Brain Injuries And Methods Of Rehabilitation Essay
Write a 5 page research paper about brain injuries and what are the methods of Rehabilitation After Them.
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Brain injury is a general term referring to any injury to the brain. Brain injury is stimulated by a number of factors such as bike and a car accident, assault, as fall, or a blow to the head, but these example of brain injuries which occur in nature. They are types of brain injuries such as, the brain injury that occur after birth, the traumatic brain injury (TBI) which is caused by an object such as stabbing or gun shots entering the brain causing widespread damage (Brain Injury Support(BIS), 2015; Volpe,2012). Apart from these types of brain injuries, the brain can be damaged due to lack of enough oxygen to the brain as a result to heart attack, internal bleeding like a stroke (ABI, 2015; Volpe, 2012). ABI (acquired brain injury) rehabilitation is an agency that specialises in rehabilitation after a traumatic brain injury and a stroke. But this paper will focus on brain injury only because it is an area of interest. Max Cavit is the manager director of ABI who came to an agreement with ACC to develop rehabilitation service in New Zealand (NZ), Max ‘s ideas evolve around how people living with brain injury were mostly garaged without access to rehabilitation service in 1996 NZ (ABI, 2015). After fifteen years, ABI has stood alone with its own facilities in Auckland and Wellington. ABI has about 200 medical specialist across all regions, and these specialists have a background whether in nursing or therapy, but they all have experience across all ages Brain Injuries And Methods Of Rehabilitation Essay
Head injury is a common disabling condition but regrettably facilities for
rehabilitation are sparse There is now increasing evidence of the efficacy of a
comprehensive multidisciplinary rehabilitation team compared to natural recovery
following brain injury. This chapter outlines some basic concepts of rehabilitation
and emphasises the importance of valid and reliable outcome measures. The
evidence of the efficacy of a rehabilitation programme is discussed in some detail.
A number of specific rehabilitation problems are outlined including the
management of spasticity, nutrition, pressure sores and urinary continence. The
increasingly important role of assistive technology is illustrated, particularly in
terms of communication aids and environmental control equipment. However,
the major long-term difficulties after head injury focus around the cognitive,
intellectual, behavioural and emotional problems. The complex management of
these disorders is briefly addressed and the evidence of the efficacy of some
techniques discussed. The importance of recognition of the vegetative state and
avoidance of misdiagnosis is emphasised. Finally, the important, but often
neglected, area of employment rehabilitation is covered.
Prof. M P Barnes,
Regional Neurorehabihtation Centre,
Newcastle upon Tyne,
Newcastle upon Tyne
Traumatic brain injury is common. Unfortunately facilities for rehabilitation of those after brain injury are few and far between. As there is now
good evidence of the efficacy of multidisciplinary rehabilitation, the lack
of appropriate rehabilitation facilities means that many people have less
than adequate rehabilitation and thus do not meet their full potential.
This will also mean there is unnecessary physical and psychological
burden both upon the individual disabled person and their carers and
family. Brain Injuries And Methods Of Rehabilitation Essay
The annual attendance rate at casualty with head injury is around
1,500-2,000 per 100,000 population per annum*. However, only a
quarter or so of these people are admitted to hospital. The majority of
those admitted will have sustained a minor head injury, whereas around
10% will have had a moderate head injury and 5% a severe head injury.
On this basis, the annual incidence of severe head injury is around 20
per 100,000 population. The prevalence of those with residual problems
after head injuries is difficult to estimate with accuracy as there have
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been relatively few studies on the subject. However, most people
surviving head injury have a normal life expectancy and, as many are
relatively young at the time of injury, it is likely there is a high prevalence
of residual disability arising from brain injury. A conservative estimate
is that there is at least 150 individuals with persistent disability per
. Head injury is certainly one of the most prevalent
neurological conditions and the prevalence is probably increasing. This
is due to the increased rate of survival given advances in medical and
surgical techniques, road side and intensive care, which are outlined in
other chapters in this book. There is little doubt that in recent years
more people are surviving, with consequently more severe injuries, who
previously would have died. It is important that advances in acute
medical and surgical management of head injury are balanced by an
appropriate increase in resourcing for rehabilitation facilities.
