Neurorehabilitation in neurotrauma

Abstract

Since time immemorial, neurotrauma has been recorded in various continents. The advancement in neurotraumatology ever since Denny Brown and Trussell’s landmark experimental study of concussion, has come a long way with major contributions from neuropathology, neurophysiology, neurochemistry, biomedical sciences, public policies, intensive care medicine and last but not the least, genetics. A simple introduction of lap and shoulder belt have reduced majority of serious accidents. Continuous recording of intracranial pressures, recognition of acute brain swelling with characteristics of cerebral blood flow in brain damage and development of Glasgow coma and outcome scales by a well-designed multi-centered multi-national outcome study in head injuries brought in major changes in squealae and outcome by preventing and reducing the secondary insults. Computed tomography (CT) and improvement in morbidity and mortality of acute extra axial hematomas by immediate surgery, has influenced and guided several organizations in developing research and formulating guidelines for treatment of acute neurotrauma. The recognition of the spectrum in head injury, aids in prevention of injury and measures to improve outcome by ever developing neuro-rehabilitative measures, apart from advancements in the genetic aspects of understanding the brain’s response to injury along with attention to modern principles of neuro-intensive and critical care, has manipulated neurotrauma towards achieving innovative newer frontiers. Assessment of the extent of injury and the deficits in neurotrauma is as challenging as the management itself. Several criteria including the Japanese Coma Scale and the proposition for the international coma scale have been attempted. Once the baseline characters and the psychology1 of the patient is understood along with the extent and nature of the severity of the injury, a defined patterned timescale with a schedule can be created & tailor made to every patient and all out efforts instituted to rehabilitate not only the individual but also the whole family and the society at large.