Traumatic Brain Injury Outpatient Rehabilitation Activities

Once inpatient rehabilitation is completed, recovery continues for Baylor patients with a variety of outpatient rehabilitation activities. These are designed to help you regain as much function as possible. These include:

Aquatics
If you successfully completed the inpatient aquatic therapy program including being able to perform aquatic exercises independently and safely, you are eligible for the outpatient Community Aquatics Program. The goal of this program is to help maintain functional gains achieved during formal therapy.

Adaptive Driving
Mobility is an important factor in maximizing your independence. At Baylor, if appropriate, driver training can be an extension of the rehabilitation process geared toward enhancing your functional independence. You are evaluated and trained by an Occupational Therapist licensed by the Texas Education Agency as a Certified Driving Instructor and who holds national certification as a Certified Driver Rehabilitation Specialist. The therapist is also knowledgeable in appropriate vehicle modification equipment and has expertise in behind-the-wheel training for the disabled.

Several vehicles with special adaptations are available to accommodate your individual needs. Evaluation and training can be done at both the car and van level. Adaptations may include:

• Hand controls
• Left foot accelerator
• Steering attachments
• Extensions to secondary controls

The two-part Driving Evaluation consists of a pre-driving clinical evaluation and a behind-the-wheel evaluation. A Driver's License or Instruction Permit is required to drive on public streets, however it is not required for a parking lot only assessment.

The clinical evaluation includes:

• General information
• Medical history
• Driving history
• Current status of driver's license
• Current physical, visual, and cognitive status as they relate to driving

The behind-the-wheel evaluation includes:

• Performing a series of basic maneuvers in a parking lot setting
• Prescribing adaptive equipment/vehicle modifications
• Possibly proceeding to the public streets at the discretion of the evaluator

At the conclusion, you will be given feedback as to your potential for driving and recommendations for additional behind-the-wheel training if indicated.

If follow-up training is recommended, the number of hours required will be estimated by the evaluator and an individual program will be developed for you. A valid driver's license or instruction permit is required for follow-up training.

After all behind-the-wheel training is completed, it is recommended you contact the Department of Public Safety for a voluntary road test. It is your responsibility to inform the DPS of any changes in your mental or physical condition that could impair your ability to operate a vehicle safely.

Driving is considered one of the most complex individual tasks performed on a daily basis and due to the nature and extent of some disabilities, driving is not appropriate for every individual. No guarantee can be made that every patient will be successful in learning to drive.

Balance/Vestibular Clinic
Following a brain injury, you may have problems with balance and are at increased risk for dizziness and falling. Therapeutic goals include improving postural stability and balance, increasing independence for walking and reducing dizziness to make carrying out daily living activities easier. The program also educates you on risk factors for falls, environmental modifications and compensation strategies.

Vision Rehabilitation Clinic
A neuro-optometrist, a low vision specialist, and an occupational therapist trained in visual impairments associated with brain trauma, conduct this clinic. Low vision assessments are completed and treatment plans established. Occupational therapists implement the prescribed treatment strategies and communicate with the entire team for continuity of care. If needed, additional services for neuro-ophthalmology or retinal specialists are available in the Baylor system.

Spasticity Management
You may experience increased muscle tone and spasticity, making straightening an arm or leg difficult or experience muscle spasms. Spasticity can affect function in every day living activities and make independence more challenging.

In the Spasticity Management, a physiatrist, physical and occupational therapists, orthotists and nurses team together to provide a comprehensive evaluation and treatment plan that incorporates advanced medication and treatment options for spasticity. Goals of treatment include decreasing muscle tone of the affected muscles, improving range of motion, improving joint positioning and more.

Treatment options include:

• Physical and occupational therapy to help improve overall abilities
• Orthotics to provide splinting and bracing to help improve positioning and decrease muscle tone
• Oral medications to help reduce spasticity
• Injections of botulinum toxin (Botox), which can control specific muscle spasticity
• Placement of an internal baclofen pump to deliver medicine directly to the spinal cord
• Orthopaedic or neurological surgery when less invasive forms of treatment are unsuccessful

Wheelchair Positioning and Seating Clinic
Because of neurological impairment, you may develop postural deficits that can cause discomfort, skin breakdown and impaired functional mobility. Most of these postural deficits can be prevented, controlled or corrected through proper positioning in a wheelchair.

In the Baylor Wheelchair Positioning and Seating Clinic, you are evaluated by physical therapists with access to a team of other specialists including an occupational therapist, rehabilitation engineer and a physiatrist. The team works to design the most beneficial seating system for you in both simple manual chairs to power chairs with custom molded support and adaptive equipment. You may receive positioning that is adjustable or permanent depending on your specific needs.