Introduction to craniocerebral injury and its staging.

Craniosynostosis is an injury to the skull area, especially the brain tissue, caused by external forces. War, traffic accidents, accidental falls, sports injuries, and other common causes. It can occur at any age. Its basic can be divided into 5 types and 3 stages: 1. According to the injury site, open (scalp crack strong, skull fracture, dural rupture, etc.) and closed two types (refers to the brain tissue is not the same as the outside world). 2, according to the injury pathological mechanism classification (primary and secondary). 3, classified by site (temporal lobe, parietal lobe, frontal lobe, brainstem, etc.) when the external force is strong, extensive brain tissue damage, can appear diffuse brain tissue damage, the patient performance deep coma, autonomic dysfunction, vegetative state, etc. 4, according to the nature of the injury classification (concussion, brain contusion and brain laceration together called brain contusion, intracranial hematoma). 5. Classification by injury condition (Glasgow coma volume GCS scoring). Rehabilitation staging: early stage refers to the normalization of vital signs and stabilization of the condition after rehabilitation intervention (15-30 days), focusing on the recovery of cognition. The recovery stage is worth the period of rehabilitation of limb function and other functions after significant improvement of cognitive function (within 3 months), and the sequelae stage refers to the dysfunction left after or without rehabilitation treatment. Today focus on the persistent vegetative state (PVS) in severe craniocerebral injury: rehabilitation clinical diagnosis is generally not difficult, according to the criteria can be easily determined from several aspects. 1, no cognitive function, no conscious activity, can not perform any commands; 2, maintain voluntary respiration and blood pressure; 3, there is a sleep-wake cycle 4, can not understand and express speech; 5, can automatically open the eyes; 6, can have purposeless eye tracking activity; 7, the basic presence of subthalamic and brain function (CT or MRI), must the above seven conditions to maintain 30 days can be determined the vegetative state. Craniocerebral injury should be carefully assessed before rehabilitation treatment, generally using the GCS scale for assessment, the vegetative state score is generally 3-5 points, after the recovery of cognitive function, the assessment will also use the GOAT scale (in order to determine the PTA) and the MMSE scale Halstead-Reitan test, etc. After the scientific assessment and quantification of the results, we develop rehabilitation goals and programs for the rehabilitation of the vegetative state. This rehabilitation program can be either immediate (cognitive) or long term (meaning that the patient’s dysfunction such as motor dysfunction, speech dysfunction, ADL ability, etc. are considered comprehensively). In particular, the specific postural reflex mechanism and the inhibition mode against abnormal posture (RIP).