There are significant problems following both minor and moderate head
injuries but the emphasis of this chapter will be on those with the more
serious consequences that follow severe injury to the head and brain.
Concepts of rehabilitation
Rehabilitation is rather different from most other medical and surgical
specialities. It is a process that is based on the principles of education
and one in which the disabled person and their family must be involved
for it to have any meaning. This process also has to go beyond the
confines of physical disease and must deal with the psychological
consequences of physical disability and with the social milieu in which
the disabled person has to operate. Here is another dimension which
differentiates rehabilitation from most acute medicine – it is a process
that cannot be carried out by physicians alone and requires active
partnership with a range of other health and social service professionals.
It is essentially a team process in which the doctor clearly has an
important role to play but a role that is not always paramount.
Modern rehabilitation practice is based around the concepts of
impairment, disability and handicap as outlined by the World Health
Organization in 1980 (Table 1). Brain Injuries And Methods Of Rehabilitation Essay
Impairment is a descriptive term and is obviously an essential part of
the diagnostic process. However, rehabilitation goes beyond impairment
and places such impairments within their functional context – the
disability. It is, after all, the disability that matters to the individual and
not the impairment. Handicap describes the social context of the
disability. Obviously rehabilitation professionals need to be aware of the
social context of the individual and the family but many aspects of
handicap go beyond the health service and are part of the necessary
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Rehabilitation after traumatic brain injury
Table 1 Definition of the WHO International Classification of Impairment Disability and
Impairment Any loss or abnormality of psychological, physiological or anatomical structure
Disability Any restriction or lack of activity resulting from an impairment to perform an
activity in the manner or in the range considered normal for people of the
same age, sex and culture
Handicap A disadvantage for a given individual resulting from impairment or disability
that limits or prevents the fulfilment of a role that would otherwise be normal
for that individual
rehabilitation process carried out by social service professionals, employment professionals and a whole variety of other governmental and nongovernmental agencies as well as the disabled person’s family and friends.
Recently the WHO has redefined these concepts. The modern terminology that will be introduced in the near future still encompasses the term
impairment but now replaces Disability with Activity and Handicap with
Participation. This is not simply a sign of political correctness but does
serve to emphasise the positive aspects of disability rather than the
Against this background it can be seen that rehabilitation is an active and
dynamic process which assists the disabled person to acquire the necessary
knowledge and skills in order to maximise their own physical,
psychological and social function. Rehabilitation uses three basic
approaches: (i) approaches to reduce disability; (ii) approaches designed to
acquire new skills and strategies that will reduce the impact of disability;
and (lii) approaches that help to alter the environment, both physical and
social, so that a given disability carries as little handicap as possible.
For example, a middle aged man after a traumatic brain injury may
have made a reasonably good physical recovery but is still troubled with
a residual hemiparesis and associated problems with spasticity as well as
difficulties with urinary frequency and occasionally incontinence.
Measures to reduce his disability could include appropriate treatment for
his spasticity and medication to help control his bladder symptoms.
