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Rehabilitation for Traumatic Brain Injuries
Introduction
Traumatic Brain Injuries has become important health problems not only in developed nations but also developing nations.
Recently, medical sciences has improved in management of traumatic brain injuries, anyway until know severe traumatic injuries still correlates with high mortality rates. Better management in acute phase of traumatic brain injuries has decreased the complications rates thus improve outcomes especially mortality rates.
But, the future challengges is the long term complication related to brain injuries, that cause serious disabilities that impact quality of life. Those disabilities result in language, memory, executive or others cognitive disorders.
Long-Term Problems that may Occur
Alzheimer's disease (AD) - is a progressive, neurodegenerative disease characterized by dementia, memory loss, and deteriorating cognitive abilities and associated with aging process. Based on current research about alzheimer and traumatic brain injuries, suggests an association between head injury in early adulthood and the development of AD later in life; the more severe the head injury, the greater the risk of developing AD. Some evidence indicates that a head injury may interact with other factors to trigger the disease and may hasten the onset of the disease in individuals already at risk. For example, people who have a particular form of the protein apolipoprotein E (apoE4) and suffer a head injury fall into this increased risk category. (ApoE4 is a naturally occurring protein that helps transport cholesterol through the bloodstream.)
Parkinson's disease and other movement disorders - Movement disorders as a result of TBI are rare but can occur. Parkinson's disease may develop years after TBI as a result of damage to the basal ganglia. Symptoms of Parkinson's disease include tremor or trembling, rigidity or stiffness, slow movement (bradykinesia), inability to move (akinesia), shuffling walk, and stooped posture. Despite many scientific advances in recent years, Parkinson's disease remains a chronic and progressive disorder, meaning that it is incurable and will progress in severity until the end of life. Other movement disorders that may develop after TBI include tremor, ataxia (uncoordinated muscle movements), and myoclonus (shock-like contractions of muscles).
Dementia pugilistica - Also called chronic traumatic encephalopathy, dementia pugilistica primarily affects career boxers. The most common symptoms of the condition are dementia and parkinsonism caused by repetitive blows to the head over a long period of time. Symptoms begin anywhere between 6 and 40 years after the start of a boxing career, with an average onset of about 16 years.
Post-traumatic dementia - The symptoms of post-traumatic dementia are very similar to those of dementia pugilistica, except that post-traumatic dementia is also characterized by long-term memory problems and is caused by a single, severe TBI that results in a coma.
Rehabilitation of Traumatic Brain Injuries
Since Traumatic Brain Injuries have serious complications and potential long term disabilities, thus makes rehabilitation as an important part of the recovery process for a TBI patient.
During the acute phase of TBI, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital. Once stable, the patient may be transferred to a subacute unit of the medical center or to an independent rehabilitation hospital. At this point, patients follow many diverse paths toward recovery because there are a wide variety of options for rehabilitation.
Before rehabilitation steps is conducted, a testing by a trained neuropsychologist, in order to assess the individual's cognitive, language, behavioral, motor, and executive functions. The assessment data provides information regarding the need for rehabilitative services.
Current recommendation for TBI rehabilitation, that TBI patients should receive an individualized rehabilitation program based upon the patient's strengths and capacities and that rehabilitation services should be modified over time to adapt to the patient's changing needs. This involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support. Medical personnel who provide this care include rehabilitation specialists, such as rehabilitation nurses, psychologists, speech/language pathologists, physical and occupational therapists, physiatrists (physical medicine specialists), social workers, and a team coordinator or administrator.
Rehabilitation therapy is an important part of the recovery process of TBI patients. Above, a physical therapist works with a patient to help improve her ability to walk.
The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient's living space, called environmental modification, to make everyday activities easier.
Some patients may need medication for psychiatric and physical problems resulting from the TBI. Great care must be taken in prescribing medications because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents. It is important for the family to provide social support for the patient by being involved in the rehabilitation program. Family members may also benefit from psychotherapy.
