Traumatic Brain Injury (TBI)

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Subacute Treatment

Subacute treatment is provided after stabilization, which ranges from medical stability to a patient's return to the community or admission to a chronic care facility. The patient is usually admitted to an acute rehabilitation hospital equipped to manage TBI and its complications. At admission, most patients still are in post-traumatic amnesia (PTA).

The main goals of subacute treatment are

• early detection of complications,
• facilitation of neurological and functional recovery, and
• prevention of additional injury.

Early Detection of Complications
In subacute treatment, facility staff watches for and treat bedsores, muscle contractions, infections, and other complications, such as fluid accumulation in the brain (e.g., hydrocephalus, subdural hygromas), that may require surgical treatment. A neurologist investigates for complications if the patient fails to progress as expected.

Facilitation of Neurological and Functional Recovery
Neurological function often improves incompletely, so rehabilitation professionals—physical, occupational and speech therapists, nurses, neuropsychologists, neurologists, and others specializing in traumatic brain injury—help patients and their families understand neurological impairments. They encourage patients and their families to take advantage of improvements as they occur. Sometimes a patient must learn new ways to do simple routine tasks—such as how to button a shirt or tie a shoe with one hand, or how to compensate for memory loss by using a logbook or calendar.

Prevention of Injury
During PTA, many patients experience poor balance, incoordination, weakness, or cognitive impairments that place them at risk for injury. They may be impulsive and unaware of their physical limitations and may try to climb out of bed or walk by themselves when it is unsafe to do so. Agitation and restlessness may also lead to injury. A well-designed rehabilitation unit and well-trained staff can keep them safe, using little or no medication.

In most cases, patients are discharged from the hospital once they emerge from PTA and can demonstrate, along with family and caregivers, that they will be safe in the home.

Disabilities and Handicaps
Disability refers to loss of physical and mental function caused by neurological impairment.

Examples include the following:

• Decreased ability to interact with others in socially acceptable ways
• Decreased ability or inability to walk
• Inability to carry or manipulate objects
• Inability to feel characteristics of objects
• Inability to process and retain information
• Inability to see clearly
• Poor coordination of fingers or limbs

Handicap refers to the overall disadvantage a person with one or more disabilities may experience. Some examples are:

• Difficulty forming and maintaining personal and professional relationships
• Difficulty participating in civic and social activities
• Difficulty participating in physical recreational activities
• Decreased ability or inability to work for pay and benefits

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