Approaches designed to acquire new skills could include physiotherapy to
improve his gait and fatigueability and the possibility of using a wheelchair
for longer distances. Intermittent self-catheterisation techniques could be
taught. The final approach would be to assist him to adapt his environment both at home and at work to make it easy for him to manage. There
may be a need for grab rails in the toilet or adaptations to the bathroom
or kitchen. Liaison with his employers might be important to make similar
adaptations to his work place. There may be a need to negotiate with his
employers to allow him to return to work part-time or alternatively to
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allow short rest breaks during the day to minimise fatigue. The involvement of his family is also likely to be important in order to involve them
more in the acceptance of his condition and necessary adjustment to their
The basic nature of rehabilitation is to work with the disabled person
and family in partnership. Professionals should impart accurate
information and advice, give guidance on prognosis and natural history
and work with the individual to establish realistic goals within an
appropriate social context. Some disabled individuals will wish to take
a major leading role in developing their own rehabilitation goals while
others will wish to take a more passive role and rely on the expertise of
the team. Whichever approach is adopted, realistic goal setting is the key
to a good quality rehabilitation programme. In many rehabilitation
units, these goals are agreed between all parties but obviously adjusted
on a regular basis. The first goal should a long distance strategic aim, for
example, to return home and remain at home independently. Once a
realistic long-term goal is agreed steps will need to be defined in order
to achieve that goal. It is important that goals are broken down into
short-term and achievable units and that such goals should be
measurable. For example, if an eventual goal is independent walking,
then this will require a breakdown into a number of short stages such as
sitting without support, standing without support, walking with
assistance, walking with aids and finally independent walking.
The implication of goal setting is that the team and disabled person
should know when those goals have been achieved. Thus, valid and
reliable outcome measures are vital to underpin the rehabilitation
process. Regrettably few units routinely use and monitor their work by
means of such measures. Crude global measures, such as the Glasgow
, are obviously too crude as active rehabilitation
monitors. There are a variety of scales available but most suffer from
significant disadvantages. The commonest used scales in the UK are the
or Modified Barthel and the Functional Independence Measure
(FIM) (sometimes with the addition of the Functional Assessment
. The former is a valid and reliable scale but is very
physically orientated and suffers from detrimental floor and ceiling
effects. It is really only of use in the immediate post-acute rehabilitation.
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Rehabilitation after traumatic brain injury Brain Injuries And Methods Of Rehabilitation Essay
The FIM is a broader measure of disability that takes longer to
administer and is also rather physically orientated. The addition of the
FAM adds a broader psychological dimension. However, it is not yet
fully validated within the context of head injury. A number of other
global scales have been developed including the Northwick Park
and the Newcastle Independence Assessment Form7
which attempt to measure a broader impact of disability and can also be
used in the longer term. However, many such scales are rather too long
and complex for use in a busy clinical setting. In addition, such global
scales may not measure short-term gains. It may be more appropriate to
use a variety of different outcome measurements at different stages
during recovery. For example, if a goal is improvement of hand function
this can be adequately momtored by use of the Nine Hole Peg Test8
whereas improvement in walking could be measured by the simple
expediency of a timed 10 m walkmg test. There is no space in this
chapter to describe and discuss all possible scales available and the
reader is referred to an excellent reference text on this subject9
it is important to emphasise that the use of valid and reliable outcome
measures is vital in order to monitor goals, assess progress and adjust
the rehabilitation programme. Collation of statistics may also be
important in the future if the performance of individual rehabilitation
units are to be compared across the country.
Traumatic brain injury, (TBI) may result in life long impairments of an individual’s physical, cognitive, and psychosocial functioning, which severely impacts the injured person’s life, their families, and significant other. A major limitation within the field of TBI rehabilitation is the narrow focus of current medical restoration approaches; the focus tends to be on enhancing capabilities of the person with TBI to help them adapt to life circumstance. Brain Injuries And Methods Of Rehabilitation Essay
However new models of rehabilitation emphasizes the parallel importance of environmental modification in order to create enabling condition for the individual. A multidisciplinary approach is key to helping people reclaim their lives and identity. Before discussing how rehabilitation can help people with traumatic brain injuries, an over view of basic brain physiology will follow as well as static’s.
Most TBI individuals suffer closed head injuries that cause both focal and diffuse damage. Focal trauma happens when the brain bounce against the inside irregular contours and bony ridges inside the skull causing tears, hemorrhages or bruise. Diffuse trauma occurs when the nerve fibers through the brain stem and into the brain are stretched or torn. Brain Injuries And Methods Of Rehabilitation Essay
Both diffuse and focal injuries affect multiple systems but the symptoms and long-term effects of TBI are strongly influenced by focal injury. In addition, the brain functions as a whole by interrelating its component parts, therefore, if the injury disrupts a particular step in the brain function the sequence is broken and the deficit reveals it self in the TBI individual.
