3 C’s to Effective Rehabilitation: Communication, creativity and competency

Many professions are made up of interdisciplinary teams. The field of brain injury rehabilitation is no different. The rehab team can include such professionals as a case manager, speech language pathologist, occupational therapist, psychologist and lawyer. There is of course family and friends and at the center – the person who sustained the brain injury. A unique and important role can often be found at the center, alongside the client – the rehabilitation therapist.

Can an unregulated professional provide clinically excellent therapy?

The rehabilitation therapist is a hands-on, front-line generalist. The rehabilitation therapist takes prescribed goals and intervention recommendations from the treatment team and shapes them into practical, meaningful and integrated treatment protocols.

On being a chameleon when integrating prescribed interventions

After suffering a brain injury many clients need both broad and intense treatment. The treating professionals and their recommendations may look like this:

  • Physiotherapist: a specific exercise regimen to regain lost gross motor control, build core strength and improve balance
  • Speech language pathologist: word finding exercises, specific reading and writing routines and evidence-based articulation training on the computer
  • Occupational therapist: practicing compensatory strategies (smartphone and organizational routines) in the context of activities of daily living
  • Psychologist: participating in graded desensitization to help the client overcome anxiety and psycho-social deficits while reintegrating back into the community

Each of the individual disciplines could implement their programs in isolation. For example, the client could meet the physiotherapist at the gym and complete a typical regime of exercises a few times a week. The client would progress, increase strength and flexibility – there is no doubt. Likewise the rest of the regulated professionals could treat the client one-on-one. In some cases, this is how brain injury rehab is carried out, and with a high degree of success. With limited funds and a wide array of deficits to overcome the utility of the rehabilitation therapist presents us with another option.

Having a rehabilitation therapist integrate all interventions into a cohesive program provides the client and rehab team with significant advantages. The revolving door of therapists and trips to clinics is reduced to a bare minimum. Rapport is drastically increased by having one person implement the bulk of therapy. Costs are reduced. Efficiency and adherence can often be increased when recommendations are integrated into meaningful activities. A corollary of the rapport: it fosters an ease with finding meaningful activities to participate in and provides the context with which to implement the team’s recommendations. Let’s look at a typical case example. A young male, suffered a brain injury: He enjoys playing sports and is rather tech-savvy. The physiotherapy schedule can be modified so that balance, coordination, flexibility and endurance exercises can be completed with a basketball and while playing basketball. Professor BJ Fogg asserts that for a person to perform a target behavior, he or she must be sufficiently motivated.

With creative integration, a rehabilitation therapist can go far beyond being a generalist

By creatively integrating treatment in this manner the rehabilitation therapist goes far beyond being a generalist, he becomes a transdisciplinary therapist – a chameleon, if you will.

The ‘Eyes & Ears’ of the team

In real estate you hear: location, location … location. Within the brain injury rehab team its communication, communication … communication. To facilitate the consistent delivery of clinically excellent therapy the rehabilitation therapist must communicate objective information so the professionals directing therapy can make sound recommendations based on reliable data.

Clinical excellence can be provided by a rehabilitation therapist when the environment has all the right pieces

Communication goes beyond operationalizing goals, likert scales and data; it involves a level of professional respect, tact and sensitivity.

The bridge between the regulated and unregulated

The title ‘rehabilitation therapist’ is unprotected. Rehabilitation Support Worker and Rehabilitation Counselor are among some other titles used to define the role. Rehabilitation therapy is a profession, however it is unregulated. How can an unregulated professional provide clinically excellence therapy? Let’s start by looking at a recent article in Rehab Matters, where Gail Kovacs described the key components of a profession:

  • A unique scope of practice statements reflecting tasks on which professionals in the field have the competencies to deliver
  • A set of competencies (knowledge and skills) needed to complete the tasks
  • Standards of practice or guidance around what quality task delivery looks like
  • Credentialing/qualification processes including exams and registration

The rehabilitation therapist can commit and comply with these standards in a number of ways. The rehabilitation therapist must have the educational foundation provided by a college or university degree. In addition, the Academy of Certified Brain Injury Specialists offers an international certification program for both direct care staff and professionals working in brain injury services. The Vocational Rehabilitation Association of Canada (VRA) also administers a registration process for professional designations such as the ‘Registered Rehabilitation Professional’. By adhering to the VRA’s code of ethics guidelines the rehabilitation therapist can ensure their delivery of care matches the guidelines of the professional that is clinically directing them.

Clinical excellence can be provided by a rehabilitation therapist when the environment has all the right pieces. When competence, respect and trust are woven into a creative model of evidence-based treatment delivery and consistent communication, everyone prospers.

Originally published in the Vocational Rehabilitation Association of Canada‘s magazine, Rehab Matters.

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