NeuroTrauma Rehabilitation (NTR) - What To Expect

Occupational therapy

Our occupational therapists assist individuals with resuming or maintaining participation in a variety of activities following an injury. With a focus on independence and safety within tasks related to mobility, self-care, work, leisure, home, and social activities, NTR's occupational therapists help individuals to:

  • Learn new ways of doing things
  • Regain and/or acquire new skills
  • Use materials or equipment that make tasks easier
  • Adapt their environment to achieve success

Intervention involves the provision of education and strategies, which may focus on the following:

  • Activities of daily living (e.g., housekeeping, budgeting, personal grooming, meal preparation, dressing)
  • Planning and pacing
  • Sleep hygiene
  • Pain and symptom management
  • Driving
  • Cognitive rehabilitation
  • Return to school or work
  • Social and leisure participation
  • Community reintegration
  • Emotional wellbeing (e.g., mindfulness, relaxation, psychoeducation)

NTR's occupational therapists have specialized training with a variety of evidence-based assessment and therapy tools including assessment of motor and process skills, BrainFX 360, as well as the Professional Goal Attainment Program (PGAP). Our occupational therapists have training in concussion management, Applied Suicide Intervention Skills Training (ASIST), and motivational interviewing. Additionally, they have expertise in hand, upper limb, fine motor, and vision therapy and technologies, including functional electrical stimulation and Bioness Integrated Therapy System (BITS Board). Select occupational therapists are individual authorizers of mobility, wheelchair and seating aids as well as communication aids with the Assistive Devices Program (ADP). 

Physiotherapy

Rehabilitation of physical trauma related to an injury typically involves the care of a physiotherapist. The physiotherapy team aims to support individuals with restoring, maximizing and/or maintaining mobility, function as well as overall health and wellbeing. Our physiotherapists pay special attention to involving individuals in the development of their own care plan. NTR's physiotherapists specialize in acquired brain injury, spinal cord injury, and amputation. Intervention may focus on:

  • Loss of mobility and motor control
  • Pain (headache, musculoskeletal, joint and/or neuropathic)
  • Vision disturbances
  • Vestibular dysfunction
  • Balance changes
  • Activity intolerance and fatigue
  • Spasticity or abnormal tone
  • Atypical gait or posture

Our physiotherapists have professional qualifications in concussion management, vestibular rehabilitation, gait retraining, Bobath, Neuro-Developmental treatment, pain management, and acupuncture.  Select physiotherapists are individual authorizers of mobility, wheelchair and seating aids with the Assistive Devices Program (ADP). Gait aid prescriptions, bracing, and orthotic recommendations are also offered.

Social work

The emotional trauma that may occur following an injury can be supported by working in partnership with a social worker. Our social workers are experts at targeting: 

  • Management of stress, anxiety, and depression
  • Adjustment to life crises/changes
  • Coping with trauma
  • Financial concerns
  • Relationship difficulties
  • Addiction issues
  • Overcoming grief and loss
  • Suicide prevention
  • Caregiver concerns

Social workers value the involvement of all those within the support network, including caregivers, spouses and other family members. Our social workers have specialized training in various treatment modalities including Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy, motivational interviewing, art therapy, and Applied Suicide Intervention Skills Training (ASIST). Our social workers help individuals identify sources of stress or difficulty, develop coping skills, and find effective solutions for these challenges.

Speech-language pathology

Communication is one of the most important life skills needed for building and maintaining social relationships, participating in roles at school and work, as well as being an active community member. NTR's speech-language pathologists are uniquely trained experts who focus on:

  • Listening, understanding and following conversations
  • Speaking and thinking of what to say
  • Reading and writing
  • Cognitive skills needed for communicating
  • Swallowing

As experts in communication, NTR's speech-language pathologists evaluate the unique circumstances of individuals following an injury, closely examining their day-to-day communication demands and roles. A functional approach to intervention is established by developing tailored goals and plans specific to each individual's needs. This may include:

  • Customized strategies and education
  • Recommending supportive aids/technologies
  • Opportunities to practice communication skills while participating in everyday routines and activities
  • Removing barriers and modifying environments to facilitate successful communication
  • Working in partnership with caregivers, spouses, and community professionals/resources
  • Empowering individuals to advocate for their individual communication needs

The NTR speech-language pathology team specializes in working with individuals who have sustained a traumatic brain injury and/or experience cognitive communication impairments. They hold post-graduate education and training in cognitive communication, incorporating evidence-based knowledge and best practice into rehabilitation plans to optimize individuals' communication. Also, select speech-language pathologists are individual authorizers for communication aids with the Assistive Devices Program (ADP).

