TBI Patients : Recovery For Traumatic Brain Injury Rehabilitation
TBI : Brain Injury.
Brain Injury Rehabilitation Program
Rehabilitation of Brian Injury
Introduction: Traumatic brain injury (TBI) is damage to the brain as a result of an external force to the brain and it is associated with change in consciousness that can cause cognitive, physical and psychosocial functional disorders. This is a typical example of multiple disability in the adult and poses a challenge to the rehabilitation team because of the myriad problems the patient presents with. This article gives a brief overview about the condition delving into much detail.
The temporary or permanent damage to the internal structures of the brain present as:
- Motor disturbance
- Sensory disturbance
- Cranial never involvement
Mild head injury is manifested by any one or more of the following:
1- Any focal neurologic deficits, which may or may not be persistent.
2- Any period of loss of consciousness.
3- Any alteration in mental state immediately after the accident.
4- Admission in a hospital for less than 48 hours.
Secondary Disability (other organ failure due to prolonged immobilization) The person with traumatic brain injury could have suffered from multiple injuries as in needed. Multiple system failure may be primary in this case, but also may be secondary due to the patient being confined to bed for a long time, in an unconscious or semi-conscious state.
Assessment Scales : Assessment is generally done clinically at the bedside on the guideline given above but when these parameters have to be quantified, for example, the level of coma, the independence level; it is advisable to use standardized scales.
Rancho Los Amigos Scale
The patient may be in coma and he is assessed according to the Rancho los Amigos Scale. This universally recognized scale was developed for used in the planning of treatment, monitoring the recovery, and classifying outcome level in brain injury. It is an easy and simple test to perform for evaluation cognition of the patients and is a validated test. Not only does it given a status on the patient but it can also follow-up and compare between patients. There are 8 classification levels.
5 Year Girl After Brain Injury
Disability Scale (DRS)
Arousability, Awareness And Responsivity.
1 = to speech
2= to pain
TBI & Head Injury Treatment.
Overview of Traumatic Brain Injury (TBI)
No Response: The patient does not respond to environmental stimuli such as sound, sights, touch or movement.
Generalized Response: There will be a delayed response to environment, which may be non specific, like chewing, sucking, breathing faster, moaning or moving some part of the body. Sweating or increased blood pressure may occur as part of an overall systemic response.
Localized Response: The patient is awake on and off during the day, moves body more and recognize people around him. He may follow simple instructions like ‘open your mouth’ but responds inconsistently or incoherently to simple question.
Confused-Agitated: The patient becomes very confused or agitated, reacting to what he sees hear or feels by lashing out, shouting, using abusive language, or tossing about. He cannot follow directions, cooperate with the care giver, or concentrate even for a few second.
Confused-Inappropriate, Non-Agitated: This confused patient is less agitated than stage 4, and is not oriented to time or place. His memory and concentration are poor. He follows commands slowly and is still fully dependent for his ADLs. He may get obsessed on an idea or activity (perseveration) and needs help to switch to the next part of the activity.
Confused-Appropriate: This patient is still confused in memory and thought processes but can remember some snatches from a conversation. He can be persuaded to follow a certain routine, but will get confused and upset if it is changed. He is more oriented to time and place but cannot do multitasking, that is many tasks at a time.
Automatic-Appropriate: This person can follow his routine, take care of himself and is independent in most self care activities. However he is still confined to a routine and any change might irritate him. Long range planning or strategies still elude him, and he gets flustered in crowded surroundings. He is incapable of hand line an emergency.
Purposeful-Appropriate: In this stage the person is more adaptable, and is more aware of his loss of memory. He starts to compensate for his deficits and does not flounder in stressful situation. However when a new challenge presents itself he may show poor judgement.
Disability Rating Scale DRS
This scale though developed for brain injury, is used for other assessment program. There are 8 items in 4 categories; arousal and awareness; cognitive ability to handle self-care functions; physical dependence and psychosocial adaptability. DRS scores range from 0 to 30; a lower score indicates a lower level of disability, and a higher score obviously means more independence.
The treatment has been dealt with as:
- Medical treatment
- Surgical treatment