Craniocerebral trauma has become the fourth cause of death after heart disease, malignant tumor and cerebrovascular disease, mostly caused by fall injuries, fights or traffic accidents, and ranks second in the incidence of trauma after limb injuries. After recovering from a mild craniocerebral trauma, headache, dizziness, anxiety, difficulty in concentration, depression and other sequelae may occur. Survivors of severe craniocerebral trauma often suffer from various degrees of functional impairment, such as hemiparesis, aphasia, memory loss, perceptual and cognitive impairment, and other complications and sequelae. Because of the many types of craniocerebral trauma, complications and sequelae, rehabilitation should be carried out throughout the treatment of craniocerebral trauma. In terms of craniocerebral trauma, some functions can be restored as before, while some functions are impossible to be fully restored. For the functions that can be fully recovered, various therapies should be used to promote their early recovery. For the functions that cannot be fully recovered, the patient should be made to understand and recognize the condition correctly, to comply with the functional involvement, to seek the maximum compensatory function, to reduce the sequelae, and to restore the patient’s daily life or social life. (1) Paralysis: If the higher centers of the brain responsible for muscle tone and muscle reflexes are damaged, it can involve the innervated limbs, and the initial stage is mostly soft paralysis, and the later stage is mostly spasticity. (2) Movement disorders: muscle contraction and tone disorders lead to movement disorders, mostly caused by cerebellar injury resulting in incoordination of muscle contraction and inaccuracy in speed, timing and direction. (3) Disorders of balance and uprightness response: damage to the brain center causes disorders in the postural adjustment response to maintain balance. (4) Sensory impairment: Sensory abnormalities or deficits due to damage to sensory areas of the cerebral cortex, as well as disturbances in tactile discrimination (pain, temperature, solidity) may occur. There may also be dysfunction of specific senses due to damage to the processing centers of the brain, such as abnormalities of vision, hearing, taste, smell and perception. (5) Speech dysfunction: dysarthria is more common. (6) Cranial nerve injury: multifocal nerve, auditory nerve, motoneurotic nerve, talocrural nerve, abducens nerve and optic nerve. (7) Late-onset epilepsy: epilepsy that occurs 1 week after the injury, usually due to scarring, adhesions, and stimulation by chronic iron-containing heme deposits. Cognitive aspects (1) decreased attention and concentration; (2) memory deficits, memory loss, and decreased learning ability; (3) perceptual disturbances: problems with spatial relations, body image disturbances, loss of recognition and use; (4) language disturbances: aphasia is the most common problem. Psychological and social aspects In the early stages of recovery from craniocerebral trauma, patients may exhibit behavioral disturbances and low functioning in psychosocial abilities, including emotional instability, aggressive behavior, impulsivity and anxiety, disorientation, frustration, denial, and depression. Early recovery Coma is the most severe form of consciousness disorder, i.e., a complete loss of sustained consciousness, a state of unresponsiveness to external stimuli, and the inability to be aroused to recognize oneself or one’s surroundings, as well as the inability to awaken to strong painful stimuli. About 10% of patients remain unresponsive for 1 month after the injury and enter a vegetative state. It is possible to awaken from the coma and gradually regain function at a later stage, but the longer the coma lasts, the less likely it is to recover. Coma Scoring Criteria (GCS) Three factors: eye opening (E), verbal performance (V) and body movement (M); mild: 13-15 points, coma time within 30 minutes after injury; moderate: 9-12 points, coma time from 30 minutes to 6 hours after injury; severe: 3-8 points, coma time more than 6 hours after injury, or those whose consciousness deteriorates within 24 hours after injury and coma again for more than 6 hours. Some people divide those with scores of 3-5 from heavy and classify them as extra heavy. Comprehensive rehabilitation measures should be taken as early as possible to avoid serious cerebral ischemia and hypoxia, closely monitor intracranial pressure and blood gas values, promptly exclude intracranial hematoma, control cerebral edema, lower intracranial pressure, prevent all possible comorbidities, stabilize the condition as soon as possible, and prevent the occurrence of persistent vegetative state. (1) Maintain nutrition, maintain water and electrolyte balance The nasal feeding diet for comatose patients should be gradually increased according to the functional status and digestive function, not less than 30-50cal per kg of body weight per day, and the protein supply should be more than 1g per kg of body weight per day to maintain positive nitrogen balance, replenish necessary electrolytes, and correct water-electrolyte disorders in a timely manner. If oral and nasal feeding cannot meet the basic nutritional requirements, gastrostomy feeding is feasible. (2) Central nervous system metabolic drugs Promptly give pro-neurotrophic and metabolic activators and awakening agents, such as the application of antidepressants, antitremor drugs, endogenous opioid receptor blockers also have a certain effect of promoting awakening. To improve cerebral blood supply and increase oxygen content, hyperbaric oxygen therapy is feasible. (3) Pay attention to the good posture of the limbs. Pay attention to the posture of the limbs and the treatment of the good limb position, especially pay attention to the prevention of lower limb flexion contracture and foot drop