Brain Injuries

Traumatic Brain Injury (TBI) also known as intracranial injury occurs when trauma causes damage to the brain. This is a result of a fall, an accident, or a sudden hit to the head that causes damage to the brain tissue. TBI symptoms can be mild, moderate or severe, depending on exact damage. Someone experiencing mild TBI may experience a loss of consciousness for a few seconds. Some symptoms of mild TBI are confusion, headaches, blurred vision, lightheadedness, dizziness, behavioral or mood changes, and problems with memory or thinking. A person with moderate or severe TBI experience the same symptoms, but their headaches never really go away, have convulsion, loss of coordination, and inability to awaken from sleep. Anyone suffering from …show more content…
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TBI can contribute to psychiatric problems including substance abuse, depression and anxiety. Some experience post-traumatic stress disorder which can result in a blow to the head during an accident or even war. PTSD is a recurring traumatic event you have experienced. That traumatic event can cause outburst and different other types of radical behavior.Brain Injuries And Methods of Rehabilitation After Them Essay
Severe TBI can result in impaired social functioning. “People with TBI have been found to have difficulty recognizing faux pas and interpreting ambiguous advertisements, sarcastic remarks, and the nature of interpersonal relationships” (McDonald and Flanagan, 2004, p. 573). People are unable to interpret the meaning of certain comments that are made by others. They do not have the ability to read the emotional state of others. TBI can cause communication problems that the person is unable to finish a complete sentence. They will also have problems with understanding an individual’s perspective. People who have a TBI will have trouble being successful at home or at work because they would lack social communication skills.Brain Injuries And Methods of Rehabilitation After Them Essay

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This article is a study on people who are able to return to work after experiencing a traumatic brain injury. The purpose of the article is to better understand the complications that come with a brain injury when the person returns to work. The people with the brain injury were compared to relatives who did not have a brain injury. The method they used for the study included 46 adults with traumatic brain injury and 46 of their relatives. They were split into 2 groups based on their employment; employed or unemployed. Thus, in the test the employed group had less difficulties with interaction. The question of this study is, are traumatic brain injury patients able to return to work and social commination ability fully after their accident? The communication deficits play a role in the returning to the workplace after traumatic brain injury, meaning there might need to be some adjustments.Brain Injuries And Methods of Rehabilitation After Them Essay

Ninety- two participants were chosen for the study, forty-six of them had traumatic brain injury and forty-six of their relatives did not have a brain injury. The subjects were male and female adults. The age varied, the education preinjury employment, the severity of the injury or postinjury time did not affect the research. They were placed into two groups based on their employment status either employed or unemployed. To be qualified for the employed group they were required to have been employed before their injury and still employed at the same or similar job. To qualify for the unemployed group, they needed to be employed before the injury and had trouble returning to work after the injury. The participants needed to have completed education in an English-speaking country to qualify.Brain Injuries And Methods of Rehabilitation After Them Essay

Traumatic brain injury (TBI), or intracranial injury, is a medical diagnosis which refers to closed or penetrative damage to the brain that is caused by an external source. Every year, TBIs affect approximately 150-250 people in a population of 100,000 (León-Carrión, Domínguez-Morales, Martín, & Murillo-Cabezas, 2005). The leading causes of TBI are traffic accidents, work injuries, sports injuries, and extreme violence (León-Carrión et al., 2005). TBI is most often fatal when the cause is an injury due to the use of firearms, a traffic accident, or a long fall (León-Carrión et al., 2005). However, fatality rates and rates of occurrence differ in various countries due to…show more content…Brain Injuries And Methods of Rehabilitation After Them Essay
Patients who suffer from a mild TBI often require little rehabilitation and function normally over the course of a week or so (León-Carrión et al., 2005). Patients with a moderate TBI often suffer psychological and physical stressors, but they have an 80% chance of being high-functioning after a certain amount of time (León-Carrión et al., 2005). However, patients with moderate to severe TBI often suffer long-term physical and cognitive problems as a result of their injury. The disabilities that result from moderate to severe TBI differ depending on the area of injury, but they may include difficulties in speech, coordination, bilateral function, memory, complex thinking, and other areas (Murrey, 2006). Emotional and social areas are also affected by TBI due to changes in familial roles, lowered self-esteem, and hopelessness brought on by the injury (Murrey, 2006). Because of this, suicide rates in these patients are remarkably high, with 33% of patients at risk (León-Carriòn et al., 2005). Recovery in TBI patients may occur spontaneously throughout the two years following the trauma (León-Carrión et al., 2005). Beyond this point, remaining disabilities are usually permanent (León-Carrión et al., 2005). Implications for Music Therapy Because both TBI and music therapy have such broad definitions, music therapy has the capability to affect patients in several ways. In the case of a mild TBI, music therapy may not be necessary. Brain Injuries And Methods of Rehabilitation After Them Essay

