SHARE Care Team

Collaborative care

Case management is the collaborative process that manages patient wellness and promotes independence through advocacy, communication, education, and the identification and facilitation of needed services.

At SHARE, case managers serve as patient advocates. They serve as liaisons between the patient and family, the interdisciplinary treatment team, physician, and the external treatment team to ensure quality care and optimal treatment outcomes. They connect patient with community and clinical resources to foster access to needed health care services. They can assist in navigating health care benefits as applicable.

For worker’s compensation patients, case managers advocate for approval of prescribed treatment and services. They act as a liaison between the patient, the treatment team, and worker’s compensation parties. They also provide work status updates to worker’s compensation case manager and adjuster and keep the worker’s compensation case manager and adjuster updated on any changes in the treatment plan.

Patients meet with their case manager when they’re admitted to therapy to review SHARE program requirements and guidelines along with an explanation of benefits. During treatment, meetings may include weekly check-ins and as needed at the request of the patient and/or case manager.

Improving abilities

Occupational therapy (OT) helps you get back to doing the things you need, want, or are expected to do in your day-to-day life.

At SHARE, occupational therapy works on a range of activities that include:

• Daily living, such as bathing, dressing, eating, grooming, and safety
• Household tasks, grocery shopping, finances, medication management, driving, education, work tasks, tool use, participation, and routines
• Upper extremity function, including strength, endurance, sensation, coordination, range of motion, and pain
• Visual deficits related to vision symptoms, both eyes working together, eye muscles, visual perceptual skills, and visual motor speed and control
• Sensory integration to retrain the body to understand and respond to information more appropriately to increase participation in daily activities and decrease discomfort

Some potential challenges

• Brain injury symptoms can impact driving performance. Driving evaluations and simulator training may be used for returning service members with traumatic brain injury.
• Family functioning is often a concern after a traumatic brain injury. Overwhelming noise and visual levels found in busy households and the demands for multitasking make it difficult for some service members to continue parenting responsibilities. Once difficulties are identified, these can be worked on in occupational therapy.
• Sensory processing refers to the way the nervous system takes in information from the senses and turns it into appropriate or inappropriate responses. Sensory processing disorder can affect one or many senses. Assessments will help us find which sensory systems may be affected and how to help you improve your quality of life.
• Common visual symptoms in individuals who have experienced blast injuries can include sensitivity to light, an inability to move both eyes inward to focus on an object and see one clear image, difficulty focusing on items close up and then quickly adjusting to seeing an object far away, eyes unable to follow a moving target or move quickly, delayed pupil response to light, and headache.

Ways OT can help

OT can help patients learn pacing and fatigue management and strategies to support them when participating in activities with family or friends. Patients develop new household skills and strategies to increase their engagement in family roles.

Driving interventions involve activities specifically designed to improve reaction time, visual scanning, attention, range of motion, or adaptive strategies. Adaptive strategies could include changes to the vehicle for easy reaching, only driving during the day, driving with another person in the car, or limited highway driving. Driving simulation may be used to decrease anxiety provoking elements of driving situations as well as to promote self-awareness of driving safety difficulties.

OT applies learned behavioral health strategies during transportation and community mobility tasks. Transportation alternatives are explored as needed.

Sensory desensitization and coping strategies are practiced improving quality of life and increase daily participation.

Eyes are treated with strengthening exercises, visual perceptual resources, visual accommodations and resources, and referrals to vision specialists as needed.

Improving symptoms

Physical therapists (PT) work to evaluate and treat symptoms of dizziness, headache, balance problems, and pain. They can also help you safely return to an exercise routine.

At SHARE, the PT works on improving symptoms you may be experiencing following a mild to moderate traumatic brain injury as well as other bodily injuries you may have had.

• Dizziness and headache: Specific exercises may be prescribed to help you focus your eyes and vision during movement. Exercises may also be performed to reduce sensitivity to busy environments.
• Balance problems: You may practice balance exercises on a variety of surfaces or terrains. For example, you may be asked to balance on foam or a balance board.
• Pain: Stretching and strengthening exercises may be prescribed. Modalities such as heat, ice, ultrasound, and electrical stimulation may also be used.

Session activities vary based on each client’s needs and goals. Examples of exercises that might be done during a physical therapy session at SHARE include:

• Balance exercises with eyes open or eyes closed
• Balance retraining on challenging surfaces
• Specific exercises to improve how your eyes focus during movement
• Strengthening and/or stretching exercises
• Pain management techniques such as dry needling, manual therapy, or modalities
• Practicing relaxation techniques, such as deep breathing or muscle relaxation

A flexibility and relaxation group will work on breathing techniques, gentle stretching, progressive muscle relaxation, and easier balance activities.

An exercise group helps with returning to fitness and an exercise routine. Exercises will work on improving arm and leg strength as well as core strength and cardiovascular fitness.

Improving communication

Speech-language pathologists (SLP) work to evaluate and treat speech, language, social communication, cognitive communication, and swallowing disorders in children and adults.

At SHARE, the SLP works with clients on improving thinking and communication skills, such as memory, attention, and executive function, that may be impaired following a mild to moderate traumatic brain injury.

For example, learning to use a planner consistently to build a daily routine and help you remember appointments or things you need to do. Doing exercises to improve your ability to focus on a task with noise in the background can help you tune out the distracting noise. Keeping a log of communication difficulties you’re having can help indicate patterns to address.

Session activities vary based on each client’s needs and goals and may include:

• Researching a calendar app to use as a memory tool and coming up with a system for using it consistently
• Creating a daily routine or schedule
• Establishing weekly goals then checking in on progress and obstacles related to those goals
• Learning strategies for improving attention or focus
• Using the SWOPS thinking and planning tool to prepare for an interaction or event. SWOPS helps patients plan the best strategies to use in a situation, instead of reacting in the moment, so they can be satisfied and meet their long-term goals.
• Practicing communication strategies such as active listening by asking questions or restating what the other person said to clarify or summarize information, which enhances  focus and recall

• Learning strategies for taking breaks to reduce mental fatigue breaks

A group speech therapy session at SHARE may include:

• Reviewing progress towards weekly goals and using that information to set new goals for the week
• Discussing potential situations that could be challenging or require planning ahead
• Discussing the benefits of having a daily routine and how to best integrate scheduling tools learned at SHARE

During the evaluation period at SHARE, the SLP guides each client in creating a goal that represents what is most important and motivating to that particular person. A technique called goal attainment scaling helps measure each goal and track levels of progress.

Each therapist works with clients to address their client-centered goal in different ways. Clients rate where they feel they are when they first come to SHARE then rate their goal again when they are discharged. They will also rate their goals during the transition phase. This is a key measure we use to track clients’ progress.