [Online] 13 January 2018 https://www.archives-pmr.org/article/S0003-9993(18)30086-8/fulltext, Accessed 6 July 2022

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