What is traumatic brain injury?
Traumatic brain injury can occur due to various reasons, most commonly traffic accidents, falls
from a height, work accidents, beatings, gunshot wounds. It emerges as an
important cause of disability in society and its rehabilitation is also very
important. After intensive care treatment in the early period, an intensive
neurological rehabilitation program including robotic rehabilitation is needed.
Traumatic brain injury is brain injuries that occur
when the head suddenly and violently hits an object or when an object damages brain
tissue by piercing the skull. It can lead to deterioration in the cognitive and
physical functions of the person and cause thinking, perception, speech,
swallowing disorders and paralysis in organs such as arms and legs. Although it
can be seen almost everywhere and at any age, its frequency is highest in young
people and especially between the ages of 15-25. Motorcycle and bicycle
accidents are a major cause. The use of helmets significantly reduces the
occurrence of 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 most sensitive and complex
organ of the body, traumatic brain injuries can have changes that deeply affect
a person's life. These changes can be cognitive changes such as memory,
perception, attention, comprehension, logical thinking, as well as physical
problems such as partial or complete paralysis, balance disorders and
swallowing and speech disorders.
The mortality rate in the early period of traumatic
brain injury is quite high. Depending on the severity of the trauma, loss of
consciousness, nausea, headache, neurological and cognitive effects are common.
Depending on the location and extent of the damage in the brain, many health
problems such as loss of arm and hand use, gait disorder, sensory disorder,
disorder in intellectual functions, behavior and personality changes, epileptic
seizures, chronic pain, depression, bladder and intestinal problems can be seen
in patients. Cognitive problems such as decrease in attention span, difficulty
in organizing thoughts, forgetfulness, confusion, difficulties in learning new
information, difficulties in reasoning and interpretation, making movements
inappropriate to social situations, difficulty in problem solving, decision
making and planning may occur. Problems with language can also vary from person
to person, as can cognitive problems. Difficulty in finding words, inability to
form sentences properly, long and erroneous expressions, difficulty in
understanding words, inability to understand different uses, idioms and implied
uses of words, regression in reading and writing skills, deterioration in mathematics
skills are among these problems. As a result of traumatic brain injury,
behavioral disorders such as personality changes, aggression, tendency to
violence and loss of control can also occur. Physical restrictions such as
partial or complete paralysis, involuntary muscle contractions (spasticity),
impaired balance and coordination, and difficulty swallowing can reduce a
person's functional independence. These findings vary according to many factors
such as the severity of the injury, the affected brain region, organ injuries
other than the brain and personality traits before the injury.
How is the treatment of traumatic
brain injury done?
Patients with traumatic brain injury need emergency
intervention and early intervention by neurosurgery and neurology clinics. This
intervention may be in the form of follow-up or surgical intervention in
intensive care. Oxygen support to the brain and the rest of the body, ensuring
adequate blood flow and controlling blood pressure are the priorities of this
intervention. The patient whose medical condition stabilizes should be
evaluated immediately by a physical therapy rehabilitation physician and an
early rehabilitation program should be initiated. When the patient becomes
eligible, it would be best to follow him up 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 healing. Research has shown
that neurological recovery after brain injury is greatest in the first 6
months. However, recovery after brain injury continues at a rapid pace for up
to 2 years. In this process, a comprehensive physical therapy and
rehabilitation program will maximize the patient's gains. Although recovery is
faster in the first 2 years, the potential for recovery may also arise in the
late period in these patients. Even in patients who are thought to have
persistent cognitive and physical impairments, some abilities can be
redeveloped. For this reason, it would be useful for a patient who has suffered
a brain injury to be followed up by a team of doctors consisting of
neurologists, neurosurgeons and psychiatry specialists under the leadership of
a physical therapy and rehabilitation specialist.
Rehabilitation in traumatic brain
injury
Today, thanks to the increasing and developing
surgical and emergency aid methods, while the deaths due to traumatic brain
injuries are decreasing, the rehabilitation and reintegration of patients into
society is becoming very important due to the increase in survival rate. The
purpose of rehabilitation in traumatic brain injury is to improve impaired
functions, to ensure walking, to restore the patient's independence at the
highest possible level and to prevent other health problems that may occur due
to the disease.
