What is traumatic brain injury?
Traumatic brain injury can occur due to various causes, most commonly traffic accidents, fall from height, work accidents, assault, and gunshot wounds. It is a significant cause of disability in society, and its rehabilitation is substantial. After early intensive care treatment, an intensive neurological rehabilitation program, including robotic repair, is needed.
Traumatic brain injury is a brain injury that occurs when the head is suddenly and violently struck by an object or when an object pierces the skull and damages the brain tissue. It can lead to impairments in the cognitive and physical functions of the person, causing impairments in thinking, perception, speech, swallowing, and paralysis of organs such as arms and legs. Although it can occur almost anywhere and at any age, it is most common in young people, especially between the ages of 15 and 25. Motorcycle and bicycle accidents are an important cause. The use of helmets significantly reduces traumatic brain injury in such accidents. Falls and non-accidental traumas in children, traffic accidents in adults, and falls in the elderly are common causes of head trauma.
What are the symptoms of traumatic brain injury?
Since the brain is the body’s most sensitive and complex organ, traumatic brain injuries can lead to changes that profoundly affect a person’s life. These changes can be cognitive changes such as memory, perception, attention, understanding, and logical thinking or physical problems such as partial or complete paralysis, balance disorders, and swallowing and speech disorders.
The mortality rate in the early stages of traumatic brain injury is relatively high. Depending on the location and extent of the brain damage, patients may experience many health problems such as loss of use of arms and hands, gait impairment, sensory impairment, impaired intellectual functions, behavioral and personality changes, epileptic seizures, chronic pain, depression, and bladder and bowel problems. Depending on the severity of the trauma, loss of consciousness, nausea, headache, and neurological and cognitive effects are common. Mental problems such as decreased attention span, difficulty organizing thoughts, forgetfulness, confusion, learning new information, reasoning, and interpretation, inappropriate behavior in social situations, and test in problem-solving, decision-making, and planning may occur. Language problems, like cognitive problems, can vary from person to person. These problems include difficulty finding words, inability to form proper sentences, long and inaccurate expressions, test in understanding words, failure to understand different uses of words, idioms, and innuendos, a decline in reading and writing skills, and deterioration in math skills. Behavioral disorders such as personality changes, aggression, a tendency to violence, and loss of control can also occur due to traumatic brain injury. Physical limitations such as partial or complete paralysis, involuntary muscle contractions (spasticity), impaired balance and coordination, and difficulty swallowing can reduce the person’s functional independence. These symptoms vary according to many factors, such as the severity of the injury, the affected brain region, injuries to organs other than the brain, and pre-injury personality traits.
How is traumatic brain injury treated?
Patients with traumatic brain injury require emergency intervention followed by an early intervention by neurosurgery and neurology clinics. This intervention may take the form of intensive care follow-up or surgical intervention. The priorities of this intervention are to ensure oxygen supply and adequate blood flow to the brain and the rest of the body and to control blood pressure. Once the medical condition has stabilized, a physical therapy rehabilitation physician should immediately evaluate the patient, and an early rehabilitation program should be initiated. When the patient becomes eligible, the best option would be to follow the patient in a physical therapy and rehabilitation clinic with specialized neurorehabilitation and robotic rehabilitation facilities.
The recovery that occurs with the disappearance of edema in the brain tissue after the early period is called spontaneous recovery. In the later period, the sprouting of nerve cells and the formation of new nerve connections contribute to the continuation of the recovery. Studies have shown that neurological recovery after brain injury is most remarkable in the first six months. However, recovery after brain injury continues rapidly for up to 2 years. A comprehensive physical therapy and rehabilitation program will maximize the patient’s gains during this period. Although recovery is faster in the first two years, these patients may also have the potential for late recovery. Even in patients who are thought to have permanent cognitive and physical impairments, some abilities can be regained. For this reason, it would be beneficial for a patient who has suffered a brain injury to be followed up continuously by a team of physicians consisting of neurology, neurosurgery, and psychiatry specialists under the leadership of a physical therapy and rehabilitation specialist.
Rehabilitation in traumatic brain injury
Nowadays, thanks to the increasing and developing surgical and emergency aid methods, deaths due to traumatic brain injuries are decreasing, while rehabilitation and reintegration of patients into society are gaining importance due to the increase in survival rate. The aim of rehabilitation in traumatic brain injury is to improve impaired functions, enable walking, restore the patient to the highest possible level of independence, and prevent other health problems that may occur due to the disease.
