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Traumatic Brain Injury Program
Patterns of Referral

The following information outlines the most common services which traumatic brain injury survivors or their families may need. Progressing successfully from one phase of care to the next can be challenging and requires knowledge of the effects of traumatic brain injury, appropriate referral, discharge planning, and awareness of case management services. A coordinated system of information and resources must be readily available to survivors, families, community-based services, and health professionals during all phases of care. 

Acute Care

Sequence of events beginning at the point of injury through admission to the hospital. more about acute care...


Progress from hospital discharge through admission to rehabilitation/nursing facility to returning to the home community. more about rehabilitation...

Community-Based Services

After the return home, further services may still be required for basic care, continued therapy, education, and employment. more about community-based services...

Acute Care

When a person incurs a traumatic brain injury, the first step toward healing is rapid transport, usually by ambulance or air flight, to a hospital emergency department. If the traumatic brain injury is minor, emergency department treatment or an overnight stay in the hospital for observation may be all the care needed. Bed rest at home will help recovery.

However, if the traumatic brain injury is moderate or severe, more intense treatment may be necessary. In many rural or remote areas of Oklahoma, the nearest emergency department may not have the necessary equipment or staff expertise to treat a patient with a severe traumatic brain injury. In these cases, either the patient is stabilized at the local hospital and transferred to a larger facility or is transported directly to the larger, well-equipped facility with skilled personnel.

When a person is admitted to a hospital for a moderate or severe traumatic brain injury, the stay may be for a few days or can extend to several weeks, depending on severity of the injury and complications. Treatment during this time may be administered by many different kinds of doctors, nurses, and therapists. For example, a neurosurgeon may operate to stop bleeding within the brain or relieve pressure and swelling and an internal medicine specialist may be consulted to prescribe medicines to control seizures. A nurse carries out the doctors' orders such as giving medicines and recording progress in the chart and a physical therapist may work with the patient to regain strength and movement. Other treatments and therapies may be provided by a neurologist, occupational therapist, recreational therapist, neuropsychologist, psychologist, psychiatrist, ophthalmologist, speech pathologist, or nutritionist. The primary doctor, or physiatrist, coordinates all facets of care the patient may need including the treatment of injuries in addition to the traumatic brain injury.


Specific rehabilitation such as physical and speech therapies are often initiated during acute care. After an assessment to determine readiness for rehabilitation, a patient is then transferred either to the hospital’s rehabilitation unit or to a rehabilitation hospital. The person’s physical and mental status, types of payment, and facility space are considered before admission to a rehabilitation center.

Rehabilitative care is usually provided within a comprehensive treatment program with the goal to reduce or overcome deficits following disease or injury, and to assist the individual to attain optimal levels of mental and physical ability and useful and productive activity. The process involves a planned, orderly sequence of multiple, coordinated services related to the total needs of the individual. The scope of services may include physical therapy, occupational therapy, speech/language therapy, vision therapy, social services, exercise physiology, counseling, recreation therapy, psychological therapy, pain management, self-care and, when necessary and possible, case management.

When the patient has recovered sufficiently so that loss of life is unlikely and the patient has regained strength and coordination, and made other improvements, the patient may be discharged home. Further treatment or therapy can be obtained on an outpatient basis. Many patients need continued therapy to improve mobility, coordination, memory, or speech. They may also need help to cope with emotional, psychological and decision making problems, or manage long-term health problems related to the injury. Treatment in a skilled nursing facility, psychiatric facility or rehabilitation center may be necessary immediately following hospital discharge.

Community-Based Services

When a traumatic brain injury survivor returns home, many challenges may await at home and in the community. Physical therapy may still be required, as well as speech, cognitive, or behavioral therapy. A person may need to re-learn common tasks and routines of home and community living.

Students re-entering school may require extra assistance from teachers and counselors in order to successfully manage classroom routines and deal with the stresses of increased social interaction. They may need an assessment to determine eligibility for special education services. Traumatic brain injury is one of the conditions for which schools must provide special services under the Individuals with Disabilities Education Act (IDEA). Students may still require physical therapy during the school day.