2. Body
The recovery process following TBI is a slow process that might take months or years, rather than weeks. Six months following an injury yields a clearer picture of what effect the injury has had, but waiting roughly a year after the accident before making any important decisions regarding the future is considered advisable. Physical recovery will take approximately a year, but psychological recovery might take considerably longer. Factors that may affect the rate of a person’s recovery include injury type, severity, location of the individual’s brain injury, age (younger patients tend to have better outcomes), pre-injury health, pre-injury personality, intelligence and lifestyle, social support from family and friends and other factors like alcohol or drug abuse. Depending on the individual’s physical abilities and potential, a rehabilitation programme will be initiated accordingly.Brain Injuries And Methods of Rehabilitation After Them Essay

The effectiveness of a comprehensive multidisciplinary rehabilitation team (Box No.3) is increased when compared to natural recovery following brain injury. The importance of recognizing the vegetative state and its management is emphasized. Finally, the important, but often neglected area of employment rehabilitation is covered. We plan to explain the rehabilitation process starting from the day of the accident with the aim of recovering from the posttraumatic brain injury sequlae and achieving reintegration into the community.

The iterative process of consultation yielded consensus definitions for each component of the rehabilitation service pathway for head-injured adults (Table 1). This chapter describes not only brain injury due to road traffic accident or fall from a great height but also brain injury in war victims. Modern rehabilitation practices are based around the concepts of impairment, disability and handicap, as outlined by the World Health Organization (WHO) in 1980. Recently, however, the WHO has redefined these concepts.Brain Injuries And Methods of Rehabilitation After Them Essay

The modern terminology that will be introduced in the near future still encompasses the term ‘impairment’, but now replaces ‘disability’ with ‘activity’ and ‘handicap’ with ‘participation’. This is not simply a sign of political correctness, but serves to emphasize the positive aspects of disability rather than its negative connotations. The rehabilitation approaches consist of three basic types; 1) reducing the disability; 2) acquiring new skills and their application for reducing the impact of disability; 3) alteration of the environment in physical and social contexts, so that existing disability will carry as little participation as possible. For example, a young male individual had a traumatic brain injury and recovery with residual hemiplegia with spasticity and urinary incontinence. A specific programme tailored to this individual’s needs was offered during brain injury rehabilitation management process. (Box No. 4).Brain Injuries And Methods of Rehabilitation After Them Essay

Title and description Sites Description of rehabilitation input
Minor HI: education – medically stable, requiring 24-48 hrs. observation prior to community rehabilitation, with low probability of acute neurological deterioration Acute A&E observation ward Assessment and observation – education, emotional and social support. Planned discharge home or moves to code 30 at 48 h
Supportive rehab – medically unstable, requiring neurosurgical or clinical care Acute hospital Identifying and addressing early rehab goals before medically stable and transfer of care to rehab team.
Supportive rehab – medically unstable, not requiring neurosurgical or critical care Acute hospital Identifying and addressing early rehab goals before medically stable and transfer of care to rehab team.
Rapid access rehab – medically stable, not (necessarily) able to actively participate due to amnesia, confusion, rejection, low response or awareness Acute hospital Needs inpatient care due to physical dependency and requires continuous clinical assessment to facilitate optimal timing for rehab input and detect clinical deterioration. Immediate early rehab delivered and judgment made on timing/ appropriateness of referral to next rehab sector.
Active participation inpatient rehab – medically stable, able to actively participate with and benefit from therapy Acute or community hospital Needs inpatient care due to physical dependency, or need for specialist therapy equipment, safe environment, supervision or intensity of therapy, which cannot be provided in community Brain Injuries And Methods of Rehabilitation After Them Essay
Behavioural rehab – medically stable, but with prolonged confusion, amnesia or behavioural difficulties, requiring specialist behavioural management, intensive supervision and secure environment Specialist inpatient unit Specialist behavioural management, including high staff/patient ratio to ensure intensive supervision and secure environment; access to neuropsychology and neuropsychiatry.