It is important for TBI patients and their families to select the most appropriate setting for rehabilitation. There are several options, including home-based rehabilitation, hospital outpatient rehabilitation, inpatient rehabilitation centers, comprehensive day programs at rehabilitation centers, supportive living programs, independent living centers, club-house programs, school based programs for children, and others. The TBI patient, the family, and the rehabilitation team members should work together to find the best place for the patient to recover.
Traumatic Brain Injuries has become important health problems not only in developed nations but also developing nations.
Recently, medical sciences has improved in management of traumatic brain injuries, anyway until know severe traumatic injuries still correlates with high mortality rates. Better management in acute phase of traumatic brain injuries has decreased the complications rates thus improve outcomes especially mortality rates.
But, the future challengges is the long term complication related to brain injuries, that cause serious disabilities that impact quality of life. Those disabilities result in language, memory, executive or others cognitive disorders.
Long-Term Problems that may Occur
Alzheimer's disease (AD) - is a progressive, neurodegenerative disease characterized by dementia, memory loss, and deteriorating cognitive abilities and associated with aging process. Based on current research about alzheimer and traumatic brain injuries, suggests an association between head injury in early adulthood and the development of AD later in life; the more severe the head injury, the greater the risk of developing AD. Some evidence indicates that a head injury may interact with other factors to trigger the disease and may hasten the onset of the disease in individuals already at risk. For example, people who have a particular form of the protein apolipoprotein E (apoE4) and suffer a head injury fall into this increased risk category. (ApoE4 is a naturally occurring protein that helps transport cholesterol through the bloodstream.)
Dementia pugilistica - Also called chronic traumatic encephalopathy, dementia pugilistica primarily affects career boxers. The most common symptoms of the condition are dementia and parkinsonism caused by repetitive blows to the head over a long period of time. Symptoms begin anywhere between 6 and 40 years after the start of a boxing career, with an average onset of about 16 years.
Post-traumatic dementia - The symptoms of post-traumatic dementia are very similar to those of dementia pugilistica, except that post-traumatic dementia is also characterized by long-term memory problems and is caused by a single, severe TBI that results in a coma.
Rehabilitation of Traumatic Brain Injuries
Since Traumatic Brain Injuries have serious complications and potential long term disabilities, thus makes rehabilitation as an important part of the recovery process for a TBI patient.
During the acute phase of TBI, moderately to severely injured patients may receive treatment and care in an intensive care unit of a hospital. Once stable, the patient may be transferred to a subacute unit of the medical center or to an independent rehabilitation hospital. At this point, patients follow many diverse paths toward recovery because there are a wide variety of options for rehabilitation.
Before rehabilitation steps is conducted, a testing by a trained neuropsychologist, in order to assess the individual's cognitive, language, behavioral, motor, and executive functions. The assessment data provides information regarding the need for rehabilitative services.
Current recommendation for TBI rehabilitation, that TBI patients should receive an individualized rehabilitation program based upon the patient's strengths and capacities and that rehabilitation services should be modified over time to adapt to the patient's changing needs. This involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support. Medical personnel who provide this care include rehabilitation specialists, such as rehabilitation nurses, psychologists, speech/language pathologists, physical and occupational therapists, physiatrists (physical medicine specialists), social workers, and a team coordinator or administrator.
Rehabilitation therapy is an important part of the recovery process of TBI patients. Above, a physical therapist works with a patient to help improve her ability to walk.
The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient's living space, called environmental modification, to make everyday activities easier.
Some patients may need medication for psychiatric and physical problems resulting from the TBI. Great care must be taken in prescribing medications because TBI patients are more susceptible to side effects and may react adversely to some pharmacological agents. It is important for the family to provide social support for the patient by being involved in the rehabilitation program. Family members may also benefit from psychotherapy.
It is important for TBI patients and their families to select the most appropriate setting for rehabilitation. There are several options, including home-based rehabilitation, hospital outpatient rehabilitation, inpatient rehabilitation centers, comprehensive day programs at rehabilitation centers, supportive living programs, independent living centers, club-house programs, school based programs for children, and others. The TBI patient, the family, and the rehabilitation team members should work together to find the best place for the patient to recover.
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