Craniocerebral injury, also known as traumatic brain injury, refers to the damage suffered by the skull and brain by external violent impact, in addition to direct damage to the skull and brain tissue, but also often complicate intracranial hematoma, cerebral edema, increased intracranial pressure and other secondary injuries, is the incidence of China’s second only to the extremity of the trauma of the serious trauma. Craniocerebral trauma injuries are often complex and serious, with a high morbidity and mortality rate. After resuscitation, most of them survive but often leave different degrees of neurological dysfunction, such as consciousness, movement, language, cognition and so on. All of these can bring pain and burden to the patients, their families and the society, so it is necessary to give active rehabilitation to patients with craniocerebral trauma. However, due to the multiplicity of traumatic brain injury sites and the complexity of the injury, its rehabilitation not only involves the rehabilitation of limb motor function, but also involves the rehabilitation of higher central functions such as memory, attention, thinking, etc., and the complexity and difficulty of its rehabilitation is far greater than that of cerebrovascular disease, and it is the most difficult rehabilitation in the neurological rehabilitation, so it is more necessary for the family members to understand and participate in the patient’s rehabilitation. I. Common Causes of Craniocerebral Injury 1. Traumatic brain injury can be divided into two categories of open brain injury and closed craniocerebral injury according to whether the brain tissue is connected with the outside world or not. Open refers to the brain tissue is connected with the outside world, while closed can have scalp laceration or even skull fracture, but the brain tissue is not connected with the outside world. The former is mostly caused by sharp objects such as knife blades, gun bullets, shrapnel and other sharp objects acting directly on the head, all accompanied by skull fracture. Closed craniocerebral injuries are mostly caused by traffic accidents, falls, and falls with external forces on the head. According to the way of external force on the head can be divided into direct injury and indirect injury. Direct injury refers to the injury caused by hard objects acting directly on the head, and indirect injury refers to the brain injury that occurs when the external force passes to the head along the spine or the brain injury complicated by chest compression injury. 2.Cerebrovascular disease Due to embolism or rupture of blood vessels in the brain, resulting in sudden interruption of blood supply to the brain, part of the brain tissue is damaged due to ischemia, hypoxia or hematoma compression. 3.Brain tumor Brain tumor can make brain tissue pressure, increase intracranial pressure, hydrocephalus and so on hinder the flow of cerebrospinal fluid, affect the cerebral vascular circulation, resulting in brain damage or tumor cell activity is strong, infiltration and destruction of neighboring brain tissues or the tumor body occurs hemorrhage, cystic degeneration, and so on sudden brain injury. 4.Others, such as encephalitis, chronic poisoning of the brain, parasitic disease, etc. lead to brain tissue damage. Second, how to prevent brain injury 1, the workplace must have strict safety measures. 2.Obey traffic rules and pay attention to traffic safety. Drivers should regularly repair their vehicles, and children should not play around when crossing the street. 3. Physical exercise should have safety measures. Elderly people should exercise moderately, not strenuous activities or overload exercise. 4. Cultivate healthy living habits, eat a balanced diet, get enough sleep, drink less alcohol and do not smoke. Scientific data show that the possibility of cerebrovascular disease in long-term heavy smokers is three times higher than that of non-smokers, and the possibility of cerebrovascular disease in long-term heavy drinkers is one time higher than that of non-smokers. Those who suffer from high blood pressure, heart disease, diabetes and hyperlipidemia should have regular checkups, timely consultation and strict medication. Pay attention to the early symptoms of brain damage, early diagnosis and early treatment. Third, the early symptoms of craniocerebral injury 1, craniocerebral injury secondary to cerebral edema and (or) hemorrhage in the light of fatigue, headache, dizziness, impaired consciousness. In severe cases, due to increased intracranial pressure, severe headache, agitation, nausea, vomiting, progressive consciousness disorder, and even coma. Neurologic signs are displayed immediately after brain injury. Except for the presence of aphasia, hemianopsia, and other locatable signs that cannot be determined due to impaired consciousness. Other parts of the brain injury often appear immediately after the corresponding signs: motor disorder limb weakness or spasm, urinary and fecal incontinence, aphasia, pupil size and respiration, abnormal changes in body temperature, personality and behavioral abnormalities and so on. 2, cerebrovascular disease, commonly known as stroke, often appear aura of stroke. Often manifested as fatigue, dizziness; numbness or weakness of one side of the limbs for a few seconds or minutes, suddenly go off course, weakness