Slow-stream rehab – medically stable, but with low awareness or response persisting beyond, e.g., three weeks after sedation; withdrawn and medically stable. Able to benefit from medical and physical therapy to prevent complications and support recovery Community hospital or specialist inpatient unit Assessment/active rehabilitation phase, which needs to be distinguished from long-term care, although planning of care an increasingly important aim after, e.g., six months. Patients may go to active participation unit if sufficient improvement occurs.
Community rehab – medically stable, able to actively participate with and benefit from, therapy. Will include spectrum of initial severity of injury with a small minority derived from code 05 category. Domiciliary or day hospital Interdisciplinary coordinated management therapy aimed at community reintegration/inclusion by enhancing independence and assisting return to work/education. In collaboration with social services, voluntary and statutory services. Includes treatment of patients in residential care or with live-in carers.Brain Injuries And Methods of Rehabilitation After Them Essay
Intensive cognitive rehab – medically stable, independently mobile, primarily cognitive impairments likely to benefit from intensive neuropsychological therapy. Domiciliary or day hospital Aiming to return to work, studies or independent community life.
Specialist vocational rehab – medically stable, living in community, aiming to enter/ return to employment. Domiciliary or residential Aiming for return to work, where this is influenced by physical or cognitive problems, or needs residential placement.
Maintenance – medically stable but permanently disabled. Domiciliary, residential or nursing home, respite unit Prevent deterioration of physical, emotional and behavioural conditions, and long-term management of seating, pressure, spasticity, etc.
Social, patient and carer support – carer support for initial injury, patient support when able to communicate. All sites Developing social skills, stamina, confidence, attention and leisure pursuits, sorting out benefits, day supervision and respite care. Specific attention paid to: community involvement and integration (further education, etc.); personal social development; structured daytime activity; family support and outreach.
HI = head injury; rehab = rehabilitation; A&E = accident and emergency
Table 1.
Classification of head injury recovery and actual/potential rehabilitation services (adult).Brain Injuries And Methods of Rehabilitation After Them Essay

Brain injury rehabilitation occurs in the following settings:

Inpatient rehabilitation: This involves intensive specialist rehabilitation for people who are not yet ready to return home after discharge from hospital. Neurological rehabilitation centres provide an ideal setting for further treatment, where a structured rehabilitation programme is in place throughout the day.

Outpatient rehabilitation: Some people may be well enough to return home and receive further treatment as an outpatient, either at a local hospital or at a separate rehabilitation centre.

Community rehabilitation: Following an inpatient rehabilitation stay, some people may be transferred to a residential transitional living unit. Here people can develop their independent living skills so that they may be able to live in a place of their own. Others will go straight back to their homes, with a community rehabilitation team or outreach team helping them to make further progress; this may involve therapists working with the person in their home or community environment [2].Brain Injuries And Methods of Rehabilitation After Them Essay

The main basic approach to treatment in the above example was to reduce disability through appropriate medication with which to control spasticity and for applying new skills of physiotherapy and occupational therapy to improve the individual’s functional activity of gait training. This was done through means of ambulation in an indoor environment, with physical aid and wheelchair aid for long distances and, by using an adaptive device to facilitate feeding and other self-care activities. Additionally, adapted fittings to bathrooms and kitchens can be installed. Liaising with the injured individual’s employer and having a dialogue for initiating his return to work in a part-time capacity or having downtime between working hours to reduce fatigue can also be instigated. The involvement of his family is also important to make them more accepting of his condition and for effecting the necessary adjustments to their own lifestyles.