deformity. Passive movement of the limbs and regular turning of the limbs should be carried out to prevent pressure sores. Start passive limb movement and joint mobility training to prevent joint tonic contracture and muscle atrophy. The principle of lower limbs first, then upper limbs, and large joints first, then small joints should be followed. (4) Sound stimulation, visual (color) stimulation, odor stimulation, heat stimulation, ice stimulation; low and medium frequency electrotherapy, ultrasound, dynamic magnetic stimulation, intense pain stimulation and other physical factor treatments, as well as massage, acupuncture and orthopedic appliance treatment. (5) Prevention of complications Prevent the occurrence of complications such as infection, water loss, constipation, urinary retention and pressure sores by giving appropriate prophylactic medications. Prophylactic application of antiepileptic drugs is not advocated. For patients with confirmed post-traumatic epilepsy, antiepileptic drugs can be used reasonably according to the type of seizure. Recovery period rehabilitation Motor function rehabilitation Extensive and multifocal injuries often occur after craniocerebral trauma, and the patient’s condition is more complicated, which may have both cone bundle damage and extrapyramidal damage, often leaving sequelae such as hemiplegia, abnormal muscle tone, ataxia, balance and coordination dysfunction. PNF technique, Bobath technique, retraction technique and motor relearning technique can be mainly applied to promote the recovery of motor function, such as training of hand function, trunk and pelvis control, lower limb function training, walking training, compensatory function training, etc. (1) Upper extremity function Usually, upper extremity function recovery starts with flexion joint movement, so patients should be encouraged to perform such joint movement in the early stage, but in the later stage, such joint movement can disturb the normal activity function, so inhibitory joint movement should be adopted, that is, developing joint movement of extensor muscles to inhibit joint movement of flexor muscles. A variety of stimuli are available, including auditory (illustrating the composition or instructions of the movement), visual (watching how it is performed), tactile (the therapist touching the limb with the hand), and finally responding to the prick from the proprioceptors to perform purposeful movements (e.g., fetching, dressing, eating, etc.). Once casual movement is triggered, attention should be paid to strengthening muscle exercises. The upper limb should pay more attention to the extensor muscle strength to promote the balance of muscle strength. (2) Lower limb function For patients with severe plantar flexion, claw toe and ankle inversion, the focus of plantar bearing can be shifted back to the heel and a foot brace can be placed to keep the foot and toe dorsiflexed. If the dominant side is the same side as the affected limb, the patient should try to develop various compensatory functions on the healthy side, such as writing, eating, grooming, etc. If the affected side has spasticity when the healthy side is exerted, it is necessary to avoid exerting too much force and making resistance activities on the healthy side. Squatting method: single or double-handed forward stretching holding a fixed object, body upright, feet apart, shoulder-width apart, slowly squatting and then standing up, repeatedly for 3-5 minutes. The affected limb swing method: single or two hands forward or lateral extension to hold the fixed object, single foot weighted and standing, the affected limb forward flexion, backward extension, abduction, abduction swing 3-5 minutes. Or supine position, both lower limbs straight, hands on the side of the body, the affected limb straight leg elevation to a certain limit, for inward and outward 5-10 minutes. Internal and external rotation method: stand with the hand on the fixed object, extend one foot slightly forward, follow the ground with the foot, make internal and external rotation for 3-5 minutes. Or the patient in a supine position, both lower limbs straight, feet shoulder-width apart, hands on the side of the body, with the heel as the axis, the tips of the feet and lower limbs for internal rotation, external rotation activities for 5-10 minutes, with the side with severe functional limitations. Hip flexion method: Patients are sitting on the edge of the bed or chair, both lower limbs are naturally separated, with the lower part of both feet as the axis, repeatedly make hip flexion and knee flexion movements for 3-5 minutes, with the side with severe hip limitation as the main focus, the amplitude and number of times gradually increase. Open lawful: the patient is sitting on a chair or stool, the hip, knee and ankle joints are each at 90°, the feet are separated, and the axis is between the feet, doing double knee abduction and inward movement for 3-5 minutes. Or the patient can take a prone position, knees shoulder-width apart, lower limbs straight, hands above the chest, then bend the knees 90°, with the front of the knees as the axis, for calf abduction and adduction activities for 5-10 minutes, with the serious side of the hip joint as the main, the amplitude and number of times gradually increased. Stirrup air flexion and extension method: the patient is in supine position, hands are placed on the side of the body, both lower limbs are alternately flexed at the hip and knee, so that the lower leg is suspended in the air, stirrup exercise for 5-10 minutes, mainly flexion of the hip joint, the amplitude and number of times are gradually increased. Rehabilitation of cognitive disorders The higher functions of the brain mainly include cognition, perception, learning and memory, speech, emotion and emotion, etc. Patients with craniocerebral trauma mostly have cognitive and behavioral disorders, which