Rehabilitation after traumatic brain injury

(By Vimal Kodai)

Inspiring Quote for post-traumatic injuries sustained individuals

Major Causes of Traumatic Brain Injuries

Rehabilitation after traumatic brain injury

Abstract from: Medical Journal of Australia (MJA)

Originally from an article by: Fary Khan, Ian J. Baguley and Ian D. Cameron

Based on medical studies done recently, and as per the courtesy of the Medical Journal of Australia (MJA), this article argues that there are several factors involved in rehabilitation after a serious condition of traumatic brain injury. It has been observed that recovery after a serious TBI (Traumatic Brain Injury) carries on its course at least 5 years after the initial impact of injury sustained. Although, traumatic brain injuries affect people of all ages, and that there are no restrictions to any particular groups or age groups of people which may encounter such an injury, TBI commonly affects adults who are in their prime. Traumatic brain injuries result from an external force to the brain causing serious damage and permanent neurological dysfunction to it. In most cases, there are no evidence or factual proofs that suggest the existence of an eminent brain injury in an individual, but through the behaviour and by the way the person handles situations and maintains conversations, there are conclusive certainties that some areas of the brain have been affected and that rehabilitation needs to take effect. In other cases of Traumatic Brain Injuries, speech is distorted, balance and mobility of the person with an acquired brain injury (ABI) are affected, paralysis may occur; part of the brain may stop to function properly—resulting in strokes, seizures, epilepsy, brain tumors, etc. Rehabilitation after TBI promotes and enhances psychosocial adjustment of the individual. In many cases, rehabilitation may last up to several years (from 2 to 10 years, or more), but depending on the mindset and willingness of certain individuals with brain injuries, based on their social surroundings, and depending on their motivational insights and determination, psychosocial adjustment occurs at a quicker pace and healing happens even faster. Attendant care and readily available assistance are crucial requirements of a person who has sustained TBI or an ABI. Being in a comfort zone and by obtaining a secure, safe and sound atmosphere with someone who is trustworthy, the individual who is suffering from such traumatic condition would be granted the abilities and first-hand support in order to recover peacefully.

Traumatic brain injuries usually cause impairment to the cognitive, psychosocial and behavioral aspects of individuals. TBI has direct ties to the connectivity of neurotransmitters in the brain. These may work very abnormally as they may take longer than anticipated time to regenerate. In fact, these neurotransmitters and neurons in the brain cells do not regenerate very much—only serious interventions, active thinking, cognitive activities (reading, writing, playing cognitive games) and cognitive engagements (developing new skills, or, adopting serious attitudes in doing common chores, artwork or handicrafts), physical exertions (exercising, walking, jogging, meditation, running, weight lifting, deep breathing, practicing yoga, swimming, etc.,) and keeping a very positive mindset in the forms of: positive thinking, positive ideas, inspirational guidance, motivational insights and optimistic thoughts may all lead to complete healing. It may take between two or more years for the neurotransmitters in the brain to attempt to regenerate actively. As such, it may even never start working as effectively as it did prior to the injury sustained. In many cases, these cells do not regenerate as much as it should have; therefore the individual tends to feel disconnected with his or her true self. Most of the time, there is a feeling of unawareness, and a sense of non-belonging is felt. Amnesia or short-term or long-term memory loss may be experienced as a result of such feeling.

The burden that results from a severe brain injury is very problematic and acute. A whole family and family unit suffer as a consequence of a traumatic episode that has occurred to an individual. Life changes in a split of a second and the future can be really scary and fearsome. Rehabilitation is required at all costs.

INSPIRING QUOTES FOR ALL (Including survivors of ABI)

Rehabilitation after TBI varies from country to country. Rehabilitation after a serious trauma and traumatic episode sometimes does not happen at all to some individuals. Facilities and amenities, healthcare and medical options, supportive people and educational backgrounds, and, several other post-trauma supportive bodies and services are not always at the disposal of many who have suffered such kinds of blows to the head. Brain injuries sustained are typically very unpredictable as they vary from case to case and people to people. Rehabilitation requires lots of insights and positive guidance on the part of healthcare professionals. The latter have to be very knowledgeable and experienced in order to provide their ongoing support to the individual who has sustained the brain injury. Based on the Glasgow Coma Scale (GCS) which ranges from 3 to 15 (3/15), severity of cases, or at risk individuals are being given first-hand care and attention. Each person who has had an acquired brain injury and/or traumatic brain injury recovers at a different pace. Depending on the individual’s previous routine daily activities and previous physical fitness level, recovery may take a lead role by carrying on its course with much ease, or it may usually be dealt with serious challenges. Support coming in various forms; namely: financially, morally, spiritually, socially, educationally, emotionally, cognitively and physically—require taking their courses all the way through. The prognostic of recovery for a patient or individual who has sustained a TBI also varies from person to person, but usually, it takes between a minimum of 2 years to several years for complete and full recovery. Officially, only 20% to 40% of individual with acquired brain injuries recover fully (or somewhat fully). But, in reality the cure never really occurs in full as damage done to the brain is permanent. Nevertheless, with much optimism and with lots of arduous work and diligent patience, recovery and many changes may manifest themselves accordingly.