BrainEx 90

BrainEx 90 is a 16-week group treatment program offered once a week for individuals experiencing symptoms after a concussion or mild traumatic brain injury. The group is led by an occupational therapist and physiotherapist. Sessions are structured in a circuit training format, where participants rotate through exercises related to vision, the vestibular system, balance and core stability, cardiovascular training, and cognitive rehabilitation. Each participant will also have a one-on-one session with the occupational therapist to focus on self-management strategies. The group also participates in educational discussions on topics relevant to brain injury, recovery and strategies.
 
BrainEx 90 is not intended to duplicate or replace one-to-one rehabilitation services. Individuals who have received (or are currently receiving) one-to-one therapy benefit from the multidisciplinary approach and the opportunity to complete a comprehensive circuit training program within a group atmosphere. The group program design also allows for participants to connect and exchange experiences with their peers. Individuals are supported when readjusting to stressors (e.g., noise, lights) that come with public, social, or group settings. This exposure is helpful for increasing tolerances for returning to work, school, and/or the community. BrainEx 90 provides participants an opportunity to learn how to independently manage their post-concussion symptoms while engaging in purposeful activity.

This program is currently being offered in a modified virtual group format. Group sessions are 80 minutes in duration and occur once weekly.     

Returning to school and work

A life-altering injury may limit an individual’s ability to join or return to school or work in a sustainable manner. Individuals may experience a loss of identity as they adjust to the changes in their overall physical, cognitive and psychosocial functioning and how these changes will impact their ability to work. This stage is a critical component to the rehabilitation process. NTR's speech-language pathologists and occupational therapists aim to take a multifaceted approach to this process, to ensure optimal success. 

Our clinicians also collaborate with employers and educational institutions to advocate for appropriate assistance, technologies, modifications and accommodations. Our SLPs also work closely with individuals to develop strategies to support changes with learning, completing school or work assignments, as well as performing on examinations. Consultation, education and parent/caregiver training are also provided, to develop strategies and promote academic achievement and workplace success. The physical and cognitive requirements are established and the individual's ability to perform school and work tasks are assessed. Additionally, clinicians take into consideration the importance of work-life balance following an injury. This ensures that each individual is able to manage their symptoms in order to successfully participate in roles and responsibilities across all environments.

Therapeutic technology

Locomotor training is an intensive activity-based therapy program that involves a combination of step training, overground walking, and functional mobility training. The training optimizes sensory cues to generate improved motor patterns after a neurological injury. Step training is provided on a body weight supported treadmill environment with manual facilitation by therapists and technicians, with the goal of helping the nervous system relearn motor patterns associated with walking. As neuromuscular capacity improves, the skills are transferred overground and integrated into home and community environments. 
 
The Lokomat is a robotic-assisted training device that uses a body weight support system and robotic leg orthoses to assist in creating an efficient and effective gait pattern.  The Lokomat is unique in that it allows the therapists to challenge the client by controlling the walking speed, and adjusting the amount of body weight support or assistance required by the robotic legs.
 
The Ekso is a robotic hip and knee exoskeleton designed to assist with gait retraining. It is a tool used in rehabilitation by physiotherapists to train patients to stand up, appropriately weight shift to achieve a proper gait pattern, and encourage correct body posture.
 
Functional electrical stimulation (FES) technology is also used through a variety of device such as the X-CITE, the FES Stepper and FES cycling. Electrical current is applied to specific muscle groups to facilitate the desired movement pattern in someone with a neurological injury.

Specialized assessments and requests

NTR clinicians offer expertise in a variety of domains, including:

  • Assessment for catastrophic determination
  • Cognitive demands analysis
  • Discharge planning
  • Physical demands analysis
  • Progressive Goal Attainment Program (PGAP)
  • Worksite assessment