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- Traumatic Brain Injury - Happens due to trauma
- Anoxic/Hypoxic brain injury - Happens due to decreased blood or oxygen supply to the brain.
- Ischemic or hemorrhagic cerebrovascular accident (commonly referred to as stroke) - Happens due to clots occluding the blood vessels in the brain or due to bleeding of blood vessels in the brain
- Brain tumors and metastasis (spreading of cancer) to the brain
- Vascular malformations of the brain such as Arteriovenous malformation, aneurysm etc -
- Brain infections
- Autoimmune conditions such as Multiple Sclerosis and auto-immune encephalitis -
- Toxic/metabolic causes such as post transplantation, sepsis, liver failure and kidney failure
- Basically any injury or illness that affects your brain function for a prolonged period of time causing temporary or permanant damage
Usually individuals affected by these conditions can have a number of symptoms directly related to the brain injury such as
- One-sided or both sided weakness and numbness of the arms and legs
- Pain and tightness of the arms and legs
- Difficulty with speech
- Impaired consciousness (i.e. impaired arousal)
- Cognitive impairment such as memory problems, slow thinking skills, problems with attention
- Changes in their behavior such as aggression
- Changes in their mood such as depression and anxiety
- Difficulty in swallowing
- Bladder and bowel incontinence
- Visual problem
- Hearing problem
There are medical complications that can be noted a few weeks or months after a brain injury. Some common ones include
- Urinary tract infection
- Deep vein thrombosis – blood clot in the veins of your arms and legs
- Pulmonary embolus – blood clot in your lungs
- Pressure ulcers
- Heterotopic ossification – a condition which causes stiffness of your joints
- Post-stroke shoulder pain – shoulder pain in the weak arm
- Spasticity – tightness of the muscles of the affected arm and leg
- Paroxysmal sympathetic hyperactivity – a condition which causes fluctuations in your blood pressure, heart rate, and also causes abnormal stiffness of the arms and legs
- Hydrocephalus – a condition where fluid builds up in your brain
HOW REHABILITATION CAN HELP?
A comprehensive, interdisciplinary team approach (i.e. care being provided by various disciplines in a coordinated fashion) with Physician (Physiatrist), Physiotherapist, Occupational Therapist, Speech and Language Therapist, Neuropsychologist, Nutritionist and a Nurse can help reduce your symptoms directly related to the injury as well as prevent and treat common medical complications post brain injury. Not all patients will require all services and usually, a combination of these services is required for an individual patient.
Patients can be evaluated by the Physician first to determine the nature and severity of the medical condition then come up with a treatment plan that best suits them. Depending on the patient’s symptoms and medical complications (listed above), the treatment plan will include recommending therapy services, prescribing medications and performing injections. Medications are commonly prescribed for medical complications as well as to reduce symptoms directly related to brain injury such as arm and leg weakness, muscle tightness, speech impairment, mood and behavior issues, cognitive impairment and impaired arousal. The physician performs injections such as tendon injections, joint injections for joint or muscle pain as well as Botulinum toxin (commonly referred as Botox injections) and nerve block injections to help relieve muscle and tendon tightness.
A Physiotherapist will focus on various physical exercises to improve weakness in the arms and legs, improve their walking and balance and to reduce muscle tightness. They might use physical modalities to reduce pain and inflammation, muscle and tendon tightness and prevent muscle atrophy. They can also fit you with an orthosis to reduce muscle tightness as well as improve your walking and arm function.
An Occupational Therapist will focus on various physical activities required for daily living for patients with severe physical and/or cognitive impairment and also teach cognitive exercises thereby compensating the cognitive deficits. Visual Training exercises are provided to individuals with visual impairment due to the neurological problem. The final phase of treatment involves patient training for successful community integration (education, employment etc).
A Speech Language Pathologist (commonly referred to as a Speech and Language Therapist), will evaluate the patient’s speech, communication and swallowing skills. The treatment plan is broken down after an initial evaluation. The program will vary depending on the extent of the injury, the stage of recovery, and the individual’s particular areas of difficulty. Specific retraining and compensatory exercises are taught to improve the above skills. However, the major focus is on helping the individual gain back his/her quality of life.
A Neuropsychologist evaluates patients with depression and anxiety, that is commonly seen after any major life-changing illness or injury and guides them through the process of rehabilitation thereby improving their quality of life through motivation and counseling. Performing an in-depth cognitive assessment and planning cognitive re-training exercises and compensatory strategies is also a major treatment aspect of a Neuropsychologist.
Malnutrition or undernourishment is a common problem in this population. For optimal recovery, a Nutritionist recommends an appropriate intake of nutrition.
A Rehabilitation Nurse trains patients with central nervous system injury to manage their bowel and bladder independently. Performing and training wound care management for patients with pressure ulcers are also handled by a Rehabilitation Nurse.
EXPECTATIONS OF RECOVERY
Depending on the severity and chronicity (time duration since injury/illness) of the injury/illness, your recovery time may differ. Complete neurological recovery is often possible if the injury is mild to moderate. In the case of a moderate to severe injury, a complete neurological recovery may not be possible and therefore the goal will be to help you be as independent as possible and integrate you into the community despite your physical and/or cognitive limitation. If the injury is too severe, then the goal would be to improve your quality of life by helping you be as independent as possible with your day to day living, decrease pain and prevent complications.