What not to say to a person with ABI?

Relationships, sexual orientation, speech and oral conversations, communication and verbally done expressions, written work, word findings and word searches, physical abilities, way of thinking and personality, sleep patterns, as well as mood and temperament may all differ substantially as a result of a serious traumatic episode. TBI impact on relationships a lot more in the post-trauma recovery periods. At times, relationships turn into break-ups and separation, and even divorce. Sexual orientation also changes drastically as a result of a brain injury. Some individuals have the tendency to have lesser orgasm and others may have an increase in orgasm. The urge and the need for sexual encounters and sexual intercourses vary from person to person. Speech and conversations may be very distorted and garbled. Word usages and word searches are very common difficult areas to those who may have not been exposed to a particular language at birth. Speech pathology and speech therapy are the best options to remedy the cases of garbled speeches and unsteady word finding in certain individuals. Physical abilities are either reduced or may require a boost in overall exertions. Physiotherapy, massage therapy and acupuncture, weight-lifting, deep breathing and calming the mind and racing thoughts all need to find suitable spots in those people who have to deal with recovery from a severe TBI. Sleep disorder and sleep patterns are often a very troublesome in the post-traumatic periods. Sleep tests, sleeping pills and psychiatric interventions may help reduce risks of obtaining seizures as a result of lack of quality sleep. Mood instability and mood disorders are common problems and show of high concerns to many families who deal with post-TBI consequences. Mood swings are often the result of a trauma. This may be considered as a mental health problem. However, ABI (Acquired Brain Injury) and TBI (Traumatic Brain Injury) are not considered as being part and parcel of the mental health faculty as they are based on acquired forms of injuries sustained to the brain. Therefore, mood disorders, although being treated under same guidelines and same treating factors of the mental health program, are consequently only the main focal point of an ABI and a post-traumatic condition. Irritability, anger and frustration are also results of post-trauma. The latter is very common and is frequently addressed as an issue and concern to families that face such testing moments. With time and through healing processes made evident, irritability and anger decreases in most cases of post-trauma. Sometimes, anger management is required to investigate the problem further, but usually, therapists and medical professionals are the best judges that interfere in the circumstances of deep provoking anger, agitation and violent reactions. Law enforcement authorities and the police may need to put a halt and calm such situations in order to prevent obscene and vulgar language uses, violent reactions and destruction of properties.

Rehabilitation After TBI

Invisible Disability

Counseling and psychotherapy are also in deep needs after a severe TBI. Social workers, psychotherapists, psychiatrists, occupational therapists, rehabilitation therapists, and cognitive behaviour consultants all need to play their shares in the role of a supportive team that will ascertain the prospective recovery of the individual who has suffered the terrible blow. In many cases, there is the need for reeducation and reassessment of knowledge, and based on the criteria and requirements of the case that is being dealt with, counseling, speech pathology, constant monitoring of behaviour, constant support, and patient acknowledgement of certain key factors affecting the person’s daily life and daily living is further bettered and maintained with stronger adhered conditions. Those who have accrued cognitive and behavioral deficits will be given occupational therapists to balance their day to day activities. Assistive devices such as wheel-chairs and gait aids are provided. Walkers and canes are also introduced in the lives of such individuals. Environmental manipulations, such as: installation rifts, ramps and rails, and bathroom alterations facilitate the basic activities of a person who has a TBI. Family education and family support, counseling and social assistance are provided to those in need. People with catastrophic (extremely severe) injuries have the following provided to their homes: bathrooms modifications, grab rails, non-skid flooring. Constant monitoring by a healthcare professional will assure and ascertain that commuting, and social outings are done in a smooth and safe manner.

How the brain works?

Fatigue Management

TBI is one such medical concern and issue that requires very adaptable support and adequate facilities, in order for the person in question to be able to restore his or her lifestyle. Medical professionals, medical requirements and medical interventions create very effective roles in the ways the person can find his or her way back on the right track or right pathway. A person with TBI, given the certainty of a convenient rehabilitation facility, would be able to find better hopes and more prospect in an eventual future while being optimistic and while setting positive goals. Survivors of TBI face continuous challenges even many years after having been treated fully. The impact of injury sustained to the head and the permanent scars that are the consequent end result of the acquired brain injury need continuous monitoring, and a sequential pattern of behaviour and symptoms observed would deduce further setbacks or eventual deteriorations or ameliorations. Despite all, and however great rehabilitation may be, TBI can not be healed in its entirety. Ultimately, it is the patient’s motivation and personal insightful guidance which will ensure that signs for an eventual getting back to a normal life may be guaranteed.