The basic treatments for brain injury include:
- Medical Treatment
- Neurosurgical Treatment
- Rehabilitative Treatment
The first line of treatment for all injured patients, including brain injury patients, is always “ABC”:
A for Airway
B for Breathing
C for Circulation
It is essential to ensure that all patients have unobstructed airways (patent), that they are breathing and oxygenating well, and that their circulatory system is functioning (normal blood pressure/pulse). Once the ABCs are achieved, treatment is usually based on the degree of injury. For example, severe brain injury patients are treated more aggressively (usually in the ICU) rather than patients whose injuries are mild.
Medical treatments for brain injuries are typically managed by Neurosurgeons, Neurologists and Internists. Some of the medical treatments will include treatment for brain swelling or cerebral edema, which encompasses the use of diuretics such as manitol and hypertonic saline. Other medical treatments include the use of:
- muscle relaxants
- analgesia/pain killers
- seizure prophylaxis
- control of body temperature (hypothermia is proven to be beneficial)
- antibiotics, if necessary
For good cerebral perfusion, the blood pressure should always be maintained within the normal range. Hypotension is bad for brain injuries, therefore it is important to avoid low blood pressure.
Neurosurgical treatment of brain injuries is managed exclusively by Neurosurgeons. There are numerous forms of neurosurgical treatment for brain injuries, the most common include:
- Placement of Intracranial Pressure (ICP) monitoring device;
- Craniotomies (for aneurysms, brain tumors, strokes, trauma-related brain injuries, etc.);
- Placement of External Ventricular Drain (EVD);
- Minimally invasive techniques including deep brain stimulation, thalamotomy, pallidectomy for the treatment of Parkinson’s Disease, and other minimally invasive techniques.
After sustaining a brain injury or experiencing a neurological illness, a person may undergo a wide range of medical, physical, cognitive, and behavioral changes. Neurological rehabilitation is a structured, doctor-supervised therapeutic program, designed to assist those who have suffered a brain ailment in improving function, reducing symptoms, and attaining the highest possible degree of self-sufficiency and participation in the community.
Patient care is coordinated by two types of doctors; a physiatrist (rehabilitation physician) and a neuropsychologist, both specializing in treating patients with brain injuries. These clinicians guide a multidisciplinary team including, psychologists, physical, speech, occupational, and cognitive rehabilitation therapist, in addressing the specific needs of patients and their families. They start by identifying the patient’s medical needs and treatment goals. Based on these individual goals, the doctors and rehabilitation team then create and implement a plan to help the patient achieve the best possible outcome.
Physiatrists, or rehabilitation physicians, are specialists in the diagnosis and treatment of patients in three areas of medical care: Diagnosis and treatment of musculoskeletal injuries and pain syndromes, Electrodiagnostic medicine for the evaluation of various neurologic disorders, and Rehabilitation of patients with severe impairments. They are charged with the coordination and management of the patient’s medical care and therapeutic program and they communicate regularly with the patient and their family regarding medical needs. These physicians work closely with the rehabilitation team to monitor the patient’s recovery, which includes needed shifts in treatment and discharge planning and consulting with other physicians as necessary.
Neuropsychologists and cognitive rehabilitation psychologists are trained to treat the changes in brain function that may affect the patient’s cognition, thought processes, behavior, or emotions. The cognitive rehabilitation psychologist provides remediation for attention, memory, executive function, and visual-spatial deficits individually. They also conduct individual and family treatment sessions to address cognitive, behavioral or adjustment issues, including the special issues of adjusting to the physical and cognitive changes brought about by the patient’s neurological condition. The neuropsychologist provides ongoing evaluations of the patient’s cognitive improvement in order to help the rehabilitation team determine when brain injury treatment levels need to be adjusted.
Physical therapists examine patients and develop a plan for the best course of treatment for conditions that affect lower mobility, limit the ability to play sports, or perform daily activities. They aim to restore function, help prevent further injury, reduce pain, maximize physical functioning and prevent disability.
Occupational Therapists assist people in recovering or maintaining daily living and work skills. They not only help clients to improve their basic upper motor functions and reasoning abilities, but also to compensate for permanent loss of function. Occupational therapists assist clients in performing activities of all types, ranging from computer use to caring for daily needs such as dressing, cooking, and eating. In summary, they create individual treatment plans to help brain injury patients regain the ability to perceive, desire, recall, plan and carry out roles, routines, tasks and sub-tasks for the purpose of self-maintenance, productivity, leisure and rest in response to demands of the internal and/or external environment.
The speech-language pathologists provide therapy for persons whose ability to speak or swallow has been affected by brain injury or illness. Speech-language pathologists (also called speech therapists) evaluate and treat speech, language, and swallowing disorders.