Treatments and rehabilitation in the acute and chronic state of traumatic brain injury

Abstract

Traumatic brain injury (TBI) is a major cause of acquired disability globally, and effective treatment methods are scarce. Lately, there has been increasing recognition of the devastating impact of TBI resulting from sports and other recreational activities, ranging from primarily sport-related concussions (SRC) but also more severe brain injuries requiring hospitalization. There are currently no established treatments for the underlying pathophysiology in TBI and while neuro-rehabilitation efforts are promising, there are currently is a lack of consensus regarding rehabilitation following TBI of any severity. In this narrative review, we highlight short- and long-term consequences of SRCs, and how the sideline management of these patients should be performed. We also cover the basic concepts of neuro-critical care management for more severely brain-injured patients with a focus on brain oedema and the necessity of improving intracranial conditions in terms of substrate delivery in order to facilitate recovery and improve outcome. Further, following the acute phase, promising new approaches to rehabilitation are covered for both patients with severe TBI and athletes suffering from SRC. These highlight the need for co-ordinated interdisciplinary rehabilitation, with a special focus on cognition, in order to promote recovery after TBI.

Keywords: cognition; neuro-critical care; neuro-rehabilitation; sport-related concussion; traumatic brain injury.

Figure 1.

Overview of the processes that occur from brain injury that will result in subsequent symptoms, highlighting the detrimental secondary injury cascade which neuro-critical care is aiming to mitigate.

Figure 2.

Overview of sideline assessments of a sports-related concussion, treatment of more severe brain injuries and highlights of neuro-rehabilitation.