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Chapter 25 - MDT and Rehabilitation of Head Injury

Published online by Cambridge University Press:  28 April 2020

Peter C. Whitfield
Derriford Hospital, Plymouth
Jessie Welbourne
University Hospitals, Plymouth
Elfyn Thomas
Derriford Hospital, Plymouth
Fiona Summers
Aberdeen Royal Infirmary
Maggie Whyte
Aberdeen Royal Infirmary
Peter J. Hutchinson
Addenbrooke’s Hospital, Cambridge
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The effectiveness of brain injury rehabilitation from early stages of recovery through acute, post-acute and community care is well documented.1 Clinical guidelines recommend early assessment and rehabilitation from specialist multidisciplinary teams.25 Key aspects of the multidisciplinary approach are highlighted as holistic and maximising the available resources (knowledge, experience, financial and physical) to work towards a common goal.2 The British Society of Rehabilitation Medicine (BSRM) guidelines point to the benefits of an interdisciplinary team working towards an agreed set of goals and recommends systems for co-ordination of disciplines, communication with patients and families and education and training with teams.

Traumatic Brain Injury
A Multidisciplinary Approach
, pp. 308 - 325
Publisher: Cambridge University Press
Print publication year: 2020

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Turner-Stokes, L, Pick, A, Nair, A, Disler, PB, Wade, DT. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 2015; Issue 12.Google Scholar
Scottish Intercollegiate Guidelines Network (SIGN). Brain injury rehabilitation in adults. Publ. 130. Edinburgh: SIGN; 2013. Scholar
Royal College of Physicians and British Society of Rehabilitation Medicine. Rehabilitation following acquired brain injury: national clinical guidelines. Turner-Stokes, L, ed. London: RCP, BSRM; 2003.Google Scholar
Scottish Intercollegiate Guidelines Network (SIGN). Early management of patients with head injury. Publ. 110. Edinburgh: SIGN; 2009. Scholar
National Institute for Health and Clinical Excellence. Head injury: assessment and early management. NICE Guideline (CG176); 2014.Google Scholar
Royal College of Physicians and British Society of Rehabilitation Medicine. Specialist rehabilitation in the trauma pathway: BSRM core standards. Turner-Stokes, L, ed. London: RCP, BSRM; 2013.Google Scholar
National Institute for Health and Clinical Excellence. Major trauma service delivery. NICE Guideline (CG176); 2016.Google Scholar
Manser, T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 2009;53 :143–51.Google Scholar
Epstein, NE. Multidisciplinary in-hospital teams improve patient outcomes: a review. Surgical Neurology International. 2014;5(Suppl 7):S295S303.Google Scholar
Clini and Ambrosini. Early physiotherapy in the respiratory intensive care unit. Respiratory Med 2005;99(9):1096–104.Google Scholar
Campbell, M. Rehabilitation for traumatic brain injury. In: Physical therapy practice in context. Edinburgh: Churchill Livingstone; 2000.Google Scholar
Stucki, G, Steir-Jarmer, M, Grill, E, Melvin, J. Rationale and principles of early rehabilitation after an acute injury or illness. Dis Rehab 2005;27(7/8):353–9.Google Scholar
ATLS Subcommittee, American College of Surgeons Committee on Trauma, International ATLS Working Group. Advanced trauma life support (ATLS): the ninth edition. J Trauma Acute Care Surg 2013;74:1363–6.Google Scholar
NHS Clinical Advisory Group for Major Trauma: Department of Health; 2010.Google Scholar
Neurosurgical National Audit Programme; 2014. Scholar
Trauma Audit and Research Network (TARN). Scholar
Bullock, R, Teasdale, G. Head injuries – ABC of major trauma. BMJ 1990;300(6738):1515–58.Google ScholarPubMed
Horiuchi, K, Jordan, D, Cohen, D, Kemper, MC. Insights into the increased oxygen demand during chest physiotherapy. Crit Care Med 1997;25(8):1347–51.CrossRefGoogle ScholarPubMed
Berney, S, Denehy, L. The effect of physiotherapy treatment on oxygen consumption and haemodynamics in patients who are critically ill. Aust J Physiol 2003;49:99105.Google Scholar
Hough, A. Physiotherapy in respiratory care: a problem solving approach. 2nd edn. Churchill Livingstone; 1996.Google Scholar
Feldman, Z, Kanter, MJ, Robertson, CS, et al. Effects of head elevation on intracranial pressure, cerebral perfusion pressure and cerebral blood flow in head injured patients. J Neurosurg 1992;76(2):207–11.Google Scholar
Lee, ST. Intracranial pressure changes during positioning of patients with severe head injury. Heart Lung 1989;18(4):411–14.Google ScholarPubMed
Gossleink, R, Bott, J, Johnson, M, et al. Physiotherapy for adult patients with critical illness: recommendations of European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for critically ill patients. Intensive Care Med 2008;34:1188–99.Google Scholar
