20.1 Introduction

After eloquent brain surgery, patients often need to be transferred to an acute inpatient rehabilitation hospital for close medical monitoring and intensive therapy. Patients often require a hospital level of care, where nursing and physicians are readily available to address their complex medical needs. A rehabilitation team is often led by a physiatrist, a medical physician specializing in physical medicine and rehabilitation (a medical subspecialty within the American Boards of Medical Specialties). ¹ In the context of neurological rehabilitation, a physiatrist has specialized training in evaluating and treating cognitive and functional impairments due to complex neurological conditions. At major rehabilitation centers, availability of board-certified brain injury specialists (CBIS) is often present to care for patients with complex brain conditions. The physiatrist works together with the rehabilitation team as well as a medical team, which may include medical internists and other medical subspecialists, to optimize patient care. In addition to understanding the cognitive and functional sequelae of neurological conditions and their recovery patterns, a physiatrist also has expertise in understanding the therapy approaches to rehabilitation and direct the rehabilitation team to optimize functional recovery.

20.2 Rehabilitation Team

A comprehensive rehabilitation team in an acute inpatient rehabilitation hospital includes the patient and families, a physiatrist, neuropsychologist/psychologist, rehabilitation nurse, speech–language pathologist, physical therapist, occupational therapist (OT), respiratory therapist, registered dietician, case manager/social worker/care coordinator, recreational therapist, and chaplain. ² The team works closely together with an interdisciplinary approach that is patient-centric, and often communicates with one another on a daily basis about patient’s progress and any barriers to progress in functional improvement. The goals are defined early in the rehabilitation process, reviewed periodically, and each team member has high accountability for the progress toward defined goals. This highly organized model of care is most successful in the inpatient rehabilitation setting (see Table 20‑1).

The patient’s goal of rehabilitation post–eloquent brain surgery is often restoration of cognition, speech–language skills, mobility, and self-care skills. From a medical standpoint, the goal is to optimize medical comorbidities and address primary, secondary, and tertiary prevention issues to minimize medical complications that may affect recovery. A speech–language pathologist typically addresses patient’s impairments in swallowing, language, cognitive, and communication skills. A physical therapist and OT typically address impairments in mobility, transfers, and self-care skills. A rehabilitation nurse often has additional training to address rehabilitation needs, including expertise in wound care, bowel and bladder management, medication teaching especially those that affect cognition and function, and patient and family education. A care manager, often a social worker or a nurse case manager, helps coordinate the patient’s care with the rehabilitation team and identify resources to help the patient receive the appropriate rehabilitation services in their recovery. This well-coordinated interdisciplinary approach to patient care maximizes the chance of recovery for a patient undergoing eloquent brain surgery.

This highly effective inpatient interdisciplinary rehabilitation approach to care can be modeled in the outpatient and home care settings. Sometimes, a patient post–eloquent brain surgery may be able to be discharged directly to their home. Rehabilitation can be instituted in the patient’s home if a patient has difficulty getting to an outpatient rehabilitation center. Nursing and all therapy disciplines can provide rehabilitative services in the patient’s home. For those who are able to go to the outpatient setting, major rehabilitation outpatient centers are able to provide dedicated programs for patients with neurological conditions. Whether at home or in the outpatient settings, the rehabilitation approaches to care should follow the model as described earlier, and, preferably, should be in collaboration with a physiatrist.

20.3 Rehabilitation Nursing

Rehabilitation nursing embraces the values of compassion, knowledge, poise, sanguinity, and skillfulness. Through these values, nurses care for patients holistically while providing patient-centered care. At the time of admission to inpatient rehabilitation, nurses are often the first person a patient meets and rapport is established very early. This connection between nurse and patient, with the patient’s goals for rehabilitation well understood, helps facilitate care throughout their recovery. Positive expression and an optimistic attitude help build trust and respect. A rehabilitation nurse is skilled at giving patients appropriate autonomy, all the while encouraging them to be a strong advocate of their care.

Patients post–eloquent brain surgeries who come to an inpatient rehabilitation hospital often have high medical acuity. Rehabilitation nurses are challenged with the management of health conditions and comorbidities as well as providing education about specific aspects of self-care. They work very closely with physiatrists, therapists, and the rest of the rehabilitation team in a goal-oriented manner. A high level of team collaboration and patient/family education is what distinguishes a rehabilitation nurse from nurses in the acute care setting. Furthermore, the use of evidence-based practices assures that nurses provide age- and development-appropriate education to patients and caregivers to maximize recovery potentials.

Many rehabilitation nurses in major rehabilitation hospitals have additional certification, officially designated as Certified Rehabilitation Registered Nurse credentials (CRRN). Obtaining this certification is evidence of high commitment to excellence in caring for patients with a neurological condition that affect cognition and function. Rehabilitation nurses with CRRN credentials engage in lifelong learning to obtain new knowledge and a skillset that allows them to coach and provide education to promote self-efficacy. In addition, many rehabilitation nurses who take care of patients post–eloquent brain surgeries have additional certification as certified CBIS. This high level of training and skillset makes rehabilitation nurse a highly valued member of the rehabilitation team.