in lifting the legs; insomnia and forgetfulness in recent times, lack of concentration, abnormal judgment and acceptance, slow action, slow reaction, emotional abnormalities, inability to self-control; language barriers within a short period of time, choking and coughing, transient darkness, or blurred vision, and so on. In case of the above situations, timely examination and treatment should be carried out to prevent the aggravation of brain damage. Brain injury caused by brain tumor Early symptoms of increased intracranial pressure and focal symptoms caused by tumor compression or invasion of neighboring brain tissues. Such as generalized or partial epileptic seizure, progressive sensory disorder, consciousness disorder and dysfunction of each cranial nerve. Once brain injury is recognized, on-site resuscitation should be carried out immediately, do not pick up the patient and shake him/her, carry him/her on the shoulder and back, move him/her to a safe and warm place, call the emergency number immediately, and send him/her to the nearest hospital for resuscitation. If the patient has been unconscious, should keep the airway open, remove vomit and blood clots in the mouth; pull out the tongue, put the patient in a semi-prone position or lateral position, to prevent the tongue from falling back to block the airway. Patients with traumatic brain injury should be bandaged with clean dressings to stop bleeding. If there is oozing of brain tissue, use a clean bowl to cover it and then bandage it to avoid sending the ooze back into the skull. Do not flush the head with water after traumatic brain injury. If there is cardiac arrest, cardiac massage outside the chest is feasible. In short, the rescue should be organized on the spot, and it is not suitable for long-distance transportation and excessive moving, and it is best to transport safely in the presence of medical personnel. V. Family rehabilitation of brain injury The late stage of brain injury mainly shows neurological symptoms corresponding to the site and degree of injury, which are mainly manifested as crooked mouth and eyes, unfavorable language, heavy stagnation of hands and feet and even hemiplegia. How to make the patients recover or improve their functions through learning and functional training, direct or compensatory methods, so as to maximize the recovery of their sensory, motor, cognitive, verbal communication and social life skills has become the focus of family rehabilitation. 1, good posture The maintenance of good posture during the recovery period of brain injury is the most important training program, which is the best posture for preventing abnormal muscle tension, not only for maintaining joint mobility, maintaining the functional position of limbs and preventing spasm, but also for preventing decubitus ulcers, respiratory infections and improving blood circulation. In the supine position, the head should be well supported, the affected shoulder and arm should be fully supported by pillow pads, so that the head and neck are correctly positioned, the shoulder is externally rotated, the upper arm is driven, the forearm is externally rotated forward, and the thumb is pointed outward. The lower limbs of the hip and knee were supported by pillow pads to make the hip internally rotated and the knee bent, and the foot was supported by pillow pads to make the ankle dorsiflexed at 90°. When lying on the healthy side, the affected shoulder is facing forward, the affected shoulder is placed on the supporting pillow cushion, the affected hip is facing forward, the affected leg is placed in front of the healthy leg, and the same pillow cushion is used for support to help the affected hip to rotate internally. When standing, the head and neck should be set squarely, eyes looking straight ahead, the affected arm naturally drooping, palm forward, thumb pointing outward, the lower limb knee slightly flexed, the joints inward, so that the hip internal rotation. The above positions can effectively resist spasm and lay a good foundation for maximizing the recovery of motor function. 2, the training of motor function after brain injury, the contralateral limb motor function is damaged, its recovery directly affects the patient’s ability to take care of themselves and the quality of social life, the family of the patient’s affected side of the limb joints, muscle passive activities should be carried out in a timely manner in order to prevent contracture of the joints, muscle atrophy. The active activities of patients are especially important. (1) Upper limbs and hands The patient holds the affected side with the healthy side of the hand to make it move in all directions; thumb-to-palm movement, pinching up small objects with the hand, and trying to improve the fine movements of the hand. (2) Lower limbs: Supine knee flexion and twisting pelvic movement and bridge movement are of great significance to the ability to stand and walk. The former makes patients lie on their backs, bend both knees and shake to the left and right to maximize the pelvic movement, which can exercise the waist and hip muscles and enhance the strength of the lower limb band muscles. The latter is the patient lying on his back, arms straight on the bed, knees flexed and together, the soles of the feet on the bed, lifting the buttocks so that both buttocks