Rehabilitative Management
Now that thankfully the person has survived the post-traumatic stage the work of the physiotherapist begins. Our job is to return this unfortunate person to the highest level of independent function possible. Sounds simple, but it can be a very complex, changeable and frustrating process as more often than not a person who suffers a traumatic brain injury displays a very multifaceted array of signs and symptoms.
Its is the complex array of injuries, deficits and symptoms that complicate management, rehabilitation and recovery. For example, a person who has marked loss of the function of a lower limb has a much more difficult recovery if there has also been an impact on understanding and cognition as it impacts the understanding of guidance and its processing. A highly skilled, specifically trained and experienced clinician however will not only offer best hope for evaluating all the issues encountered but also bring enjoyment, positivity, confidence, compassion, understanding and education.
Some of the most important issues to aim to overcome are:
- Physical
- Mental
- Emotional
- Cognitive
- Perceptual
- Social
Deficits Related To Head Injury
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Consciousness
A coma is defined as a score of 8 or less on Glasgow Coma Scale. However, it only lasts up to a month after which a person is deemed to be on a ‘persistent vegetative state’ if still in a state of unconsciousness with or without subcortical level responses e.g., eye following. Post Traumatic Amnesia is described as the time between the accident and when the person is able to recall what can be described as ongoing events e.g., what they had for breakfast or the day before. This can last for an indefinite amount of time and while in this time it can seem that each moment exists in isolation. This can also be similar in behavior to Alzheimer’s and other forms of dementia as well as post Epileptic fit. However, in this period there is no carryover of information or memory from day to day or hour to hour. These symptoms can be very different person to person, week to week and from an improvement perspective. This has obvious implication for rehabilitation, however even people without what’s described as ‘declarative’ memory i.e., to answer a question about the previous day may actually retain ‘procedural’ memory where in fact when you start a similar routine-based approach especially in early rehabilitation the person may improve without remembering the previous session. Amazing stuff.
More deficits e.g., cognition, behavior and sensorimotor as well as their impacts on the rehabilitative process will be discussed shortly.