NOTE: This toolkit is meant for educational purposes only. The information within it should not be used to diagnose or treat brain injury in your clients

Where to Refer

In addition to a family doctor or general practitioner, there are several types of health professionals that can support survivors in recovering from brain injury and adjusting to their new normal. Based on feedback from survivors and frontline workers, here are some examples of what kinds of service providers might be helpful, what they do, and what survivors might expect from a first appointment.

NOTE: All services may not be available in all areas, provinces, or territories.

Speech-Language Pathologists

What would an appointment with an SLP look like?

The first visit with an SLP could take place remotely (using technology) or in person. An in-person visit could take place in the client's home or at a clinic. There are usually options and the client/person can let the SLP know what they prefer. Unless the client has a clear speech problem or difficulty swallowing, (and that was the reason for the referral) it is highly unlikely that there would be any physical touching. Typically the SLP would sit across from the client perhaps at a table or a desk. The client can certainly request the seating be adapted to their comfort level.

As above, during the first visit, the SLP would work with the individual to identify the specifics of their communication challenge(s) and how it impacts their daily life. This typically involves a conversation, some 'getting to know the client', some history taking (and the person can indicate if they don't feel comfortable answering, that is fine), and often some assessments. An assessment may involve answering questions as well as reading, perhaps looking at pictures or videos of various scenarios. There are many different types of assessments and the format may vary depending on what the assessment is for.

What is a speech-language pathologist (SLP)?

Speech-language pathologists (SLPs) are regulated health care professionals who work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.

What does an SLP do?

An SLP can help individuals identify their communication challenges and how they impact their daily life. Then the SLP would work with the person to establish some goals that are meaningful and practical. Finally, the SLP will develop and teach the person strategies to support successful communication as well as working to improve overall communication abilities. SLP's sometimes work with communication partners so that they can also better understand the types of challenges and use strategies to support their loved one.

How does an SLP support someone with a brain injury?

SLPs are actively involved in the care and support of people with TBI who may have challenges with understanding, following, and remembering conversations, finding words, expressing themselves clearly, and being able to say the right thing at the right time. People with TBI may also have difficulty with slower thinking as well as difficulty understanding where the other person is coming from. For example, is the person teasing or serious, are they being sarcastic, are they being truthful?

Occupational Therapists

What would an appointment with an OT look like?

Appointments and services can vary depending on your injury severity and needs. A few services specific to concussion/mild traumatic brain injury may include:

Helping you develop routines and organizational skills in a gradual manner that will help you achieve your goals
Developing and delivering remediation-based intervention to help you regain some of the skills you have lost post injury
Assisting you in recognizing your current abilities and providing appropriate education regarding energy conservation and prevention of recurring symptoms
Recommending equipment and/or devices to help you perform your day-to-day tasks
Providing suggestions on how you can adapt your environment at home or at work to improve your overall performance

What is an occupational therapist (OT)?

Occupational therapists are client-centred professionals who are concerned with promoting the health and well-being of people through occupation. Their primary goal is to enable people to participate in the activities of everyday life.

What does an OT do?

Occupational therapists work with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement (WFOT, 2012). An OT can help individuals return to work, school, and other meaningful activities. Examples of these activities include:

Self-care – getting dressed, eating, moving around the house
Being productive – going to work or school, participating in the community
Leisure activities – sports, gardening, social activities

How does an OT support someone with a brain injury?

An occupational therapist will initially conduct a comprehensive assessment to understand your unique circumstances, including barriers and challenges related to your brain injury. An occupational therapist may problem solve to minimize or prevent your barriers/challenges, analyze tasks to help you return to pre-injury roles and/or provide you with strategies that will better enable you to perform the task unaided or with accommodations. OTs can help you:

Learn new ways of doing things
Regain skills and develop new ones
Use materials or equipment that makes life easier, or
Adapt your environment to work better for you

Physical Therapists

What would an appointment with a PT look like?

The PT will help you improve your physical function and mobility. The PT’s role is to teach you how to be as physically independent and as safe as possible within your environment. This is accomplished through therapeutic exercises and re-education of your muscles and nerves, with the goal of restoring normal function. Specific goals to be accomplished in the physical therapy gym include strengthening your muscles and improving endurance, walking and balance.

Sources

What is a physical therapist (PT)?

Physical therapists are trained to help strengthen a patient’s physical abilities. They help relieve pain through the use of therapeutic exercise, heat, cold, and electric stimulation. Their primary goal is to help a patient recover from physical injuries and impairments.

What does a PT do?

PTs are specialists in evaluating and treating disorders of the human body by using physical means rather than drugs. Physical therapy treatment often includes exercise, especially for patients who have been immobilized or who lack flexibility, strength or endurance. PTs encourage patients to use their muscles to increase their flexibility and range of motion. More advanced exercises focus on improving strength, balance, coordination and endurance. This often includes instructing patients and their families and supervising physical therapist assistants, students, and other health care workers in carrying out the program or selected parts of it. PTs work in a variety of settings including:

Hospitals, rehabilitation centres, outpatient clinics
Schools, athletic facilities, research centres
In a patient’s home

How does a PT support someone with a brain injury?

