Rehabilitation after traumatic brain injury

About the injury

Traumatic brain injury (TBI) is damage to the skull and/or brain as a result of falls, accidents on the road, injuries at work or at home, during sports, as well as as a result of an intentional blow to the head.

TBI differs in severity and type of tissue damage, as well as in clinical form.

By severity:

In most cases, TBI has a mild degree. This is, for example, a concussion
Moderate TBI occurs as a result of a "mild" head injury. It provokes the accumulation of blood between the bones of the skull and the dura mater Severe TBI is the result of a head injury, when hematomas form with compression of the brain and so—called diffuse axonal tissue damage occurs. This can happen, for example, in an accident — as a result of sudden braking. The consequences of severe TBI can be very serious: mortality in the most severe forms of injury reaches 41-85%, while the average mortality rate in TBI is 5-10%.

By type of tissue damage:

Closed TBI is a head injury without violating the integrity of the skin and soft tissues or with minor injuries. Concussion also belongs to this type
Open TBI is a head injury with penetration through the skin, soft tissues and bones of the skull.

According to the clinical form:

Concussion is the most common type of TBI, which occurs in 70-80% of patients with such an injury.

With a concussion, the following symptoms may occur::

severe headache
short—term loss of consciousness - up to 30 minutes
short—term memory loss - up to a day
nausea or vomiting
weakness
stunning.

A concussion can also cause flushes of blood to the face, sweating, and trembling of the eyeballs.

There may be several symptoms at the same time, but they usually disappear in a few days.

A brain injury has a wider range of symptoms. Among them:

impaired consciousness that can last for several weeks
severe headache
memory loss (in mild cases, up to 24 hours )
nausea and vomiting
arbitrary movements of the eyeballs
impaired coordination and gait
speech disorder

Compression of the brain — accumulation of blood, cerebrospinal fluid or air in the cranial cavity, resulting in increased intracranial pressure.

Signs of brain compression:

nausea and repeated vomiting
severe headache
sleep disorder
impaired consciousness, hallucinations
apathy, lethargy, lethargy
respiratory disorders, wheezing
arterial hypertension
drooping of the upper eyelid, strabismus, facial asymmetry
epileptic seizures
impaired coordination and gait.

Diffuse axonal brain injury — rupture of nerve cell processes (axons).

This type of TBI is the most severe, as it can cause a prolonged coma (up to 3 weeks) with the risk of passing into a state where brain functions are partially disrupted, a person is not aware of himself and others, but his body is able to support respiratory, cardiac activity, and alternation of sleep and wakefulness. This period can last from several days to several months.

Consequences of TBI

Even a mild head injury can affect a person's well-being, cognitive abilities, speech disorders, and sensory organs (vision, hearing, and smell). However, the consequences may not appear immediately — weeks or even years after the incident.

Almost 90% of patients who have suffered a TBI experience periodic headaches, and 40-60% experience dizziness from time to time.

Also, after a TBI, there may be difficulties with concentration and memory problems, impaired vision and hearing. Rapid fatigue and sleep disorders are observed.

After severe TBI, limb sensitivity may be reduced and even complete paralysis may occur. Memory impairments are more significant than in mild and moderate TBI, up to complete amnesia. There may be impaired coordination of movements, as well as swallowing, nausea or vomiting.

Therefore, after a TBI, regardless of its severity and consequences, rehabilitation is mandatory. And it begins at the earliest stage — during the acute period of TBI, that is, from the moment of injury to the stabilization of the general functions of the brain and the entire body.

Stages of rehabilitation after TBI

The task of rehabilitation is to restore the lost functions — motor, cognitive functions, self-care skills. This is the work of a multidisciplinary team, which includes various specialists. For example, a physical therapist works with motor disorders, and an occupational therapist works with self—service recovery skills. The patient is guided by a rehabilitologist. He oversees the rehabilitation process: he manages the process from the medical side and helps in the interaction of specialists.

The rehabilitation program includes a range of methods in the combination that the rehabilitologist selects - according to the indications, capabilities and needs of the patient.
The methods include:

Physical therapy — work with a physical therapist. His task is to select, together with a rehabilitation doctor, a set of exercises to restore motor functions. Various simulators can be used here. For example:
- suspension systems for fixing limbs or body. This "turns off" gravity and reduces the patient's weight. In this condition, you can work out certain muscle groups. In particular, EMC has an Exart system for working out the deep muscles of the spine and joints. Or the unique Bioness Vector ceiling system, which allows you to practice walking or other exercises in the most natural conditions thanks to the ceiling mounts;
- underwater treadmill: exercising in the water also allows you to relieve body weight;
- Anti-gravity treadmill: reduces gravity load due to compressed air chambers and other exercise equipment.

