Continuum of Care

The Traumatic Brain Injury (TBI) Model System provides a multidisciplinary system of rehabilitation care specifically designed to meet the needs of individuals with TBI, including:

  • Emergency medical services.
  • Acute neurosurgical and rehabilitative care in a trauma center environment.
  • Comprehensive rehabilitation services in an inpatient TBI rehabilitation facility.
  • Long-term interdisciplinary follow-up and outpatient rehabilitation services.

Mayo Clinic physicians trained in physical medicine and rehabilitation and support staff offer a full range of brain rehabilitation treatment options, from intensive hospital care through outpatient and community-based services. Services are provided along the continuum of care to improve health and function, social integration, and employment and independent living outcomes.

Brain rehabilitation during acute hospital care

Mayo Clinic physicians and other staff in the TBI Model System are trained in brain rehabilitation and provide and coordinate care as soon as someone affected by a brain injury or illness arrives at the hospital. They work closely with the hospital treatment team, initiating rehabilitation assessment and treatment while closely monitoring progress and planning for the next step.

Brain rehabilitation unit

If further rehabilitation treatment is needed, patients may be admitted to the state-of-the-art inpatient brain rehabilitation unit at Mayo Clinic Hospital — Rochester, Saint Marys Campus. There the rehabilitation team provides treatment to help improve physical, cognitive and behavioral functioning and facilitates the transition to living at home independently, living at home with assistance, or living in another type of facility.

Brain Rehabilitation Clinic

Outpatient rehabilitation focuses on helping patients continue to improve their physical, cognitive and behavioral functioning to maximize independence. Evaluation may include referrals to rehabilitation doctors and nurses, physical and occupational therapists, speech language pathologists, and other specialists. Outpatient programs in concussion management, neuromuscular rehabilitation, cognitive and communication rehabilitation, vocational coordination, and a brain injury coping skills group are available.