lifted off the bed, can exercise the lumbar, buttock muscles, enhance the strength of the sacroiliac muscles, in order to facilitate the lumbar and iliac drive the lower limbs to achieve the purpose of walking. (3) Passive activity of joints The de-cerebral tonus and de-cortical tonus caused by craniocerebral injury can lead to abnormal muscle tension increase, coupled with the coma caused by long-term inactivity of the joints, it is easy to occur muscle spasm. Therefore, the whole body limb joints, to maintain the range of motion of the joints is necessary. Generally, each time you can passively move the joints of the limbs 3 to 5 times, 1 to 2 times a day. When moving, pay attention to gentle techniques to avoid pain and injury. Rehabilitation training of language function: After brain injury, most of the patients have motor aphasia and unfavorable speech, so the speech training of patients should be strengthened. Communicate with the patients more, correct their pronunciation, let the patients look at your mouth shape and speak with you. Let the patient count, say familiar things or the name of relatives, repeated training, strengthen the exercise, so that its language communication function recovery. 4, cognitive function training The so-called cognitive rehabilitation refers to the rehabilitation measures to improve the daily life ability of the patients through training and relearning to regain the ability of effective information processing and execution of actions after the brain function is damaged. At present, there are many commonly used rehabilitation methods, which can be divided into two categories: unidimensional method and multidimensional method. (1) Unidimensional approach, i.e., treating a certain dysfunction in cognitive impairment alone. (1) Memory training: the recovery of memory after craniocerebral injury mainly depends on the recovery of brain function. Giving patients oral Nimotopes 30mg 3 times a day and Haberin 100mg 3 times a day is helpful in improving patients’ memory. At the same time, the patient can be trained to memorize. It can be trained by the following methods: ② visual memory training: show the patient several pictures of daily life items familiar to the patient for 5 seconds, and then withdraw them and let the patient say the name of the items he sees, repeat the process and gradually increase the number of pictures. ③ Newspaper reading training: let the patient say the name of the section of the newspaper that he/she has read, and then train him/her to say what he/she is interested in after success. ④ Map work training: use a map with streets and buildings without text markings, the therapist points out with his/her hand to start from a certain place, walk along the street to a certain place and stop, and let the patient return to the starting point along the route from the stopping place. Repeat 10 times, two consecutive days without error, and then increase the difficulty. In addition, in daily life should also pay attention to: the establishment of a constant routine; make full use of visual, auditory, tactile, olfactory and motor and other sensory input with the training; each training time should be short, the memory of the correct and timely encouragement; more use of memory aids, such as notepads, which have a home address, commonly used phone numbers, birthdays, etc., and to develop the habit of frequent recording and frequent access to records. ⑤ Attention training: Attention refers to the mental process of focusing one’s mental activities on a certain object for a certain period of time. Attention disorders can be trained in the following ways: ⑥ Guessing game training: first use two transparent cups and a pinball, under the patient’s gaze, put the pinball into one of the cups and let the patient point out the cup with the pinball. Repeat this several times and change to an opaque cup when it is correct. Increase the difficulty as the patient progresses, e.g., increase the number of cups or the number of balls. (vii) Deletion work training: Write several capitalized Hanyu Pinyin letters on a piece of paper, have the patient delete the specified letters with a pencil, change the order of the letters when successful, and then delete the specified letters again. Gradually narrow the letters to complete the above training. ⑧ sense of time training: let the patient start the stopwatch according to the requirements, and stop at 10 seconds, repeated several times. After the success of the gradual extension of time, when extended to 1 minute, the error is less than 1 to 2 seconds, changed to not let the patient look at the table, the mental calculation to 10 seconds to stop, until correct. ⑨ thinking training: thinking is a higher function of the brain, including reasoning, analysis, comparison, synthesis, abstraction and other processes. Thinking disorders can be trained in the following ways: ⑩ Point out the news in the newspaper: take a local newspaper and first ask the patient to say the information on the front page, such as the name of the newspaper, the main headline, the date and so on. If correct, then ask him to point out the columns of the newspaper, e.g., sports, business classified ads, etc. If it is correct then train him to look for special information, such as the weather forecast for the day. ⑪Arrange the numbers: Have the patient