Occupational therapy. It involves restoring the lost functions of self—care - self-eating, brushing teeth, and so on. If complete restoration of some functions is not possible, special devices are used. For example, a special spoon that allows you to take food with a weakened hand.
Breathing exercises
Massage of extremities to improve blood circulation and trophic (nutrition) of tissues
Drug therapy, selected for the treatment of both the underlying disease and concomitant (if any)
Classes with a speech therapist — restoration of swallowing and speech functions that may suffer after injury
Classes with a neuropsychologist — combating cognitive impairments, restoring memory, attention, and higher mental functions
Position treatment, which involves fixing the correct position of the limbs using orthoses, special rollers and rolls Reflexotherapy — combats pain, cramps.

There are three periods of TBI:

1. Acute period

The acute period lasts from two to 10 weeks, meaning rehabilitation can begin in the hospital and continue after discharge. At this time, it is important to avoid complications of the respiratory or cardiovascular system.

2. The interim period

This is followed by an interim period. Depending on the severity of the injury, it lasts from two to 6 months. Basic functions are being stabilized until they are fully or partially restored.

3. The distant period

It implies full or maximum possible recovery, taking into account the consequences of injury that occur in the long term. In case of severe injury, this period can last for years.

In the acute period, physical therapy, breathing exercises, and massage are mainly started. But all specialists can start working with the patient already in the acute period, if his condition is stable and he can study in a rehabilitation center. It is very important to start rehabilitation as early as possible.

How to prepare for rehabilitation after TBI

According to the prescription of the attending physician, rehabilitation can begin even at the stage of treatment in the hospital. Otherwise, the recovery program should start immediately after discharge from the clinic.

If the patient has not been previously observed at the EMC, it is sufficient:

general blood test
biochemical blood analysis
urinalysis.

At EMC, all necessary additional research and specialist consultations are done already at the Rehabilitation Center after receiving a rehabilitation doctor. EEG (electroencephalogram of the brain), Echo-EG (echoencephalogram), ECG, Dopplerography of cerebral vessels, MRI, CT, consultations with a neuropsychologist, speech therapist, and so on may be required.

Multidisciplinary team

The rehabilitation program involves the work of a team of specialists led by a rehabilitologist. Rehabilitation treatment of the patient is carried out:

the rehabilitologist guides the patient, oversees work with other specialists and their interaction, prescribes drug therapy and treatment methods
physical therapy instructor
occupational therapist — responsible for restoring self-service functions and household skills
speech therapist — engaged in the restoration of functions of swallowing, speech
neuropsychologist — helps to restore cognitive functions
clinical psychologist — works with the patient's emotional background and motivation
massage therapist
rehabilitation nurse.

The EMC Medical Rehabilitation Center employs more than 40 experienced specialists of various profiles who manage both adult patients and children. Heads the department Vitaly Fomenko is a medical rehabilitation doctor with more than 15 years of experience.

Terms of rehabilitation after TBI

The duration of rehabilitation depends on the severity of the injury, the patient's condition and the timeliness of the start of rehabilitation treatment. In case of severe injuries, several rehabilitation courses with a combined duration of up to two years may be required.
One course of rehabilitation treatment takes an average of 21 to 30 days.
With mild to moderate TBI, the first improvements are noticeable after a week of training with specialists — the headache decreases, and habitual skills are restored.

How to achieve the best effect from rehabilitation after TBI

Recommendation No. 1. Rehabilitation should not be postponed or neglected. To achieve the best results, you need to start in the first year after the injury, if later, the predicted result will be worse. The risks of consequences and additional costs for their relief are too high. In addition, lost skills and opportunities can significantly impair the quality of life.

Recommendation No. 2. The patient's family should understand the rehabilitation process. Even if specialists take care of a person during the recovery period, it is better for the family to know about the peculiarities of the body's condition at this time and have basic nursing skills.

Recommendation No. 3. Follow the doctor's recommendations. If, after the rehabilitation course or instead of it, the doctor has prescribed independent exercises in therapeutic gymnastics, it is important not to skip these classes.

Recommendation No. 4. Regularly undergo periodic check-up by a rehabilitologist. Then he will be able to assess the dynamics and adjust the recommendations.

Recommendation No. 5. After head injuries, a gentle regime should be observed. Sleep more, do not strain your eyes, walk outdoors if possible, exclude salty and spicy foods from the diet, and take vitamins and trace elements as prescribed by a doctor.