Beneath the forehead is the frontal lobe if damaged or bruised this area produces diminished or altered state of consciousness. Results in changes in personality creating an egocentric behavior; impulses and drive that desire immediate gratification, they have difficulty seeing how this behavior affects others.
Behaviors such as inappropriate sexual and social behavior can be seen. Also there maybe an inability to maintain two lines of thoughts simultaneously therefore The TBI person appears inconsiderate, non-empathetic, self-centered, and selfish even when their intention is otherwise. They suffer loss of memory for some habits and word meaning. They may also be plagued by a single persistent thought, may have difficulties focusing on a task, solving problems, and thinking. Difficulties are seen in planning sequences of complex movements to complete mult-stepped tasks, such as making a sandwich. Also, loss of self-esteem and self worth is common and can cause depression. Brain Injuries And Methods Of Rehabilitation Essay
When the parietal lobe, located near the back and top of head, is damaged, deficits are dependent on which side of lobe is damaged; right, left, or bi-lateral. Damage to the left causes “Gerstamann’s Syndrome” (Suddarth, 1991, p.1137). and causes difficulty-distinguishing left from right. In addition the damage can affect ability to recall strings of numbers; difficulty doing math. Damage to right lobe results in neglecting parts of the body which can be seen in patient having difficulties in self-care, dressing, and washing. Bi-lateral damage can cause “Balint’s Syndrome” (Suddarth, 1991, p.852). Characterized by inability to control gaze.
The parietal lobes contain the sensory cortex also, which control sensation, such as, touch and pressure, and fine sensation such as, judgment of texture, weight, size and shape. When the body is stimulated the sensory cortex receive it information from receptors in skin, but when the lobe is damaged difficulty can be seen in intergrading different senses that allows for understanding a single concept and loss of touch perception. Brain Injuries And Methods Of Rehabilitation Essay
At the very back of the head is the occipital lobe is where our vision center is, which is rarely damaged due to its position in the head. If damaged one of the strangest side effects is blind sight the person claims that they have no vision at all, but can, when asked, point to or identify objects at a distance unconsciously. Other effects include writing impairment, inability to recognize words, and identifying faces. Disorders causes illusions, which causes objects to appear larger or smaller than they are or different in appearance in color. It also causes visual hallucination. Brain Injuries And Methods Of Rehabilitation Essay
According to the National Pediatric Trauma Registry, (NPTR) the brain cannot repair itself. It cannot grow new brain cells, called neurons, once they are damaged. In addition, NPTR states,
Ø Traumatic brain injury is the most frequent cause of disability and death among children and adolescents in the United States.
Ø Each year, more than one million children sustain brain injuries, ranging from mild to severe trauma.
Ø More than thirty thousand children have permanent disabilities as a result of brain injuries annually.
Ø Of all pediatric injuries cases in the United States, about one third are related to brain injury.
And according to The National Institutes of Health
Ø Those individual eighteen and over that are afflicted with adult-onset brain impairments is between two million five hundred thousand and three million seven hundred thousand. Brain Injuries And Methods Of Rehabilitation Essay
The article by National Institute of Health (NIH) (1998) states in 1989, the US Congress passed a joint resolution proclaiming the 1990’s the “Decade of the Brain”. The resolution called for greater recognition of, and advances in, all areas of the neurosciences and other research-seeking causes, cures, and treatment for Americans of all ages afflicted with brain diseases and disorders.
