Trauma-Informed Care Across the Lifespan: A Clinical Framework for Practice

Abstract

Background: Trauma-informed care (TIC) is increasingly recognized as essential in rehabilitation settings, where patients frequently present with complex medical, neurologic, and psychosocial histories. Despite this, integration within physical medicine and rehabilitation (PM&R) remains inconsistent.

Objective: To provide a clinically applicable framework for implementing TIC across the lifespan within PM&R contexts.

Methods: This narrative review synthesizes guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA) with rehabilitation-focused clinical practices and case-based application.

Results: TIC implementation in PM&R is supported through universal precautions, the triad of consent (adversity, distress, strengths), and alignment with SAMHSA’s Four R’s. Application of these principles improves therapeutic alliance, reduces behavioral escalation, and enhances engagement, particularly in populations with neurologic injury and co-occurring trauma.

Conclusion: TIC is a foundational component of high-quality rehabilitation care. Standardization of training and integration into interdisciplinary practice models are necessary to improve patient outcomes and reduce disparities.