Rehabilitation For Brain Injuries Essay

Traumatic brain injury (TBI), which is defined as a physical injury to brain tissue that temporarily
or permanently impairs brain function, is a global health concern and a growing socioeconomic
problem. TBI is the leading cause of mortality and disability among individuals under the age of 45,Rehabilitation For Brain Injuries Essay

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with young adult males accounting for approximately 75% of cases. Due to the complex
pathophysiology associated with TBI, there is currently no effective pharmaceutical treatment
available for widespread clinical use. Consequently, individuals who suffer debilitating TBI often
require lifelong medical care and support.
TBI is commonly classified based on the clinical severity of the injury, ranging from mild to severe.
The Glasgow Coma Scale (GCS) has become the universally accepted severity classification system
for TBI. Based on scores (ranging from 3-15) from eye, motor, and verbal tests, the GCS classifies
TBI cases as mild (GCS 14-15), moderate (GCS 9-13), or severe (GCS 3-8). In addition to clinical
severity, TBI has also been traditionally classified based on the mechanism of injury. Mechanismbased classification usually categorizes TBI as either closed or open head injuries. Closed head
injury, also called blunt or non-penetrating brain injury, does not involve a breach of the brain’s
dura mater; however, skull fractures may occur. Closed head injury is the most common type of
TBI in the general population, and is typically caused by sports injuries, motor vehicle accidents,
and physical assault. In contrast, open head injury involves the penetration of the scalp, skull,
meninges, and often brain tissue itself. Such penetration injuries are more common amongst
military personnel, and are usually caused by foreign objects such as bullets.Rehabilitation For Brain Injuries Essay
TBI might involve various types of gross or microscopic brain damage depending on the
mechanism and severity of injury. Despite this heterogeneity, the associated damage of TBI is often
categorized as resulting from either primary or secondary injuries. Primary injuries are induced at
the moment of impact, when mechanical forces are applied to the brain. These forces most
commonly affect the frontal, parietal, and temporal lobes, and result in focal and/or diffuse injury
patterns. A focal injury pattern typically occurs following a direct blow to the head and may result
in contusion, hemorrhage, and ischemic infarct. Diffuse injury patterns are typically a result of the
stretching and/or shearing of white-matter tracts due to the differential motion of the brain within
the skull. The severity of this diffuse pattern ranges from a brief disruption and misalignment of
axonal neurofilaments to widespread axonal tearing. Secondary injuries result from processes that
are initiated by the primary insult, and may develop over the hours, days, or weeks that follow.
While different variations of TBI may initiate a range of secondary mechanisms, with variable
extent and duration, these processes most commonly involve increased excitatory neurotransmitter
release, calcium-mediated damage, mitochondrial dysfunction, free radical generation,
hyperphosphorylated tau, amyloid plaques, and a neuroinflammatory response.
Depending on the severity and brain structures affected, various signs and symptoms may appear
within the seconds to weeks following TBI. These might include a loss of consciousness, headache,
vomiting or nausea, convulsions or seizures, dilation of one or both pupils, clear fluid draining from
ears or nose, loss of bladder or bowel control, slurred speech, confusion, dizziness, sensory
problems, sleeping abnormalities, memory loss, cognitive impairments, agitation, irritability,
combativeness, disinhibition, impulsivity, anxiety, depression, mood swings, motor problems, and
other unusual behaviors like paranoia or mania.
To date, improvements in TBI patient outcomes have resulted from advances in intensive care  Rehabilitation For Brain Injuries Essay
management, neurosurgical techniques, and rehabilitation. Unfortunately, these strategies often
result in limited benefits after TBI. Given that TBI is an international health concern with limited
treatment options and no effective pharmaceutical intervention, it is imperative that research is
conducted to better understand the underlying pathophysiological mechanisms of TBI and improve
TBI treatment strategies.

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.Rehabilitation For Brain Injuries Essay

Methods
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.Rehabilitation For Brain Injuries Essay

Traumatic brain injury (TBI) is the result of an external force against the head that causes displacement of the cranial structures, either through impact with an object or through acceleration and deceleration. TBI is not isolated to a single ethnic group, socioeconomic class, or region (Berquist et al., 2009; Jang et al., 2013). In 2002, the United States had the highest incidence of reported TBI cases of any developed country. The incidence of hospital admissions due to closed head injuries in the United States was estimated to be approximately 200 per 100,000 people, and the number of penetrating head injuries was estimated to be 12 per 100,000—approximately 500,000 new cases in total. Many of those cases had significant neuropsychological deficits and exhibited severe long-term disabilities (Maas, Stocchetti, & Bullock, 2008). The United States Center for Disease Control and Prevention (CDC) reported that in 2010, there were 2.2 million emergency department visits and 280,000 hospitalizations with the diagnosis of TBI alone or with other injuries (Faul, Xu, Wald, & Coronado, 2010). TBI can occur at any age; however, there has been a higher incidence seen in older adults due to longer lifespans and an increased risk of falls. Adolescent males have traditionally been the group at the highest risk for TBI, in particular in relation to sports and recreation. The advancement of technology and implementation of safety regulations, such as mandatory seatbelt use in vehicles and helmet use on bicycles, lead to a decrease in the overall number of reported cases of TBI in the 20th century (Maas et al., 2008). According to the CDC, between the years 2000 and 2010, emergency department visits involving TBI showed a 70% Rehabilitation For Brain Injuries Essay

