Acute Rehabilitation in Traumatic Brain Injury.

Malays J Med Sci. May–Jun 2017; 24(3): 101–103 www.mjms.usm.my © Penerbit Universiti Sains Malaysia, 2017 For permission, please email:[email protected] Sir, The main aims during acute rehabilitation management for traumatic brain injury focus mainly on cognitive rehabilitation and complications prevention. Early assessment and intervention can improve patients’ ability to return to their previous level of function and quality of life (1). Every patient with mild, traumatic brain injury should be screened for functional deficits and daily living activities, including bowel and bladder continence, speech and swallowing, motor control, sensory impairment, language comprehension and production, cognition and potential psychiatric and medical comorbidities (2). Any impairment or disability noted should be addressed accordingly. Ideally, all patients with moderate to severe traumatic brain injury should be referred to a rehabilitation team, including a rehabilitation medicine specialist, a neuropsychologist, an occupational therapist and a speech therapist to evaluate patients’ cognitive functioning (2). Acute management of cognition, in moderate to severe traumatic brain injury, is based on the patient’s respective Rancho Los Amigos Level of Cognitive Functioning. The Rancho Los Amigos (RLA) Scale of Cognitive Functioning is a medical scale used to measure and identify the recovery pattern of the cognitive level and behavioral changes observed in patients with traumatic brain injury. It is a descriptive scale, and it does not require specific training in its use (3). It has adequate to excellent inter-rater reliability (3). Its utilisation is recommended in acute care of traumatic brain injury by the Traumatic Brain injury Taskforce (4). The first three levels of RLA are known as disorders of consciousness, including the comatose state (RLA Level I), vegetative state (VS) (RLA Level II) and minimally conscious state (MCS) (RLA Level III). Assessment of patients during this period is done using the 2012 Coma Recovery Scale-Revised (CRS-R 2012) (1). CRS-R 2012 is a medical scale for the disorder of consciousness, which includes 23 items with 6 subscales, including auditory, visual, motor, oromotor, communication and arousal functions. This scale differentiates the patient’s recovery stage, whether he or she is in the comatose state, vegetative state, minimally conscious state or is emerging from the minimally conscious state. The CRS-R 2012 does not require specific training, and it has excellent test-retest reliability and interrater and intrarater reliability (5). A systematic review, which identified one randomised control trial (RCT) (n = 14) and two controlled clinical trials (n = 54), concluded that, for the multisensory stimulation of patients in the comatose or vegetative states, the results were invalid and, therefore, no clinical outcomes or practice recommendations could be made, due to the methodological and statistical limitations of all three studies (6). Novel treatment for disordered consciousness in traumatic brain injury patients includes hyperbaric oxygen, deep thalamic stimulation and transcranial magnetic stimulation (4). To cite this article: Hanafi MH. Acute rehabilitation in traumatic brain injury. Malays J Med Sci. 2017;24(3):101– 103. https://doi.org/10.21315/mjms2017.24.3.13