Abstract
Traumatic brain injury (TBI) and its potential long-term consequences are of major concern for public health. Neurorehabilitation of affected individuals has some specific characteristics in contrast to neurorehabilitation of patients with acquired brain lesions of other aetiology. This review will deal with the clinical consequences of the distinct lesions of TBI. In severe TBI, clinical course often follows a typical initial sequence of coma; followed by disturbed consciousness; later, post-traumatic agitation and amnesia; and finally, recovery of function occurs. In the different phases of neurorehabilitation, physicians should be aware of typical medical complications such as paroxysmal sympathetic hyperactivity, posttraumatic hydrocephalus, and posttraumatic neuroendocrine dysfunctions. Furthermore, we address questions on timing and on existing evidence for different rehabilitation programmes and for holistic neuropsychological rehabilitation approaches.
Highlights
Recent studies [1,2] estimated that over 40% of patients who were hospitalized as a result of an acute moderate to severe traumatic brain injury (TBI) show long-term disability, with prevalence rates ranging from 3.2 to 5.3 million in the USA, that is, more than 1.1% of the U.S population.In Switzerland, estimated incidence of severe TBI was 10.58 per 100,000 inhabitants per year [3]
We will focus on in-patient rehabilitation and some specific topics that are clinically relevant in neurorehabilitation of TBI, and point out what distinguishes it from the care of patients suffering from other brain injuries
In a typical case of severe TBI, the natural history of recovery consists of a period of impaired consciousness, sometimes accompanied by paroxysmal sympathetic hyperactivity (PSH), followed by a period of posttraumatic agitation (PA) and/or confusion with amnesia and, subsequently, by a period of post-confusional recovery of function, characterized by a diversity of cognitive, behavioural, emotional, and sensorimotor disturbances [11]
Summary
Recent studies [1,2] estimated that over 40% of patients who were hospitalized as a result of an acute moderate to severe traumatic brain injury (TBI) show long-term disability, with prevalence rates ranging from 3.2 to 5.3 million in the USA, that is, more than 1.1% of the U.S population. Data on the economic impact of this problem are scarce, but estimates for the USA rate the annual cost to be more than 221 billion U.S. dollars, while estimates of the Center of Disease Control being more conservative with 56 billion. We will focus on in-patient rehabilitation and some specific topics that are clinically relevant in neurorehabilitation of TBI, and point out what distinguishes it from the care of patients suffering from other brain injuries
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