Adults attempting to return to work may require retraining to do the same job they used to do or need training in a new skill if returning to the same job is not feasible. It may take many weeks for a survivor to build the strength and stamina to endure a 40-hour work week. A person may need understanding and encouragement from supervisors and co-workers to cope with the increased fatigue and stress incurred during the workday. The Office of Handicapped Concerns and Client Assistance Program are two of many organizations that can assist clients in returning to work or new employment.

Possible Acute care/acute rehabilitation may be needed after the patient has been discharged to home and the community. A person with traumatic brain injury may experience various complications from the injury such as new or continuous bleeding, infection, respiratory distress, hemiplegia, severe headache or other problems that require return to the hospital or acute rehabilitation center.

Basic health services include a wide range of care available in the community for all persons to maintain their physical and mental status such as immunizations/vaccinations, treatment for minor illnesses and injuries, emergency medical services, health education, and screening for disease. Many diverse health and social work professionals provide the care in offices, agencies, and clinics.

Community supports include the many support groups for various conditions, religion and faith-based centers that help citizens in the community to obtain meals, clothing, and help pay utility costs, and the agencies providing safety and sanitation. Legal aid is also available for interpreting rules and regulations and helping clients to negotiate the legal and penal systems.

County health departments provide a wide array of health and social services such as immunizations, education to prevent disease and injury, nutrition and safety programs, treatment of minor conditions, and referral to needed services. They serve large populations in the community and are a principal source of health care in the state and nation.

Community services vary considerably according to size of the population, culture, economics, and geographical location, but all of the following services are commonly available.

Advocacy – Many communities have groups that are active in understanding and supporting the needs of persons with traumatic brain injury and work to increase services, funding, and health care coverage of services. These groups also are important in raising awareness and supporting legislation for prevention and treatment.

Assistive technology – Many communities have several offices, stores, and agencies that have apparatus and equipment needed in the home and workplace that allow people with physical limitations to live their daily lives more conveniently, wheelchairs, hand rails, bathroom safety equipment, and many other aids are available.

Assisted living – Depending on the type of housing unit, a wide variety of services may be offered to residents by public, private, or non-profit organizations to assist them in their daily activities and to maintain their homes. Assistance includes cleaning, cooking, shopping, home maintenance, and other personal/social activities.

Entitlement programs enable persons with traumatic brain injury or other conditions to receive monies from government programs for basic needs such as food and utilities, medicines, clinic and hospital services. Medicaid, Medicare, Social Security Insurance, Social Security Disability Insurance, and Veterans' benefits are among these programs.

Group Homes are units that accommodate anywhere from 4 to 50 people who require some level of care or supervision because they are not able to be totally independent. The state does not have group homes specific for the care of persons with traumatic brain injury. The Developmental Disabilities Services Division in the Department of Human Services has about 45 group homes that are owned and operated by private or non-profit organizations. There are also many group homes within the Department of Mental Health and Substance Abuse Services.

Independent Living Centers provide services to persons with disabilities on an outpatient basis that include assistive devices, transport, linkage to other community services, and education/training in daily living skills. Oklahoma has six centers across the state.

Personal assistance services are usually funded by Medicare and Medicaid and consist of care provided in the home to persons with disabilities that includes assistance with bathing, dressing, grooming, hair care, meal preparation, exercise, light housekeeping, laundry, errands, and other activities of daily living.

Substance abuse centers provide mental health and substance abuse prevention and treatment services. Oklahoma has a network of centers statewide with a central office at the Department of Mental Health and Substance Abuse Services. Principal payment sources include Medicaid, Medicare, and private/HMO insurance.

Indian and Tribal Clinics in Oklahoma provide basic health services, screening, education, and treatment for members of tribes and the general population. Each center maintains an ongoing record of the member's health status and services provided, enabling health professionals to understand the individual's complete history and treatment.

Associated Agencies

Office of Disability Concerns

Department of Mental Health and Substance Abuse Services

Department of Rehabilitation Services

Department of Human Services

Oklahoma Health Care Authority

Oklahoma Indian Health Service

Oklahoma Department of Education

Oklahoma Disability Law Center

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