ABSTRACT
The last 25 years have seen dramatic changes in the care and treatment of patients with traumatic brain injury (TBI). These changes have impacted on both the acute care as well as the post-acute rehabilitation by lowering the mortality rate and increasing the number of persons that require longer term neurorehabilitation. The treatment of head-injured patients has increasingly occupied the neurosurgery area.(1-4) While earlier the focus was on the purely clinical aspects, for example, concerning suitable therapy concepts for acute care and intensive medical treatment, the interest is now concentrated on outcomes and therapeutic approaches in the clinical research of pathophysiological and post-traumatic changes. How can imminent secondary and tertiary damage be avoided or recognized early on and subsequently minimized? This is the starting point for rehabilitation research in the neurotraumatology field.(4-8) However, in respect to the so-called “evidencebased” concepts for post-traumatic rehabilitation, prospective controlled clinical trials are still lacking in neurorehabilitation.(1) This is why there are so few standards for management in post-traumatic rehabilitation although there is a lot of experience and expert opinion documented in the literature over the last 100 years – along with expert opinions in this field which provide for some algorithms and options.(1,9-12) Cognitive impairment and neuropsychological disabilities determine the final performance capacity and the degree of the handicap of the patients with TBI. In contrast to the TBI patient, sensory-motor disabilities are the major handicap in persons with spinal cord injury (SCI), which differs according to the stages of the
transsection syndrome, many of these patients can look after themselves because of the intact cognitive and neurobehavioral functions.(13,14)
Neurorehabilitation is primarily based on the prevention, diagnosing and treating post-traumatic complications and defining specific strategies in respect to the various impairments that decrease functional ability. The ultimate goal is the achievement of the patients’ functioning in society.