Rehabilitation in traumatic brain injury should be started early. Simple measures such as passive joint movements and turning the patient every two hours while the patient is in intensive care or even unconscious can prevent problems such as common restrictions and pressure sores that may affect the success of rehabilitation in the future. Therefore, it is crucial that the patient is followed up by a physical therapy and rehabilitation specialist from an early stage. This way, complications that may arise in the acute period are prevented, and the patient is prepared for transfer to a rehabilitation clinic.
Patients who become medically stable are enrolled in a more intensive and comprehensive rehabilitation program. At the beginning of rehabilitation, the patient is evaluated in terms of the level of consciousness, motor, sensory, perception, balance, gait, and activities of daily living with a comprehensive examination, and a unique physical therapy and rehabilitation program is planned for the patient. This program is followed up with weekly evaluations and shaped according to newly determined goals.
Early mobilization of patients with traumatic brain injury is essential. Thus, complications such as muscle atrophy, pressure sores, osteoporosis, joint restrictions, and soft tissue calcifications that may arise due to immobilization are prevented. The physical therapy and rehabilitation program includes:
- In-bed mobilization.
- Sitting balance training.
- Using hands and arms.
- Getting out of bed and transferring activities.
- Standing up.
- Standing balance training.
- Walking.
- Climbing up and down stairs.
- Work occupation and movement of activities of daily living following the patient’s current medical condition and functional level.
In traumatic brain injury, involuntary muscle contractions called spasticity may occur. If these contractions disrupt the patient’s joint movements, positioning, and hygiene or cause pain during exercise, they must be treated. In addition to medications, physical therapy, and exercises, interventional and surgical methods can also be applied.
If the patient has joint contracture, range of motion exercises, stretching, bracing, or surgical intervention may be required. Muscle weakness can be seen in traumatic brain injury. In these cases, muscle-strengthening practices are used to bring the muscles back to normal strength. If there are balance and coordination disorders, exercises are also performed. Orthotics and other assistive devices can be utilized during these activities when needed.
Robotic rehabilitation is an effective rehabilitation method that can be used from an early period in patients with traumatic brain injury. It contributes to the early mobilization of the patient, stimulates neurological recovery through neuroplasticity, and increases the patient’s compliance with the rehabilitation program, motivation, and awareness. Early Stroke Mobilization Device (vertical movement device with electrical stimulation), Walking Robot (robotic walking device), Armeo (shoulder-arm robot), and Amadeo (hand-finger robot) are among the robotic technologies used for this purpose. Integrating robotic rehabilitation into the rehabilitation program from an early stage significantly increases success in the rehabilitation of patients with brain injury.
Hydrotherapy, or in-water rehabilitation, is another rehabilitation option that has a place in the treatment of patients with traumatic brain injury. In-water exercises help to strengthen weak muscles, improve balance and coordination, and reduce involuntary muscle contractions.
Occupational therapy (occupational therapy) is a therapy and rehabilitation program that aims to improve the quality of life of individuals by enhancing their independence and life roles in daily life through work, occupation, and activity. Occupational therapy is also actively used in the treatment of patients with traumatic brain injury.
Speech and language therapy and swallowing therapy are essential in rehabilitating patients with traumatic brain injury. First, the specialist therapist determines the areas where the patient is inadequate and organizes a treatment program for them. If necessary, a cognitive assessment can also be applied. In addition to exercises for speech and swallowing, mental problems such as forgetfulness are also addressed.
Respiratory rehabilitation, psychotherapy, neuropathic pain management, and treatment of bladder and bowel problems are other important aspects of rehabilitation for patients with traumatic brain injury.
The success of rehabilitation in traumatic brain injury is influenced by many factors, such as the severity of the brain injury, age, gender, pre-illness status, socioeconomic parameters, and the state of cognitive functions. Although the process is long and clinical recovery is sometimes prolonged, these patients, most of whom are young, can lead an independent and productive life with an appropriate rehabilitation program. If the patient is not included in a rehabilitation program designed for them in every aspect, he/she will fall behind in his/her performance. The ultimate goal of rehabilitation is to complete the vocational and economic rehabilitation of patients who have suffered a traumatic brain injury. Suppose they are unable to continue their old occupation. In that case, they should be given a new occupation or placed in a suitable job and brought to a self-sufficient, productive life level.