The traumatic brain injury (TBI) population is one of the most challenging that a physical therapist may encounter. PTs work on soft tissue mobilization and range of motion exercises early on after the injury to maintain joint integrity and mobility and prevent contractures. They also coordinate with family and caregivers for long-term management. As a part of a multidisciplinary team, a PT performs evaluations, makes recommendations for individual and group therapy, formulates and implements treatment plans, provides staff and family education and training, makes possible community access and mobility, assesses assistive devices, and collaborates with other medical personnel to obtain the necessary items.

Social Workers

What would an appointment with a SW look like?

First appointments will include a general ‘get to know you’ conversation that includes a discussion around confidentiality and the SW’s skills and techniques. The SW will also try to assess your situation and get a sense of what kind of help you would like and how best to support you in your goals. Appointments and services can vary depending on your goals and needs. A few services specific to traumatic brain injury may include:

Helping you identify key goals in adjusting to life with a brain injury
Supporting your mental health using a variety of therapy techniques
Assisting you in identifying important community resources and gaining access to them
Making referrals to other support professionals who can help you achieve your goals

Sources

https://www.casw-acts.ca/en/what-social-work/what-social-workers-do

https://www.cihi.ca/en/social-workers

https://msktc.org/tbi/factsheets/traumatic-brain-injury-and-acute-inpatient-rehabilitation

https://www.brainline.org/article/who-are-rehab-specialists

What is a social worker (SW)?

Social workers are regulated health professionals who work with individuals, families, groups and communities to enhance their individual and collective well-being. SWs advocate for social justice, human rights, and equitable access to health and social services. They provide counselling, therapy and problem-solving interventions and help individuals gain access to information and resources (e.g., community support programs). In addition, they address broader social issues such as oppression, discrimination, domestic violence, unemployment and poverty.

What does a SW do?

SWs help people deal with their relationships with others. They work with clients to solve their personal, family, and community problems. SWs also help clients grow and develop as they learn to cope with or shape the social and environmental forces affecting daily life. They are often employed in hospitals, community health centres, mental health clinics, schools, advocacy organizations, government departments, social services agencies, child-welfare settings, family services agencies, correctional facilities, social housing organizations, family courts, employee assistance and private counselling programs, school boards, and consultation agencies.

How does a SW support someone with a brain injury?

The SW will provide you and your family with information about community resources and help plan for your hospital discharge and return to the community. They will offer individual, group, and family counselling to help you adapt to life with a brain injury. They come from a ‘client centred’ perspective and will work with you to achieve your identified goals. SWs are also strong advocates and can help you navigate systems such as justice, child welfare, and family law. Some offer services from within a hospital or rehabilitation centre, others have private practices in community office spaces, and some will visit you in your home.

Brain Injury Coordinator/Navigator

What would a first appointment with a Brain Injury Coordinator/Navigator look like?

Attempts are made to hold a first visit in a space where the client feels comfortable meeting (e.g. their home, or a clinic or hospital setting). They will have a discussion with the client regarding the nature of their ABI, as well as areas they feel require support such as medical, financial, or housing as well as identify some barriers they previously were facing in these areas. Physical touch is not usually necessary unless the client initiates something such as a handshake and is never done without request or consent.

The following are suggestions on what to bring to a first appointment with a coordinator/navigator:

1) List of questions they would like to ask me

2) List of areas they want support with i.e. housing, financial, legal, medical

3) List of other services (or support persons/family members) they're currently working with such as any mental health agencies so that partnerships can be formed.

What is a Brain Injury Coordinator or Navigator?

A Brain Injury Coordinator or Navigator is someone who usually has extensive experience in a variety of contexts and has good working knowledge of services available. Brain injury is a complex condition that can impact a survivor in many different ways. It is important for the coordinator/navigator to have a basic knowledge of how to support and speak with individuals with varying backgrounds and experiences in order to best serve them. This role is based in advocacy, diverse knowledge, and a flexible approach to client-directed support. They are usually found through your local brain injury associations.

How do they support someone with a brain injury?

Brain Injury Coordinators/Navigators guide survivors and their caregivers through many individual and complicated systems of care. They provide individuals with brain injury with client-directed, agile, barrier free assistance with service navigation and connect individuals with other community agencies to create wrap around supports. They often also provide support through advocacy to ensure individuals receive proper and adequate support from service providers. Clients generally do not require a formal diagnosis in order to access services and they are often provided free of charge. They can help individuals with a variety of systems and contexts such as:

Medical: Connection to doctors and other specialists that can further long-term wellness for individuals affected by brain injury.
Housing: subsidized housing applications, housing search, landlord engagement, support with LTB
Legal: Advocacy within family court, criminal court, referral and connection with legal aid
Support for victims of violent crime through victim services, advocacy with the social justice tribunals
Financial stabilization and connection with disability supports, CPP/CPP-D, taxes,
Working collaborations with mental health providers to ensure individuals with brain injury who are also affected by mental health issues are having their needs met by both supporting agencies.

A coordinator/navigator can support a client’s goal in a variety of ways, for example:

A client says they are not getting proper mental health care. They identify memory impairment as a cause for this as they keep forgetting and missing their appointments. The coordinator/navigator might work to build a plan to utilize memory aids to assist in attending appointments regularly, offer to attend appointments with the client, provide reminders, or assist in planning transportation to and from the appointment.