The basic nature of rehabilitation is to work with the disabled person and family in partnership. The interdisciplinary rehabilitation team should provide accurate information and advice, explain the prognosis and natural history and work with the individual to establish realistic goals within an appropriate social environment. Whatever approaches implemented, setting a realistic goal is key to a good quality rehabilitation programme. For example, the long-term goal of independent walking requires a number of short stages to be implemented, such as sitting, balance training without support, standing balance without support, walking in parallel bar, walking with a person’s assistance, walking with aids and lastly independent walking.Brain Injuries And Methods of Rehabilitation After Them Essay

The rehabilitation team and disabled person should know what the goal is and when this goal has been achieved. Thus, valid and reliable outcome measures are very important for supporting the rehabilitation process. The most common measures used in the UK is the Barthel Index, but functional independence measures are also very common worldwide. Physiotherapy and occupational therapy using a 10-meter walking test for improvement of walking and a nine hole pick peg test for improvement of hand function, respectively, are also used. There are many other tools for measuring variable functional independence measure (FIM) cognitive and motor functions, the Glasgow coma scale (GCS), Rancho Los Amigos levels of cognitive functioning scale (RLA), disability rating scale and the Coma Recovery Scale-(Revised). It is important to highlight that the use of valid and reliable outcome measures is important in order to observe goals, assess progress and adjust the rehabilitation programme. The author has published articles related to the above-mentioned variables influencing and predicting functional outcomes after TBI [3].Brain Injuries And Methods of Rehabilitation After Them Essay

For example, in her study [3], she pointed out that there was positive correlation of functional independence measure on discharge (FIMd) and RLA (Figure1). The researcher postulated GCS as a predictor of functional outcome and showed in her result positive correlation of GCS and FIM cognitive. Rehabilitation should begin as early as possible (even at the level of acute care) (Figure 3) [4]. It is common for individuals to ultimately be transferred to a rehabilitation unit when avoidable complications are already present. Unfortunately, muscle contractures, pressure sores and unnecessary aggressive behaviour are atypical during stay in rehabilitation unit . If the rehabilitation team can be involved in the early stage of acute care setting, perhaps even on the intensive care unit, it is more likely that such complications can be avoided. Studies provide evidence that undertaking rehabilitation within the first days of evolution improved cognition, perception and motor recovery of brain-damaged patients, and led to shorter lengths of stay (LOS) in rehabilitation units [5,6,8].Brain Injuries And Methods of Rehabilitation After Them Essay

Figure 1.
Correlation of FIM d and Rancho

Figure 2.
Correlation of FIIM cog D and GCS

Figure 3.
Rehabilitation following brain injury
An early intervention rehabilitation team (EIRT) has been initiated by the author at the level of trauma or surgical intensive care units in Hamad General Hospital (HGH), Qatar. A rehabilitation programme focusing on cognitive stimulation and prevention of musculoskeletal complications of contractures has been offered. Pressure ulcers and aggressive behaviour has been limited by providing appropriate orthoses, frequent positioning, psychotropic medication or psychiatric consultation, while transfer to rehabilitation units as early as possible have resulted in shorter LOS in acute care units in HGH and have shown improvement in physical and mental impediments. This chapter will classify and promptly summarize the rehabilitation process of the slow stream rehabilitation programme, the active participation programme and long-term rehabilitation programme, the community based rehabilitation programme and returning to the community or work.Brain Injuries And Methods of Rehabilitation After Them Essay

Most rehabilitation units will admit individuals a week or so after injury once they are medically stable. Generally, individuals have an average stay of about three months. However, longer-term rehabilitation is important if short-term gains are not to be lost. Outpatient rehabilitation should continue at least until physical recovery has plateaued. Recovery of cognitive and intellectual problems can take longer than physical problems and it is often such psychological difficulties that cause most handicaps and distress to the injured individual’s family. This problem must be compensated by establishing a long-term facility that must be allowed to give the injured individual rehabilitation and medical service for at least one year. Following on, another important step in the rehabilitation setting is that the rehabilitation team will need to clearly establish links with social services as well as other relevant professionals, such as employment rehabilitation experts.Brain Injuries And Methods of Rehabilitation After Them Essay

The rehabilitation team recommends developing close links with the established community rehabilitation centre (CRC) in the state or province, with CRC in turn having links with the regional rehabilitation unit or rehabilitation hospital. Most post-acute rehabilitation is conducted in the hospital setting or at the regional rehabilitation unit, before individuals are discharged back into the community. At this point, the community team becomes involved and is able to deliver ongoing physical and psychological rehabilitation through a multidisciplinary team, based in a peripheral hospital, as well as being able to deliver services within the home. The author is working on establishing CRC in Qatar under the national strategy of rehabilitation. Brain Injuries And Methods of Rehabilitation After Them Essay

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