What to Expect in Rehab After Moderate-to-Severe Head Trauma

Rehabilitation after head trauma follows an organized approach

Head trauma can cause a traumatic brain injury. Any time there is damage to the brain from head trauma, it is important to receive rehabilitation from specialists who understand this type of an injury. Rehabilitation helps preserve and recover as much brain function as possible.

Research shows that starting rehabilitation as soon as possible after moderate to severe head trauma, makes a big difference in how well the brain heals.

As soon as a patient’s vital signs are stable and any emergency surgeries are over, it can begin.

Rehab addresses the cognitive, psychological, and physical elements of recovery. There are several phases of rehabilitation: acute rehab, post-acute residential rehab, sub-acute care, and home-based therapy.

Depending on the severity of the brain injury, it can be started at any phase. For moderate-to-severe head trauma, it usually begins in the intensive care unit, continues at a formal rehabilitation facility, and follows the patient when they are discharged home.

What Happens in Acute Rehab?

In order to determine how much baseline brain function has been lost, doctors, nurses, and specialists complete a very thorough patient history. The patient and family will be asked about normal abilities prior to the head trauma. The history will cover:

  • Baseline level of physical activity
  • Pre-existing physical disabilities
  • Education level
  • Baseline cognitive function
  • Underlying psychological or emotional issues, such as depression
  • Pre-existing learning disabilities
  • Medical and surgical history
  • History of drug or alcohol abuse
  • Any other relevant concerns

The history helps the team develop a plan that will bring the patient as close to his or her pre-accident level of functioning as possible.

Since many care providers and therapists are involved in head trauma and traumatic brain injury rehabilitation, the same questions will be asked many times. This is to ensure that that each therapeutic discipline receives the information directly from the patient and family.

While it can be frustrating to answer the same questions repeatedly, it prevents misunderstandings. If the history is just passed by word of mouth through a long line of medical professionals, mistakes can happen. Ultimately this helps the patient receive better care.

Acute rehabilitation involves several therapeutic disciplines, including physical therapy, language and speech therapy, and occupational therapy.

Post-Acute Residential Rehabilitation

It’s important to remember that a patient who experienced a head trauma may also have other serious injuries, such as organ damage and broken limbs. Post-acute residential rehab is a live-in facility that treats many types of injuries, including head trauma. Twenty-four-hour nursing care is provided.The staff at a rehabilitation facility is trained to create an environment that is both supportive and challenging.

All recovery needs are integrated into a single, patient focused plan. Treatment may last a few weeks, up to several months until the patient is ready for the next phase. Day to day activities such as bathing and dressing, traveling throughout the community, and making food are re-learned.

Sub-Acute Care

The goal is to send a patient home after acute residential rehabilitation. Sometimes this is not possible. For example if the head trauma victim is not able to perform self-care, or would not be safe at home, it is necessary for them to go to rehabilitative nursing home. 

Home-Based Therapy

Going home is a wonderful step, and rehabilitation continues in this environment. There are usually home visits by a variety of therapists. The patient may also visit an outpatient therapy center several times a week. Getting back into the community is sometimes challenging for individuals who have been hospitalized for a long time. Recreational therapy is very helpful at this point. Activities such as swimming, art classes, and sports match personal interests with long-term recovery needs.

There are many resources available to help the newly disabled adjust to their environments. It is essential that individuals or families affected by head trauma discuss symptoms or medical problems with the primary care provider.


Davenport, A., & Foster, A. M. (2011). The value of early intervention for moderate and severe traumatic brain injury. Journal Of The Australasian Rehabilitation Nurses' Association (JARNA), 14(3), 14-16Matchett, K., & Institute of Medicine, (. (U.S.). (2013). Cognitive Rehabilitation Therapy for Traumatic Brain Injury : Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, District of Columbia: National Academies Press.

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