Which pitch is the hardest to catch

Psychiatry, Psychosomatics & Psychotherapy

Rehabilitation after traumatic brain injuries

Every traumatic brain injury is a decisive event for those affected, but also for their relatives, which "tears out of life" a mostly healthy person. The aim of rehabilitation is to enable those affected after their accident to cope with their private and possibly also professional everyday life. Depending on the severity of the trauma, recovery will require long and arduous daily work from everyone involved. Only the joint effort of an interdisciplinary team of therapists together with the relatives can lead to success. In all stages of medical rehabilitation, treatment must be based on a uniform therapy concept with great commitment from doctors, therapists and nursing staff. A high quality of medical care is essential for the best possible rehabilitation success.

The stages of treatment at a glance:

  • Intensive care unit - the patients' vital functions are monitored and kept stable.
  • Early rehabilitation - first everyday tasks are mastered with assistance.
  • Rehabilitation - the patient is becoming increasingly independent and may be able to take part in therapy offers in small groups;
  • Follow-up treatment - treatment of residual problems such as attention disorders.
  • Outpatient therapy or day clinic - with social integration, patients can already be discharged home and only come to the clinic for treatment.

The patient is treated in different stages. It begins with intensive care, leads through early rehabilitation to long-term rehabilitation and can then move on to outpatient aftercare at home. However, if severe disabilities remain, care is required. The assessment of the overall situation must show which rehabilitation options, i.e. which chances of recovery, exist.

The effects of brain damage are diverse and require treatment of motor, psychological, linguistic and visual deficits after the acute phase. It is important that different professional groups work together, such as psychologists, physiotherapists, neurologists, internists, occupational therapists, and logotherapists. It is also decisive for the further treatment and recovery of a traumatic brain injury to what extent it is possible for the relatives to participate and to support and motivate the patient.

In traumatic brain injury, rehabilitation measures are necessary in the early phase of intensive care. It is also important to include the patient in a regular daily routine of washing, getting dressed and eating. Active cooperation of the patient should be encouraged by the nursing staff.

After a severe traumatic brain injury, in addition to symptoms of paralysis, balance disorders and sensory disorders, brain disorders with impaired attention, memory, planning and thinking often persist. On the long-term reintegration into the family and into working life, the brain disorders have a greater impact than the symptoms of paralysis or other motor failures. Traumatic brain injuries can already be overwhelmed by the normal demands of everyday life. They tire easily and it is not uncommon for patients to be moody, quick-tempered, irritable or tearful. The trauma can permanently change the patient's personality.

Serious disorders of the higher brain performance such as disorders of attention, i.e. concentration, memory and problem-solving thinking, require treatment by a psychotherapist. The field of activity of psychotherapists also includes influencing behavioral problems such as increased aggressiveness, reduced drive or depression. The psychotherapist also represents the link between the patient, relatives and doctors.

Speech disorders are particularly common. Speaking, understanding, but mostly reading and writing are also affected to varying degrees. The prognosis of the restoration of language performance through speech therapy depends on the type of language disorder. Initially, it is a matter of generally reactivating linguistic performance, as the traumatized often do not speak at all on their own initiative. But the opposite can also be the case, namely that the patient concerned speaks excessively, but mostly in an incomprehensible manner. In this case, the flow of speech must be blocked by the therapist in the initial phase.

In the next so-called disorder-specific exercise phase, therapy methods are used that are based on the respective disorder focuses.

In the third phase, the so-called consolidation phase, an attempt is made to transfer what has been learned into everyday situations. The person concerned trains what they have learned in role-plays or in everyday situations such as shopping. Relatives should be advised by a speech therapist on how to deal with the patient at the beginning of a speech disorder. Here they learn, for example, that it is not necessary to speak to a speech-impaired patient like a toddler and that, on the contrary, this only leads to unnecessary frustration for him.

If there is a speech disorder, the person concerned cannot exercise control over the muscles necessary for speaking. If the speech disorder occurs in combination with a voice disorder, the patient speaks slurred and with a pressed or hoarse voice. In addition to speech therapy, assistive devices such as so-called speech vision devices are also used for speech and voice disorders. The patient receives immediate feedback about his pitch and volume on a screen in the form of curves (feedback therapy).

Speech aids, so-called communicators, can be used for the most severe speech and voice disorders. These have a voice output that prints out a message entered by the patient, displays it on a screen or even outputs it using an artificial voice. Operation is made easier for patients with severe motor impairments with a special keyboard.

In the case of swallowing disorders, it must be ensured that the patient is positioned upright while eating and drinking, especially in the early phase. In this case, feeding through a gastric tube may be necessary; in severe cases, the patient is given a tracheostomy tube. An inflatable balloon around the cannula then prevents material from entering the airways and lungs.

If the swallowing disorder persists, swallowing training carried out by a specialist therapist is necessary. This swallowing therapy can take several weeks. The aim is to use appropriate stimulation techniques to restore the disturbed swallowing reflex or to teach the patient methods to replace the missing swallowing reflex with special head postures and special larynx training. During this time, patients are often not allowed to ingest any food or only eat food of a certain consistency, such as porridge. Relatives should be included in the swallowing therapy.

If the coordination of movement sequences is disturbed after the brain injury, rehabilitation tries to rebuild the correct sequence of movement and action sequences. For this purpose, everyday activities such as eating or getting dressed are trained with the patient. When dealing with patients with apraxia, it is important to know that the disorder has nothing to do with confusion, but rather that the injury means that the patient is no longer able to implement the "normal" sequences of movements and actions for healthy people.

Technical support: Dr. med. Uwe Meier (BDN), Grevenbroich