Rehabilitation in traumatic brain injury should be
started at an early stage. With simple measures such as passive joint movements
to be performed while the patient is unconscious and even unconscious, and
turning the patient every two hours, problems such as joint restrictions and
pressure sores that may affect the success of rehabilitation in the future can
be prevented. For this reason, it is important that the patient is followed up
by a physical therapy and rehabilitation specialist from the early period. In
this way, complications that may arise in the acute period are prevented and
preparations are made for the transfer of the patient to a rehabilitation
clinic.
Patients who become medically stable are taken to a
more intensive and comprehensive rehabilitation program. At the beginning of
rehabilitation, the patient is evaluated in terms of consciousness, motor,
sensory, perception, balance, walking and daily living activities with a
comprehensive examination and a special physical therapy and rehabilitation
program is planned. This program is followed by weekly evaluations and shaped
according to the newly determined targets.
Early mobilization (mobilization) of patients with
traumatic brain damage is important. Thus, complications such as muscle
atrophy, pressure ulcer, bone resorption, joint restriction, soft tissue
calcifications that may arise due to immobilization (immobility) are prevented.
Physical therapy and rehabilitation program, in accordance with the patient's
current medical condition and functional level; It includes mobilization in the
bed, sitting balance training, using hands and arms, going out of bed and
transfer activities, standing up, standing balance training, walking, going up
and down stairs, work-occupation and training of daily living activities.
In traumatic brain injury, involuntary muscle
contractions called spasticity may occur. If these contractions disrupt the
patient's joint movements, positioning, hygiene or cause pain during exercise,
they need to be treated. In addition to drugs, physical therapy and exercises,
interventional and surgical methods can also be applied in the treatment.
If the patient has joint contracture, joint range
of motion exercises, stretching, instrumentation or surgical intervention may
be required. Muscle weakness can be seen in traumatic brain injury. In these
cases, muscles are tried to be brought to normal strength with muscle
strengthening exercises. If there are balance and coordination disorders,
exercises for this are also done. During these studies, orthotics and other
auxiliary devices can be used when needed.
Robotic rehabilitation is an effective
rehabilitation method that can be used from an early period in patients with
traumatic brain injuries. It contributes to the early mobilization of the
patient, stimulates neurological recovery through neuroplasticity and increases
the patient's adherence to the rehabilitation program, motivation and
awareness. Early Stage Paralysis 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 the success
in the rehabilitation of brain-damaged patients.
Hydrotherapy, or in-water rehabilitation, is also a
rehabilitation option that has a place in the treatment of traumatic brain
injury patients. Thanks to in-water exercises, strengthening of weak muscles,
improvement in balance and coordination, as well as reduction of involuntary
muscle contractions are provided.
Occupational therapy (occupational therapy) is a
therapy and rehabilitation program that aims to increase the quality of life by
acquiring the independence and life roles of people in daily life by acquiring
work, occupation and activity. Occupational therapy is also actively utilized
in the treatment of patients with traumatic brain injury.
Speech and language therapy and swallowing therapy
are very important in the rehabilitation of patients with traumatic brain
damage. First of all, the areas where the patient is deficient are determined
by the specialist therapist and a treatment program is arranged for them. A
cognitive assessment may also be performed if necessary. In addition to
exercises related to speech and swallowing, studies are also carried out for
cognitive problems such as forgetfulness.
Respiratory rehabilitation, psychotherapy,
neuropathic pain treatment and treatment of bladder and bowel problems are
other treatment topics that have an important place in the rehabilitation of
traumatic brain injury patients.
The success of rehabilitation in traumatic brain
injury is influenced by many factors, such as the severity of the brain injury,
age, gender, pre-disease status, socioeconomic parameters, state of cognitive
functions. Although the process is long and clinical improvement is sometimes
very slow, these patients, the vast majority of whom are young, can move to an
independent and productive life with an appropriate rehabilitation program. If
the patient is not taken to a rehabilitation program created for him in every
aspect, he will fall behind the performance he can show. The ultimate goal of
rehabilitation is to complete the occupational and economic rehabilitation of
patients who have suffered a traumatic brain injury and if they cannot continue
their old profession, to acquire a new profession or to be placed in a suitable
job and brought to a self-sufficient, productive living level.