المتخصصون في المجالات الطبية

Sept. 10, 2026

Rehabilitation is a critical component of trauma care and should begin as early as medically appropriate, often while a patient is in the intensive care unit (ICU), says Brittany Snider, D.O., a physiatrist and physical medicine and rehabilitation (PM&R) liaison to Mayo Clinic Trauma Center.

"We see them as early as appropriate, because early rehabilitation is associated with better functional outcomes, fewer complications, shorter ICU and hospital length of stay, and improved survival," she says.

The timing and sequence of rehabilitation involvement often depend on the nature of the patient's injuries. For patients with traumatic brain injury (TBI) or spinal cord injury, a physical medicine and rehabilitation physician is often involved from the outset, beginning in the neuroscience ICU.

For patients whose injuries do not involve the brain or spinal cord, physical and occupational therapists often are the first rehabilitation professionals to evaluate the patient, particularly when activity tolerance is limited. Before therapy begins, however, the trauma surgeon must determine if there are activity restrictions due to the patient's injuries such as inability to bear weight through a broken leg or needing to wear a brace when out of bed due to a spine injury.

"You also have to have medical stability first before you can be cleared for therapy," Dr. Snider says.

Therapists may subsequently refer patients to physiatry when additional rehabilitation expertise is needed. Physiatry team members also participate in interdisciplinary rounds, collaborating with trauma surgeons, therapists, nursing staff and other specialists to align rehabilitation goals throughout hospitalization.

Building function and preventing complications

In the acute setting, rehabilitation focuses on preserving function, preventing complications and preparing patients for greater independence as recovery progresses.

Early interventions may include range-of-motion exercises, bed mobility training, transfers, and education regarding activity restrictions or spinal precautions. Physical and occupational therapists work with patients on practical activities such as moving safely from bed to chair or commode while adapting to new physical limitations. They also evaluate the need for supportive equipment, such as braces, protective devices and mobility aids.

Speech-language pathologists may become involved as early as the ICU stay, particularly for patients with cognitive, communication or swallowing impairments related to TBI or other traumatic injuries.

The ICU team directs the patient's overall medical management in the acute setting. Physiatrists play a key role in addressing rehabilitation-specific concerns, including bowel and bladder management, TBI-related agitation, and complications associated with spinal cord injury. They also help anticipate injury-related challenges before they become barriers to recovery. For example, patients with spinal cord injuries may experience significant orthostatic hypotension, even when progressing to simple activities such as sitting at the edge of the bed.

Determining the appropriate post-acute care setting

As patients become medically stable and mobility improves, the rehabilitation team helps determine the most appropriate setting for the next phase of recovery. Options may include inpatient rehabilitation, skilled nursing facilities, home-based therapy services or outpatient rehabilitation.

"Some patients need a skilled nursing facility," Dr. Snider says. "Some patients who've had a traumatic injury cannot even get upstairs to their apartments immediately after hospitalization."

Certain patients also require additional healing time before they can participate in more-intensive rehabilitation programs.

Physiatrists play a significant role in prognostication, helping patients and families understand expected recovery trajectories and need for long-term adaptations of their environment. Patients without neurological deficits can often expect improvement as injuries heal. In contrast, spinal cord or brain injuries may result in permanent functional limitations that require long-term accommodations and accessibility planning.

Intensive inpatient rehabilitation

Patients referred to Mayo Clinic's inpatient rehabilitation program receive the highest level of rehabilitative care, including daily physiatrist oversight and approximately three hours of therapy each day. The goal is to maximize recovery, restore independence and continue necessary medical treatment.

According to Dr. Snider, many patients entering inpatient rehabilitation must relearn fundamental activities of daily living, including feeding, dressing and personal care tasks. Caregiver education is an equally critical component of care. Family members frequently participate in therapy sessions to learn safe transfer techniques, mobility assistance skills and strategies to support recovery after discharge.

For patients whose injuries have resulted in spasticity, Dr. Snider and colleagues may provide injection-based treatments while on the rehabilitation unit. They collaborate with Peter C. Rhee, D.O., M.S., an orthopedic surgeon at Mayo Clinic, when a surgical approach is indicated later in their patients' recoveries.

The average length of stay in inpatient rehabilitation is approximately two weeks. For patients with spinal cord injuries, however, the average stay is closer to 30 days because of the complexity of their rehabilitation needs.

Preparing patients and caregivers for discharge

Discharge planning begins early. Physical and occupational therapists often review photographs of the patient's home to identify barriers such as stairs, narrow doorways or inaccessible entrances. The rehabilitation team then recommends durable medical equipment and home modifications, including wheelchairs, ramps and other adaptive devices needed for a safe transition home.

Case managers, therapists and physiatrists work closely with patients and caregivers to ensure that the necessary support systems are in place, whether the next step is home, outpatient therapy, home-based services or another care facility.

Special considerations in pediatric trauma rehabilitation

Children recovering from traumatic injuries are cared for by a dedicated pediatric rehabilitation team that includes a pediatric physiatrist and physical, occupational and speech therapists.

"The goal is to move as soon as possible," says Mary E. Lynch, M.D., a Mayo Clinic pediatric physiatrist.

Like adults, even children who remain intubated in the ICU may benefit from early mobilization.

Dr. Lynch notes that additional injuries may sometimes become apparent after a child awakens and can participate more fully in the examination, particularly following severe polytrauma and traumatic brain injury.

Like in the adult care model, pediatric physiatry is often involved early after a child has a neurological injury. If therapists determine that a child they are seeing with orthopedic injuries would benefit from inpatient rehabilitation, a pediatric physiatrist is brought into the care team as well to help guide treatment planning and recovery goals.

Supporting school reintegration and recovery at home

Pediatric rehabilitation extends beyond physical recovery. A pediatric speech-language pathologist and a pediatric neuropsychologist often evaluate cognition, communication, attention and learning needs, helping guide school accommodations and support services after discharge. Pediatric psychologists and social workers also help patients and families navigate the emotional effects of trauma, including grief, disability and other life-changing outcomes.

The rehabilitation team works closely with families throughout recovery, addressing supervision needs, environmental modifications and equipment requirements. Team members frequently collaborate with school nurses, teachers and administrators to facilitate a successful return to the classroom. For families requiring extensive home modifications, rehabilitation healthcare professionals may connect them with social services and community resources.

"It's essential for injured children that we get their families equipped and educated on how to get safely home, care for them and help them continue to participate in preferred community activities," Dr. Lynch explains.

This multidisciplinary approach helps ensure that rehabilitation addresses the physical, cognitive and psychosocial effects of traumatic injury while supporting patients and families from the ICU through reintegration into home, school and community life.