take three number cards and arrange them in order from smallest to largest. Then give the patient a number card and ask him to insert it between the three cards according to size, and ask about the relationship between the numbers when correct, such as odd, even and multiple relationships. ⑫ Classification: Give the patient a list with the names of 30 items and tell him that these items belong to three main categories and let the patient classify them. After successful training have him perform finer categorization. After success you can give the patient a list of items that have something in common, such as bread-egg-steak, and let the patient answer what they have in common. (2) Multidimensional Approach. Multidimensional approach is a kind of environmental therapy, which means that instead of treating a particular cognitive disorder, many factors such as the patient’s personality, emotions, life and society are taken into account in a comprehensive way. In addition, computers are widely used in cognitive rehabilitation, which can be used to train the patient’s attention, concentration, hand-eye coordination, discrimination and other aspects of the ability. Its advantages are: it can give patients stimulation under a high degree of control; patients only need to compete with themselves, and it is easy to see the results, thus increasing the patient’s motivation and confidence; accurate and objective, patients are happy to use. However, its shortcomings are: the computer lacks human feelings and social, can not communicate with the patient, so can not rely on the computer alone for training. Sixth, the rehabilitation of behavioral disorders Through the assessment of the patient’s behavior, to determine the target behavior and scoring, the following measures can be taken to give treatment. 1, reinforcement and punishment Reinforcement is in the behavior after the emergence of any kind of measures that can promote the behavior to repeat; punishment is in the behavior after the emergence of a kind of measures that can make the behavior as little as possible. Both are important tools for behavioral treatment. The common types of reinforcement we see in everyday life are attention and praise. If someone is praised for doing a good deed, it will motivate him to continue to do good deeds. But incorrect reinforcement can also keep wrong behavior coming up. If a child gets what he wants when he cries, it will also motivate him to cry more often. For a patient with conduct disorder when he behaves appropriately, or when he has not behaved inappropriately for a long time, the patient can be given favorite physical objects such as chocolates, drinks, cigarettes, etc. and praised at the same time. The patient may also be given concessions or privileges such as going to the movies. When a patient exhibits inappropriate behavior, systematic withdrawal of his favorite reinforcers given in the past is commonly used as a form of punishment. For example, a patient was originally given the privilege of watching a movie once a week, and when he physically attacked others, the privilege should be canceled until normalcy is restored. 2, elimination Elimination is the behavior can not be strengthened and automatically weakened or disappeared. Such as when the patient appears inappropriate behavior, take him to the empty house (pause room) to stay 2 to 5 minutes, or take him to the other end of the house, can also be taken to ignore the method, so that its behavior is not strengthened and gradually disappear. Seven, sensory-motor training Listening stimulation: you can have a formal conversation with the patient, thematic discussions, or with the radio, television sound, but be careful to prevent noise or a variety of sound mixing. Visual stimulation: you can use family members or friends of the photos to the patient, should pay attention to the whole field of vision within the scope of the systematic stimulation Olfactory stimulation: put the patient usually like perfume or coffee in front of the patient’s nose, so that the patient with the breath inhalation, each time for 10 to 15 seconds. Taste stimulation: use a cotton ball dipped in sauce on the patient’s lips or tongue, or use ice cubes with sauce in the patient’s mouth. However, it should be noted that this should not be done in patients with swallowing disorders because of the risk of choking. Tactile stimulation: Tactile stimulation can be performed on various parts of the body by turning the patient over, bathing, dressing, etc. It can also be performed by massaging the patient’s body. Vestibular stimulation: Vestibular stimulation can be performed by performing neck movements on the patient, rotating on a cushion, or rocking propulsion movements on a wheelchair. The above stimulation can be utilized in one training session of 1 to 2 types for 15 to 30 minutes at a time. During the stimulation, close attention should be paid to observing the patient’s response, such as changes in heart rate, blood pressure, respiration, etc., as well as the presence of eye movements, strange facial expressions, and head rotation. Family rehabilitation after brain injury is very important, and patients should be encouraged to enhance their confidence, so that they can be sick but not disabled, disabled but not disabled, and lay the foundation for returning to social life.