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Community Neurorehabilitation for Traumatic Brain Injury - Daniel Friedland, Consultant Clinical Neuropsychologist

13/12/17. The total incidence of traumatic brain injury (TBI) in the general population in the UK is estimated at 229 per 100,000. 1 Moderate to severe traumatic brain injury account for approximately 20% of traumatic brain injury. A moderate to severe traumatic brain injury is generally defined as having one of the following: loss of consciousness beyond 30 minutes, post-traumatic amnesia beyond 24 hours, and/or trauma-related abnormalities on neuroimaging. 2

The outcome following moderate to severe traumatic brain injury is far more variable than mild traumatic brain injury. Moderate to severe traumatic brain injury can result in temporary, prolonged, or permanent neurological impairments (motor impairments, balance and dizziness problems, headaches, visual impairments), cognitive impairments (reduced information processing, memory impairments, executive impairments), and/or neuropsychiatric impairments (apathy, disinhibited behaviour, depression, anxiety). 3

The initial emphasis in the management of traumatic brain injury is on acute medical management which is usually overseen by neurosurgery. In London this is managed through the four major trauma centres. Following the acute management of traumatic brain injury, the individual usually has a period of inpatient rehabilitation. This inpatient rehabilitation focuses on neurological and cognitive impairments. There are some specialised inpatient neuropsychiatrically led units, but these are rare in the UK. Much research has been conducted into the effectiveness of inpatient rehabilitation for acquired brain injury, including traumatic brain injury.

Over the last fifteen years there has been increased emphasis on the importance of community neurorehabilitation. It is surprising that it has taken so long to appreciate the importance of community neurorehabilitation given that the majority of people who have sustained a moderate to severe traumatic brain injury ultimately return to the community. It is only in the most severe cases where individuals do not return to community living but may rather reside in a residential placement. In this author’s opinion it does not make sense to provide excellent acute care and inpatient rehabilitation without community follow-up, as it is likely that without this community follow-up the gains made in inpatient rehabilitation are likely to be lost over time. In addition, community neurorehabilitation interacts positively with the natural recovery following traumatic brain injury. This natural recovery takes place for approximately 2 years following the injury.

In community neurorehabilitation the...

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