Treating individual with head injuries can be challenging. Those with traumatic brain injuries present a myriad of clinical signs often related to trauma to other body regions. As with all emergency trauma patients, airway, breathing, and cardiovascular system dysfunctions must be stabilized first. The systemic effects of shock must also be managed appropriately to restore physiology indices of perfusion. This can be done by establishing a baseline and frequently reassessing the patient for changes and monitoring the patient’s neurological status. Brain Injuries And Methods Of Rehabilitation Essay
A blunt cranial injury may cause hemorrhage, concussion; an injury to the brain produced by a violent blow that results in temporary or prolonged loss of function, contusion; bruising of brain, laceration, and cerebral edema; swelling of the cerebrum. These abnormalities may elevate intracranial pressure (ICP), and compress the cerebral arterial supply, which results in hypoxia; deficiency of oxygen reaching the tissue, wo!
rsen the cerebral injury and may cause secondary brain injury, such as, hypotension, hypoxia, anemia, hypothermia, and other abnormalities.
Acute Care, initially patient is admitted to Intensive Care Unit length; of stay will vary depending on injuries then patient is transferred to the Neurological floor; length of stay again varies usually around three weeks. Rehabilitation treatment is basically the same while in ICU and on the neurological floor. Patient is seen by a physical therapist. Brain Injuries And Methods Of Rehabilitation Essay
Treatment is amid at the integration of reflexes and development of normal movement to promote skillful functional abilities by way of strength endurance, coordination, and range of motion through exercise, massage and hot or cold therapy. In addition, focus is also on preventing secondary complications. The physical therapist’s role primarily is to minimize physical disability, to hasten recovery, and to contribute to the patient’s comfort and well-being. Various diagnostic and functional activity testing is done to determine patients’ abilities to care for themselves. The occupational therapist also sees the patient,! Brain Injuries And Methods Of Rehabilitation Essay
but focuses are on helping find ways to master everyday activities. It includes teaching patient that may have trouble swallowing how to eat or drink. Later in therapy focus is on showing patient how to use special tools to put on shoes and socks, close zippers, and button shirts. For patient going home the focus is on cooking and housekeeping. Respiratory therapist also cares for the patient the focus is on breathing retraining, through breathing and relaxation techniques, which teaches ways to conserve energy. The goal is to decrease respiratory symptoms and complication.
Education is also important in the acute phase of the rehabilitation program, which may include written material and or videos. In addition individual teaching session with the patient, family, and health care professional are important to review specific medications, treatments, and routines that will follow. Psychosocial counseling can also help the patient and family deal with a variety of emotions, including anxiety and depression, which can interfere with recovery. Relaxation exercise can be offered. Brain Injuries And Methods Of Rehabilitation Essay
There are many differences in the scheduling, length of stay and individual components of rehabilitation programs for each patient, but most formal rehabilitation programs will have physicians, nurses, rehabilitation therapists, psychosocial staff, and dietitians all working together through out patients rehab stay. But some nontraditional therapy have become an intergraded part of the patient rehab stay and are helping to hasten the recovery process, such as, virtual, art, music, pet, and play therapy.
According to Adikins, Virtual therapy was inspired by NASA programs that prepared astronauts to make quick decisions and automatic movement in space. Rehabilitation centers are applying Virtual therapy to activities of daily living training. The goal is to help patients with TBI relearn how to do things automatically. These is done by having the TBI patient sit in a small room wearing gloves and goggles, repetitively practicing a task, such as opening a can of soup or spreading peanut butter on bread.
The more cans the patient opens or sandwiches made patient can increases their procedural memory, until it’s automatic. But when the patient is done instead of having piles of half-made sandwich and open cans to contend with, patient only has to take off goggles and gloves. According to Adkins traditionally, patients performed repetitive ADL’s until they reintegrated the information and perform the tasks seamlessly, a boring and potentially dangerous task, imagi! Brain Injuries And Methods Of Rehabilitation Essay
ne a patient learning to pour a cup of boiling water or slicing a roast with virtual therapy endless repetition without injury. According to Adkins, while the technology is promising it still needs more research unlike art therapy that’s always been a medium to express out inner thoughts.