Brain injury is a general term referring to any injury to the brain. Brain injury is stimulated by a number of factors such as bike and a car accident, assault, as fall, or a blow to the head, but these example of brain injuries which occur in nature. They are types of brain injuries such as, the brain injury that occur after birth, the traumatic brain injury (TBI) which is caused by an object such as stabbing or gun shots entering the brain causing widespread damage (Brain Injury Support(BIS), 2015; Volpe,2012). Apart from these types of brain injuries, the brain can be damaged due to lack of enough oxygen to the brain as a result to heart attack, internal bleeding like a stroke (ABI, 2015; Volpe, 2012). ABI (acquired brain injury) rehabilitation is an agency that specialises in rehabilitation after a traumatic brain injury and a stroke. But this paper will focus on brain injury only because it is an area of interest. Max Cavit is the manager director of ABI who came to an agreement with ACC to develop rehabilitation service in New Zealand (NZ), Max ‘s ideas evolve around how people living with brain injury were mostly garaged without access to rehabilitation service in 1996 NZ (ABI, 2015). After fifteen years, ABI has stood alone with its own facilities in Auckland and Wellington. ABI has about 200 medical specialist across all regions, and these specialists have a background whether in nursing or therapy, but they all have experience across all ages Rehabilitation For Brain Injuries Essay

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Rehabilitation after brain injury is largely unpredictable as every injury is unique. This section gives an overview of the processes and timescales for recovery and rehabilitation, explains how families can assist in the process, and details where people can receive help and support.

Unlike most other cells in the body, brain cells do not regenerate when they are destroyed. However, this does not mean that no recovery can occur. The brain is somewhat flexible and is able to reorganize itself, to an extent, in order to regain lost function. This is known as brain ‘plasticity’.

During recovery, other areas of the brain take over the activities of the damaged areas and new nerve pathways can be established using undamaged brain cells. Engaging in activity helps these alternative pathways to develop.Rehabilitation For Brain Injuries Essay

Rehabilitation aims to help the brain learn alternative ways of working in order to minimise the long-term impact of the brain injury. Rehabilitation also helps the survivor and the family to cope successfully with any remaining disabilities.

Timescales for recovery and rehabilitation
In the first month or two after a severe brain injury it is only possible to guess at the length of time that recovery will take and the likely outcome. All that is certain is that recovery is a slow process and will take months or years rather than weeks.Rehabilitation For Brain Injuries Essay

Six months after the injury the picture will be clearer, but it is wise to wait until about a year after the accident before making any important decisions regarding the future. After a year or so one can be reasonably certain about the eventual degree of physical recovery. However, psychological recovery can take considerably longer and it is usually these more subtle psychological problems that cause longer-term difficulties, particularly for family members.

People do sometimes talk about there being a limited ‘window’ for recovery after brain injury, for example, that recovery ceases to take place beyond two years. However, this is now known not to be the case and people may actually continue to improve for a number of years after brain injury. Indeed, many people say that they never stop re-gaining the skills that they lost following the injury.

Nevertheless, the greatest visible progress does occur in the first six months or so post-injury and after this improvement is often less obvious.Rehabilitation For Brain Injuries Essay

Accessing brain injury rehabilitation services
There are many rehabilitation services across the UK, run by the NHS or private firms. You can search for Headway approved rehabilitation and care units in the Supporting you section or contact the Headway helpline for more information.

Choosing which rehabilitation unit to refer someone with a brain injury to should involve the clinical team, the patient and their family. Once a referral has been made, the rehabilitation unit will usually carry out an assessment to make sure their service is suitable.

Availability and funding for places varies. However, most units, including private ones, accept NHS referrals and will be funded by the NHS. Other possible sources of funding include the local authority, medical insurance, compensation claims and self-funding.Rehabilitation For Brain Injuries Essay

It is important to ensure that whoever is likely to have to fund the rehabilitation is aware that a referral has been made. The rehabilitation service will not be able to accept an admission until funding has been authorised. Many services accept referrals from outside their own area, but there are often limited places available and long waiting lists. Specific details about the referral process, availability of places and funding options will be available from the unit.

Taking up a rehabilitation placement is an important commitment, and it is wise to explore all the options, visit different rehabilitation settings, and ask as many questions as possible before a placement is confirmed.

Rehabilitation settings
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.Rehabilitation For Brain Injuries Essay
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.
The role of family members in rehabilitation after brain injury
The British Society of Rehabilitation Medicine (BSRM) has produced guidelines on rehabilitation after acquired brain injury. The guidelines recognise the important role family members and carers play in the rehabilitation process:

“Family members are very often a crucial asset to the patient, providing both long-term support and a major contribution to the rehabilitation process. It is also important for the team to recognise that family members often have a special rapport with the patient and may detect subtle communication in advance of the professionals.Rehabilitation For Brain Injuries Essay

“Families can provide valuable insights into the patient’s character, choices and ambitions, as well as important information on the presentation of difficulties in the home setting. This is essential in initial assessment, and in the monitoring of rehabilitation gain, to minimise under-reporting of difficulties when the brain-injured person lacks insight”

(From: Rehabilitation following acquired brain injury: national clinical guidelines, BSRM, 2003).Rehabilitation For Brain Injuries Essay

What if no rehabilitation has been provided?
If your relative has been discharged home without any access to rehabilitation, and you have reason to believe that they would benefit from it, there are still options available.

You are perfectly within your rights to actively seek rehabilitation services, even if you have been told that there are none available or needed. The first thing to do is discuss the matter with your relative’s GP and/or consultant. They may be able to provide a referral. You can also contact rehabilitation services directly. The Headway helpline can provide information on specialist brain injury rehabilitation centres and you can search for Headway approved care providers in the In your area section.Rehabilitation For Brain Injuries Essay

It is advisable to contact several units and visit them to assess their suitability before making a decision. There are several other directories of rehabilitation professionals in private practice and you can find some of these in the Useful organisations section.

For more detailed information on brain injury rehabilitation see the Headway booklet Rehabilitation after brain injury Rehabilitation For Brain Injuries Essay

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