25 Oct Traumatic Brain Injury – Rehabilitative Management
Management Based on Cognitive Level
The rehabilitation of a person who suffers from a traumatic brain injury is difficult and wide ranging due to the array of deficits, presentations, signs, symptoms and issues that can arise from the trauma.
It is essential to collaborate with wide a wide range of health care professionals to achieve optimal care for the person depending on the issues they have to overcome e.g. a general practitioner (especially to monitor effects of any medication required), occupational therapist, and speech and language therapist to name a few.
Although the cognitive level of the person relates the level of rehabilitation, they are able for it must be stated that people all cognitive levels can be seen to be paired with all physical levels in rehabilitation e.g., someone with low level of comprehension may still be able to complete complex tasks.
Low Level Management
Patient with lower levels of responsiveness have little if any interaction with the environment and people around them.
Goals of early rehabilitation:
- Prevent contractures
- Prevent decubitus ulcers
- Improve environment reaction & response to stimulation
Evaluation:
- Passive range of motion
- Spontaneous activity
- Response to stimulation
- Muscle tone
- Reflexes
- Gross motor skills e.g., postural reactions
Treatment:
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Passive Range Of Motion
Early Passive range of movement exercises can be aggressive in regularity and progress as much as able to prevent early issues. However, you must consider the patients consciousness, responsiveness, nociception, sensitivity etc. Control, slower pace, rotations have been shown to be effective.
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Positioning
The aim here is to provide support to the body, prevent deformities and skin breakdown, to improve cosmesis and to allow mobility where possible. The most important aspect of this is ongoing evaluation of the effects of what you are doing and change as required so as to not just consider it a ‘forever’ plan that can lead to suboptimal assessment and management. You must also consider the rate at which the person improves. That is to say this may be a very quick stage for someone improving at a faster rate but a person who seems to be in a consistent vegetative state may plateau at this level and requires appropriate, long term positioning planning and management to provide comfort and the aforementioned issues.
In the next blog I will discuss Stimulation and Mid-Level Management and High-Level Management of Traumatic Brain Injuries as well as the issues that cross all levels e.g. range of motion, mobility, documentation, goal setting and outcome prediction.