cause certain difficulties for rehabilitation. (1) Attention and concentration training ① Guessing game: take two transparent glasses and a pinball, let the patient watch the operator snap a glass over the pinball and point out the glass with the pinball, repeat several times. After this is correct, switch to two opaque cups and repeat the same operation as above several times. After success, switch to more cups or more balls of different colors, snap them on and ask the patient to point out the cups with various colors of bouncing balls respectively, and repeat several times. (ii) Deletion work: write several capital Hanyu Pinyin letters such as KBLRBPYO (numbers and figures can also be used) on a piece of white paper and ask the patient to delete the letters specified by the operator with a pencil, such as B. Then rewrite the order of the letters and specify the letters to be deleted, and repeat several times, increasing the number of lines and difficulty of the letters after success. ③Sense of time: Ask the patient to start the stopwatch on command and stop the stopwatch at 10 seconds, then gradually extend the time to 1 minute, when the error is less than 1-2 seconds, change to not let the patient look at the watch, start and let him mentally calculate to stop at 10 seconds, then extend the time to stop at 2 minutes, the error should not exceed 1.5 seconds per 10 seconds. After meeting the requirements change to talking to the patient while letting the patient perform the above training so that the patient tries to control himself not to be distracted by the conversation. (4) Homework therapy: knitting, woodworking, puzzle practice, etc. (2) Memory training ①Visual memory: first place 3-5 picture cards with everyday objects in front of the patient, tell the patient that he/she can look at each card for 5 seconds, then put the cards away and ask the patient to write down the names of the items he/she sees with a pen, repeat several times, and increase the number of cards after success. ②Make up stories: Make up the content to be remembered into stories according to the patient’s habits and hobbies, which helps to remember. ③Operational therapy: woodworking, clay work, inlay, arrow throwing, etc. In daily life, attention should be paid to: ① establish a constant daily activity routine for the patient to repeat and practice constantly; ② ask questions and give orders to the patient patiently and quietly; ③ practice from simple to complex, break down the whole exercise into several small parts, train in small parts first, and then gradually combine them after success; ④ use multiple sensory inputs such as visual, auditory, tactile, olfactory and motor to match the training; ⑤ each training time should be (5) Each training session should be short, and the patient should be rewarded when the memory is correct in a timely and frequent manner; (6) The patient should be able to distinguish the key points and remember the most necessary things first instead of the irrelevant trivial things. (3) Thinking training Thinking includes reasoning, analysis, synthesis, comparison, abstraction, generalization and other processes, often expressed in the solution of problems. ① Information acquisition: Take a local newspaper and first ask the patient about the information on the front page of the newspaper such as the headline, date, name of the newspaper, etc. If the answer is correct, then ask him to point out the columns in the newspaper such as sports, business, classified ads, etc. After the answer is correct, then train him to point out the columns in the newspaper. After the answers are correct, he is then trained to look for special news, such as the score of two teams’ games, a movie released in a cinema, etc. After the answers are correct, he is then trained to look for news that requires the patient to make his own decisions. ②Arrange the numbers: Give the patient three number cards and ask him to arrange them from smallest to largest, then give one more card at a time and ask him to insert them between the three cards already arranged according to the size of the numbers. After they are correct, give a few more number cards and ask what they have in common, such as which ones are odd or even, which ones are multiples of each other, etc.? ③Classification: Have the patient classify and match multiple item names according to the purpose of the item, etc. ④Operational therapy: picture synthesis, woodworking, etc. The training is varied, and it is also not the case that all the steps in a particular training are completed in one day. The training can be continued at home after discharge from the hospital without special supplies, so the family members of the patient should also be trained to master the training methods. Rehabilitation of behavioral disorders For episodic loss of control and frontal lobe aggression, medication and positive punishment behavioral therapy are used. For negative behavior disorders, behavioral therapy, such as negative punishment, molding, and tokens, is used. Occupational therapy is also available to eliminate aggressive affect. Psychological rehabilitation The sudden change of a patient from a healthy, working situation with a certain degree of ability to a state of physical dysfunction and the need for care by others can bring great mental shock and psychological stress. Depression, depression, pessimism, and even thoughts of light-heartedness usually occur. Therefore, the patient’s personality, intelligence level and social status before the injury should be used to stimulate his mental reserve, give him psychological support, encourage him to face the reality, eliminate his negative emotions as soon as possible, cooperate with the treatment with a positive attitude, build up confidence and medical staff to work together to restore or compensate for his lost functions and return to his family and society.