Art therapy is a specialized form of therapy that uses both psychological theory and creative process to help patients, according to American Art Association. Art therapy does not depend on patient’s ability to use words to describe their trauma. Instead, it works, with the ability to create images in the mind and to translate these images outward rather than through words, “express[ing] their most innermost thoughts visually through [tools such as, paint, clay, crayons, and paper] or some other art form rather than through words.” (Miller. 1999, p.B3)
Using art therapy can both settle emotional conflicts and foster self-awareness that allows for healing through a creative process. In addition art therapy can be used for all ages struggling with trauma. According to Miller (1999) “children have at least a temporary advantage in that they are less inhibited as artists than teenagers and adults” (p. B3). Art heals by changing a person’s physiology and attitude. Brain Injuries And Methods Of Rehabilitation Essay
e body’s physiology changes from one of stress to one of relaxation, from one of fear to one of creativity, and inspiration. And according to the New England Art Institute, “power of speed and personal growth is drastically increased when you engage image from the unconscious. When you step aside and let the image come through, the image themselves becomes the agent of transformation. Through creativity, the soul knows instinctively to heal itself.”
Music therapy also, has the power to heal. Therapist use music to promote, maintain, and restore mental, physical, emotional, and spiritual health. Which can be gained through guided imagery, active listening, singing, visual art, drama, poetry, and relaxation music. According to American Music Therapy, Music has nonverbal, creative, structural, and emotional qualities. Music facilitates contact, interaction, self-awareness, learning, self-expression, communication, and personal development.
Music’s clinical value provides a non-threatening vehicle of interaction and communication with patient. Activities include, singing which helps with speech impairment and improves patient’s breathing control. Listening to music helps develop cognitive skills such as, attention and memory. It also provokes memories and stimulates thoughts, images, and feelings, which can be further examined and discussed, later with the therapist. Composing facilitates sharing of feelings, Brain Injuries And Methods Of Rehabilitation Essay
iting songs of healing for and with patient to bring self-awareness. Playing instruments can improve gross and fine motor coordination. Music provides a calming effect. It can be used for pain management the focal point is the music, in addition long after the session the patient continues to have soothing results. Music therapy can also be used to improve memory skill by adding familiar music to the learning process, which will act as a cue to remember.
Also when patient is learning, certain actions must appear before any learning can take place such as, attention span, following direction, and eye contact are necessary components to develop other skills. Attention span is often difficult for these patients because of the inability to filter out unimportant stimulus thereby not acknowledging what is important. Music can help the patient use as many senses as possible and provide motivation for the patient to continue to learn. According to the American Music Associati!
on This can be accomplished through high and low stimulus intervention. Ability to follow direction is often achieved by focusing on the intervention that uses sequencing skills, such as one step direction, and two step direction. For example a therapist will sing a song in which the lyrics will contain cueing directions such as, sit down, a one step direction, sit down and play with the drum, a two step direction. Music therapy influence a richer and fulfilling quality of life. Brain Injuries And Methods Of Rehabilitation Essay
Pet therapy is another rewarding and enhancing therapy for patients with traumatic brain injury. Pets provide unconditional love and affection. In the hospital where patient may feel isolated, loneliness, loss, separation from home, and a sense of no longer being needed the comfort of pet therapy is a gift. In a study published by Jama vol 275, 1001 apr 3 96 the author states pet therapy provides a “significant positive” changes in patient well-being. According to Delta Society animals have a way of “accepting without qualification.”
They don’t care how a person looks or what they say. An animal acceptance is nonjudgmental. Pet therapy provides many benefits such as feeling “spiritually fulfilled” according to Delta Society, and for patients with low self esteem an animals can help them focus on their recovery rather than thinking about their injuries. According to Brain Injury Association, pets provide immediate feedback in the form of nip, scratch, or bark, this ! Brain Injuries And Methods Of Rehabilitation Essay
may help the patient correct or relearn more appropriate behavior with out the repeated embarrassment of a social mistake or verbal correction by staff members. Delta Society, also states staff members have reported that it is easier to talk to patient during and after animal visits. In addition animals help presented an air of emotional safety, if a therapist has an animal in his or her office it presence may open a path through the person’s initial resistance. Children are especially likely to project their feelings and experience onto an animal. Brain Injuries And Methods Of Rehabilitation Essay