The brain injury may be caused by traumatic and non-traumatic conditions. Disorders like stroke, cancer and poisoning, which may lead to non-traumatic brain injury, require disease-specific approaches in the acute phase. Regarding the chronic phase, the treatment principles depend on the outcome of the brain injury, affected brain area, and the severity of the injury. The treatment of brain injury is considered in two groups as treatments in acute and chronic phases.
Treatment In The Acute Phase
Every patient with cranial or cerebral injury should be referred to the emergency medical care. Even mild head traumas may have serious consequences. The brain injury and its severity can be diagnosed with the physical examination, computerized tomography, and magnetic resonance imaging.
In brain injuries, there is generally primary damage at the time of the first impact or disease and secondary damage emerging hours or days later due to the increase of the intracranial pressure and brain edema. The emergency medical care enables the prevention or reduction of secondary damage.
During the emergency care, first the vital functions are brought under control. Afterwards, some patients need to be transferred to the intensive care unit. Keeping the head up, oxygen support, pharmacotherapy against seizures, hyperosmolar treatment to reduce the brain edema, reduction of the cerebral oxygen consumption with the help of anesthetics are methods used in the traumatic brain injuries. In addition, cooling the whole body or the brain may help to decrease the brain damage. The physical examination, tomography and monitoring of the intracranial pressure are useful in the decision for surgery. If hematoma (blood accumulation) developed, the cranium is opened with a technique called craniotomy and the blood is removed and the bleeding is brought under control. In patients with brain edema, the brain is depressurized and a space for the swelling is provided with a surgical technique called decompressive craniectomy.
The Consequences Of Brain Injury
The weakness in arms and legs and paralysis related to brain injury are findings easy to observe at first sight. However, brain injury may impair cognitive, emotional, and behavioral functions and sometimes these dysfunctions are not recognized by the patients or relatives. The rehabilitative approach should comprise all these problems.
The Effects of Brain Injury
Weakness in the arm or leg due to brain damage, can be seen at first glance. However, brain damage also causes mental, emotional, and behavioral effects and may be more difficult to understand by the patient and those around the patient.
BASIC PRINCIPLES OF THE REHABILITATION IN BRAIN INJURY
The patient, who hospitalized in the rehabilitation center for the treatment of the brain injury, should be thoroughly evaluated by the physiatrist. Nevertheless, all health personnel should work as a team for a comprehensive therapeutic approach. Of course, the patient and his/her relatives are at the center of this team. After the vital risks are eliminated, the rehabilitation should be initiated at the early phase. The basic principles of the rehabilitation:
- The swallowing function is evaluated and if necessary therapeutic precautions are considered.
- The diet is arranged by a dietitian.
- The medication and rehabilitation are monitored by the nurses.
- If the patient has speech and cognitive disorder, speech therapy should be considered for the recovery of the communication skills.
- Occupational therapy is essential for the regaining of the self-care ability and routine daily activities.
- In order to provide the freedom of actions (from bed to the chair, gait, balance), physiatrists implement certain exercise programs. High-tech methods such as robotic rehabilitation, computer-assisted balance devices may be used.
- After the evaluation of the physician, if necessary, orthosis technicians will produce orthosis specific for the patients and supervise the implementation.
- Electric stimulation and heat application are implemented by the physiotherapy technicians for the treatment of pain, joint stiffness and the strengthening of the muscles.
- The psychiatric evaluation is performed by the specialists and if necessary, the suitable treatment is organized.The social worker will take care of a proper job for the patient and provides social support.
- Stem cell therapy, transcranial magnetic stimulation, environmental enrichment are some new methods under research for the treatment of the chronic phase of brain injury.