Volume 15, Issue 1: Major Issues in Post-acute TBI Rehabilitation

Content currently available in print only
Post-Acute Rehabilitation Edifying Efficacy Evidence
Nathan D. Zasler, MD and Mark Ashley, ScD

What Should Comprehensive Neurorehabilitation in a Transitional Residential Rehabilitation Program Look Like?
Gary Seale, PhD and Brent Masel, MD

Post-acute Transitional Residential Rehabilitation and Changes in Decision-Making Capacity
Margaret Kroese, MSSW and Martin Waalkes, PhD

What Families, Clinicians and Payors Need to Know About Transitional Rehabilitation
Gary Seale, PhD, Nicholas Cioe, PhD, and Susan Connors

Money, Management and Mergers:  The Business Aspects of Post-Acute ABI Neurorehabilitation
Dexter Braff, MBA, Ted Jordan, MBA, and Nancy Weisling, BS

Message from the Guest Editor

Nathan Zasler, MD, and Mark Ashley, ScD

It is with great pleasure that we introduce this special issue on post-acute rehabilitation for Brain Injury Professional. We hope that readers find the articles both informative and thought provoking. We have tried to assemble an array of topics that address some of what we perceive as the major issues and interests germane to post-acute rehabilitation with particular emphasis on transitional residential rehabilitation services.

The article by Zasler and Ashley entitled ”Post-acute rehabilitation: Edifying efficacy evidence” examines the current literature supporting the clinical efficacy as well as cost benefit of such services. Our hope with this article is to also encourage professionals to advocate for access to these services given the existing evidence as well as to expand research efforts to add to the existing foundational tenants for such services.

In their article on “What should comprehensive neurorehabilitation in a transitional residential rehabilitation program look like?”, Drs. Seale and Masel discuss historical aspects of the TBI continuum of care and recommended components of a comprehensive interdisciplinary transitional residential treatment program. The role of various “players” is nicely reviewed in this context. They also emphasized the role of discharge planning follow-up and need for outcomes reporting.

Kroese and Waalkes address issues of decision-making capacity in their article “Post-acute transitional residential rehabilitation and changes in decision-making capacity.” This is a very important topic that often does not receive appropriate attention by health care professionals involved with TBI care. The authors discuss the evolution of decision-making capacity in the context of neurorecovery and neurorehabilitation. They also provide a nice overview of capacity determination and the types of abilities germane to same. They bring up important points regarding the implications of limited decision-making capacity and attempts to optimize the involvement of the person with TBI in appropriate decision-making tasks. The article’s main focus is how we might go about treating patients with changing levels of capacity and the ethical and programmatic challenges involved in same within the post-acute setting. We think all readers will find this information helpful and of assistance in dealing with these clinical and ethical challenges.

In the article entitled, “What families, clinicians and payers need to know about transitional rehabilitation”, Seale, Cioe and Connors clarify the scope of transitional residential rehabilitation and how it differs from other treatments. A major emphasis of this article is the challenges that are faced by those of us in the trenches to advocate for payment for such services given the lack of familiarity by many payers with this level of service as well as with the evidence of transitional rehabilitation (TR) efficacy. The authors also provide some nice insights into how increased payor understanding of TR services for persons with TBI results in a panoply of benefits for not just the patient, but the payor as well.

Taking a somewhat different focus, the article by Braff, Jordan and Weisling, “Money, management and mergers: The business aspects of post-acute ABI neurorehabilitation” provides readers with some “out of the box” perspectives on the business of post-acute ABI/TBI care. These authors provide a very insightful examination of some of the elements that those of us who are involved in ownership and/or management of such programs need to be well aware of. In that context, issues of quality of care, profit, revenues and growth including revenues cycle management, expenses and technology deployment are discussed. There is also commentary on the pros and cons of owning the real estate, the complexities of growth in the current health care market, and the challenges involved with risks of running such businesses.

Lastly, given Dr. Ashley’s long-standing work in the field and, in particular, his work in post-acute rehabilitation care, I (Dr. Zasler) thought it would be intriguing to interview my colleague and co-editor for this issue. I have tried to tap Dr. Ashley’s brain regarding a number of different issues in the context of how the field of post-acute TBI care has evolved, what some of the challenges are contextually in terms of service provision and program viability, and the importance of continuing to advocate for such services and provide evidence through good research for same.
We both hope this issue of Brain Injury Professional expands the reader’s knowledge regarding the subject matter and provides some useful insights into how to move this piece of the brain injury continuum of care forward for our patient’s, their families, and all invested parties.

about the guest editors: 

Nathan Zasler, MD, is founder, CEO & CMO of Concussion Care Centre of Virginia, Ltd. and Tree of Life Services, Inc.. He is board certified in PM&R, fellowship trained in brain injury and subspecialty certified in Brain Injury Medicine. Dr. Zasler has several academic appointments and lectures nationlly and internationally on topics related to brain injury. Dr. Zasler has published extensively on TBI related neuromedical issues. He is co-chief editor of “Brain Injury” and “NeuroRehabilitation” and serves on numerous journal editorial boards. Dr. Zasler is active in local, national and international organizations dealing with acquired brain injury and neurodisability.

Mark Ashley, ScD, CCC-SLP, CCM, CBIST, is President/CEO of Centre for Neuro Skills® (CNS), which has operated postacute brain injury rehabilitation programs since 1980. Dr. Ashley serves on the Board of Directors of the Brain Injury Association of America, and is an Emeritus Chair. He serves on the Board of Directors of the California Brain Injury Association. Dr. Ashley is an Adjunct Professor at the Rehabilitation Institute of the College of Education at Southern Illinois University. Dr. Ashley founded the Centre for Neuro Skills Clinical Research and Education Foundation, a non-profit research organization.

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