The types of rehabilitation care and services available are not the same across Ontario.After a TBI, a person can receive care from many different healthcare providers in hospital,rehabilitation and/or community settings and there needs to be guidance about how care

People with a TBI and their families don't always know what to do after a TBI and what type

used evidence from research studies,worked with brain injury experts, health agencies and professional associations, andasked for input from people and family members with lived TBI experiences.

The Ontario Neurotrauma Foundation (ONF) believes in providing the best information tohealthcare providers, patients and families. ONF is working to raise awareness about the carepeople should receive after a moderate to severe traumatic brain injury (TBI).

In July 2020, ONF shared a report called “Standards for the Rehabilitation of Adults with Moderate to SevereTraumatic Brain Injury”. The standards are needed for three reasons:

should be coordinated.

of care to expect.

The standards are about helping people get the right care, from the right provider, at the right time.

ONF is working to have the standards be more widely accepted and followed across the province. To createthese standards, ONF:

This handout is a summary of the standards for patients and families to use. The standards tellpeople what they need to know about quality care for TBI and can help them advocate for the services theyneed. A more informed patient or family member can make sure they are getting the right care, from theright provider, at the right time. It may not be possible for every care setting across the province to followthe standards at this time, but they are all are included here as standards to work towards in the goal toprovide the best evidence-based care.

For more information about recovering from a moderate to severe TBI, read our patient handbook. braininjuryguidelines.org/modtosevere/patient-version

THE STANDARDS FOR THE REHABILITATIONOF ADULTS WITH TRAUMATIC BRAIN INJURY

Ontario Neurotrauma Foundation © 2020 Standards for the Rehabilitation of Adults with Moderate to Severe TBI

We recommend that all people with a TBI...

speech-language pathologistoccupational therapistphysiotherapistsocial workerpsychologistnursephysician/physiatrist

People with a TBI should have a core team thatincludes the services of a:

neuropsychologistpsychiatristneuropsychiatristrehabilitation support personnelnutritionisttherapeutic recreationistpersonal support workerpsychotherapistpharmacist

They might also need the services of a:

receive timely, specialized interdisciplinary rehabilitation services based on their needs as soonas they are medically stable.

motor impairmentsinjuries/fracturespainspeech/swallowing problemshearing lossvisual problemsnumbnessreduced bowel/bladder controlattention/orientation/memory problemsemotional/behavioural issuesmental health issues

be assessed for common TBI issues,regardless of stage of recovery. These issues may include:

coordinating the interdisciplinary teamadvocating for needscoordinating transition between phases of careensuring continuity and good communication among healthcare providersbeing a key contact for the person with a TBI, their family/caregivers and the interdisciplinary team

Ideally, people with a TBI should have an experienced case/clinical coordinator who specializes in TBI for each phaseof their care (e.g., hospital, rehabilitation, community-based services). The coordinator should oversee the planningand delivery of the rehabilitation, including:

be actively involved in setting goalsfor their rehabilitation plan withtheir rehabilitation team andfamily/caregivers. This should happen in the early stages of therehabilitation phase of care. Rehabilitationprogramming should be at a level and in anenvironment that is individually tailored.

receive care that helps them move from acute care to a rehabilitation setting easier and helpsthem manage common TBI problems.

have access mental healthand addiction/substanceuse supports, services andprograms that offermanagement strategies, ifneeded.

receive neurobehaviouralchange strategies fromhealth care professionalstrained in management ofbehaviour problemsspecific to TBI.

have periodic assessmentsfrom their interdisciplinaryteam with specializedtraining in TBI during thefirst-year post-injury.

Ontario Neurotrauma Foundation © 2020 Standards for the Rehabilitation of Adults with Moderate to Severe TBI

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ask healthcare providersquestions about:

ask for a secondopinion or talk to aspecialist about therehabilitation plan, ifthey think one isnecessary

speak with thehealthcare facility’sPatient or ClientRelations or PatientAdvocacy contact if theyhave concerns abouttheir care

People with a TBI and their family members/caregivers should...

Standards for the Rehabilitation of Adults with Moderate to Severe TBI

receive easily understoodinformation about the:

People with a TBI and their family members/caregivers havethe responsibility to...

treat everyone involvedin their care withcourtesy and respecteven if they are tired,frustrated oruncomfortable

provide accurateinformation about theirmedical and treatmenthistory, medicationsthey are taking andtheir rehabilitation plan

report immediatelyany episodes ofconvulsion or seizures,loss of consciousness,different sized pupils,memory loss, slurredspeech, repeatvomiting andnumbness in arms orlegs

work as a partner withtheir healthcare team

Ontario Neurotrauma Foundation © 2020

Neurotrauma Care Pathways (Ontario Neurotrauma Foundation, 2019)

how they will develop thetreatment planhow they assess if thetreatment is working andhow long they thinktreatment is needed

diagnosistreatment rehabilitationdischarge planning anddecision-making processpossible outcomes