I. Timing of intervention and criteria
The earlier the rehabilitation treatment for traumatic brain injury casualties, the better, and should be carried out from the acute to the recovery period. All injured patients with neurological dysfunction should receive rehabilitation treatment to varying degrees.
Second, treatment principles and methods
1.Acute period
Generally refers to 2-4 weeks after a mild injury, 4-6 weeks after a moderate injury, 6-8 weeks after a severe or very severe injury.
(1) The casualty should be kept in a natural position while lying in bed. Shake the head of the bed high several times a day for 20-30 minutes each time. In principle, turn once every 2 hours.
(2) Encourage the conscious casualty to take the initiative to perform light physical activities. If active movement is not possible passive joint movement must be performed to avoid joint contracture.
(3) The casualty should be given positive environmental stimulation, including music, touch, and calls from loved ones, to ensure adequate nutrition. Back patting, breathing exercises and postural drainage should be given to casualties with respiratory impairment.
(4) Any treatment should avoid inducing epilepsy and cranial pressure increase, etc.
2.Recovery period
During this period, the vital signs of the casualty are relatively stable, neurological symptoms are not aggravated, cerebral edema and intracranial hypertension have been controlled, and no new changes in condition requiring surgical treatment have occurred. The external cerebrospinal fluid drainage tube has been removed or the ventriculo-abdominal drainage tube is open, and there is no cerebrospinal fluid leakage. No serious dysfunction of other important organs, no progressive development of lesions on CT or other imaging, no serious infection, diabetic ketoacidosis. There is still persistent neurological dysfunction or complications that affect self-care.
During this period, treatment should be arranged in a targeted manner for the type and degree of functional impairment of the casualty, with gradual progress and attention to changes in condition and casualty safety. In addition to rehabilitation professionals and technicians, the joint participation of family members and other relevant personnel is required to.
(1) Assessment of the casualty’s somatic function, mental and psychological state, speech and swallowing function, etc., detailed understanding of the degree of functional impairment, according to which rehabilitation treatment programs and goals are formulated.
(2) Casualties with impaired consciousness can be treated with medication and hyperbaric oxygen to promote recovery of consciousness, and family members should actively cooperate in affectionate arousal.
(3) Traumatic brain injury casualties are often combined with impairments in memory, attention, orientation, and calculation, which can be rehabilitated through medication, hyperbaric oxygen therapy, and cognitive function training, requiring active cooperation from family members.
(4) Injured patients who have decreased language expression, comprehension, reading and writing skills should undergo speech training. Medical personnel and family members, etc. should communicate more verbally with the casualty.
(5) Feeding should be determined on the basis of assessing the casualty’s diction and swallowing function, and if necessary, retaining a gastric tube for diction and swallowing function training. Family members and other relevant personnel should feed the patient under the guidance of rehabilitation professionals to prevent the occurrence of aspiration or asphyxia.
(6) On the basis of full consideration of the casualty’s condition, physical strength, and cardiopulmonary function, assist the casualty with training in joint movement, sitting, standing, balance and coordination, walking, and motor control. Safety should be observed during training to prevent accidents such as falls.
(7) Strengthen the training of the injured person’s ADL ability, strive to restore the self-care function of the healthy limb as early as possible, and gradually promote and restore the self-care ability of the affected limb. Use of assistive devices and orthoses when necessary.
(8) For casualties with urinary and faecal dysfunction, first find the cause and carry out targeted treatment. Select appropriate defecation and urination methods and cultivate correct defecation and urination habits.