Worldwide, traumatic brain injury [TBI] is a leading cause of death and disability in persons aged 2 Minor Risk Factors [CHIP Rule]YesCategory 3YesModerateYesSevereYesCritical
- GCS 3 - 4
- Reduced / Absent Pupillary Reactions
- Reduced / Absent Motor Reactions
The aims of initial emergency and early medical management are to limit the development of secondary brain damage while providing the best conditions for recovery from any reversible damage that has already occurred. This involves establishing and maintaining a clear airway with adequate oxygenation and replacement fluids to ensure good peripheral circulation with adequate blood volume.
Emergency surgery is often required to decompress the injured brain and minimise damage:
- Surgery to remove the haematoma and thus reduce pressure on brain tissue.
- Removal of part of the skull in order to relieve pressure.
- Surgical repair of severe skull fractures, and/or removal of skull fragments from brain tissue.
- Insertion of intracranial pressure [ICP] Monitoring Device.
Medication may also be used to limit secondary damage to the brain:
- Coma-inducing medication may be given, as a brain in coma requires far less oxygen. This is therapeutic where oxygen and nutrient supply to the brain is restricted by compressed blood vessels and increased cerebral pressure.
- Diuretics, given intravenously, can be used to reduce the amount of fluid in soft tissues and thus help reduce pressure on the brain.
- Anti-epileptic medication is often provided in the early stages to avoid any additional brain damage, which may be caused if a seizure were to occur.
Just as two people are not exactly alike, no two brain injuries are exactly alike. Therefore, the approach to neurological rehabilitation and physiotherapy after traumatic brain injury should observe neuroplasticity, motor learning, and motor control principles as well as taking a patient-centred approach with individual involvement in goals setting and choice of treatment procedures.
- Initial treatment during the acute phase focuses on promoting respiratory health and prevention of secondary adaptive changes to the musculoskeletal system.
- Subacute physiotherapy management focuses on the provision of an appropriate environment to assist functional recovery and on the assisted practice of meaningful tasks, relevant to the ability of the individual, using a full range of treatment modalities.
- Postacute physiotherapy management focuses on reversing secondary adaptive changes and improving specific motor skills with a focus on functional goals for the day to day activities and is dependent on skilled sensorimotor assessment and a collaborative approach with other team members, the individual, and family. This stage can include inpatient, outpatient, and community-based settings and for some individuals may require lifelong access to services including planned reviews.
With the complexity of the traumatic brain injury and its wide-ranging consequences, no single medical speciality is sufficient to address all areas of management. In traumatic brain injury management, the role of the multidisciplinary team is invaluable with the physiotherapist/physical therapist role at its heart from acute to chronic stages.
The increasing recognition of the impact of traumatic brain injury on the individual, the family and society is resulting in developments in prevention, service design, legislation and funding. Developments in neuro-protective and neuro-restorative treatments and therapeutic approaches increase neuro-plastic change at cell and network levels. Access to more precise diagnostics is enabling more effective treatment choices. The expertise of specialist medical and rehabilitation centres is becoming more widely shared and implemented. We are living in truly exciting times when more than ever can be done for traumatic brain injury survivors.
BrainLine - An American multimedia website providing information and resources about treating and living with TBI; it includes a series of webcasts, written online resources and an electronic newsletter. It has a version in Spanish too.
Model Systems Knowledge Translation Centre [MSKTS] - The Model Systems Knowledge Translation Centre works closely with researchers in the 16 Traumatic Brain Injury Model Systems to develop resources for people living with traumatic brain injuries and their supporters. These evidence-based materials are available in a variety of formats such as printable PDF documents, videos, and slideshows.
Headway - A UK charity for TBI which has a comprehensive website, with information on the different aspects of TBI and its rehabilitation. It has a number of useful written resources for patients on the website, including ones on Brain Injury and Epilepsy, Loss of Taste and Smell after Brain Injury and Balance Problems and Dizziness after Brain Injury