Batt, J, Dos Santos, CC, Cameron, JI, Herridge, MS. Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms. Am J Respir Crit Care Med 2013;187:238–46.Google Scholar
Puthucheary, ZA, Rawal, J, McPhail, M, Connolly, B, Ratnayake, G, Chan, P, et al. Acute skeletal muscle wasting in critical illness. J Am Med Assoc 2013;310:1591–600.Google Scholar
Endotracheal suctioning of mechanically ventilated patients with artificial airways. American Association of Respiratory Care (AARC) Clinical practice Guideline; 2010.Google Scholar
Choi, JSP, Jones, AYM. Effects of manual hyperinflation and suctioning on respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. Aust J Physiotherapy 2005:51:2530.CrossRefGoogle ScholarPubMed
Frederique, P, et al. Benefits and risks of manual hyperinflation in intubated and mechanically ventilated intensive care unit patients: a systematic review. Criti Care Aug 2012;16:R145.Google Scholar
Pathmanathan, N, Beaumont, N, Gratrix, A. Respiratory physiotherapy in the critical care unit Continuing Education. Anaesthes Crit Care Pain J 2015;15(1):20-25.Google Scholar
Zahran, EM, Abd El-Razik, AA. Tracheal suctioning with versus without saline instillation. J Am Sci 2011;7(8):2332.Google Scholar
Thomas, PJ, Paratz, JD, Lipman, J, Stanton, WR. Lateral positioning of ventilated intensive care patients: a study of oxygenation, respiratory mechanics, hemodynamics, and adverse events. Heart Lung 2007 36(4):277–86.CrossRefGoogle ScholarPubMed
Malkoç, M, Karadibak, D, Yildirim, Y. The effect of physiotherapy on ventilatory dependency and the length of stay in an intensive care unit. Int J Rehabil Res 2009;32(1):85–8.Google Scholar
McCarren, B, Alison, J, Herbert, R. Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study. Aust J Physiother 2006;52:267–71.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence. Rehabilitation after critical illness in adults. NICE Guideline (CG83); 2009.Google Scholar
Lance, JW. Symposium synopsis. In Feldman, RG, Young, R, Koella, WP, eds. Spasticity: disordered motor control. Chicago, IL: Year Book Medical Publishers; 1980.Google Scholar
Pathmanathan, N, Beaumont, N, Gratrix, A. Respiratory physiotherapy in the critical care unit Continuing Education. Anaesthes Crit Care Pain J 2015;15:20-25.Google Scholar
Williams, PE. Use of intermittent stretch in the prevention of serial sarcomere loss in immobilised muscles. Ann Rheum Dis 1990;49:316.Google Scholar
Cipriano, CA, Pill, SG, Keenan, MA. Heterotopic ossification following traumatic brain injury and spinal cord injury. J Am Acad Orthop Surg 2009;17:689–97.Google Scholar
Katalinic, OM, Harvey, LA, Herbert, RD, Moseley, AM, Lannin, NA, Schurr, K. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev 2010;9:CD007455.Google Scholar
Gracies, JM. Pathophysiology of spastic paresis. II: Emergence of muscle overactivity. Muscle Nerve 2005;31(5):552–71.Google Scholar
College of Occupational Therapists and the Association of Chartered Physiotherapists in Neurology (ACPIN). Splinting for the prevention and correction of contractures in adults with neurological dysfunction; 2015.Google Scholar
Jo, HM, Song, JC, Jang, SH. Improvements in spasticity and motor function using a static stretching device for people with chronic hemiparesis following stroke. Neurorehabilitation 2013;32:369–75.CrossRefGoogle ScholarPubMed
Doucet, BM, Mettler, JA. Effects of a dynamic progressive orthotic intervention for chronic hemiplegia: a case series. J Hand Ther 2013;26:139–46.Google Scholar
Barnes, MP, Johnson, GR (eds). Upper motor neurone syndrome and spasticity: clinical management and neurophysiology. Cambridge: Cambridge University Press; 2008.Google Scholar
Lapeyre, E, Kuks, JB, Meijler, WJ. Spasticity: revisiting the role and the individual value of several pharmacological treatments. NeuroRehabil 2010;27:193200.Google Scholar
Esquenazi, A, Novak, I, Sheean, G, Singer, BJ, Ward, AB. International consensus statement for the use of botulinum toxin treatment in adults and children with neurological impairments – introduction. Eur J Neurol 2010;17:18.Google Scholar
Simpson, DM, Gracies, JM, Graham, HK, Miyasaki, JM, Naumann, M, Russman, B, et al. Assessment: botulinum neurotoxin for the treatment of spasticity (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2008;70:1691–8.Google Scholar
Mathiowetz, V, Haugen, JB. Motor behaviour research: implications for therapeutic approaches to central nervous system dysfunction. Am J Occ Ther 1994;48(8):733–45.Google Scholar
Topp, R, Ditmyer, M, King, K, Doherty, K, Hornyak, J III. The effect of bed rest and potential of rehabilitation on patients in the intensive care unit. AACN Clin Issues 2002;13:263–76.Google Scholar
Stevens, RD, Dowdy, DW, Michaels, RK, Mendez-Tellez, PA, et al. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007;33:1876–91.Google Scholar
Gillick, BT, Marshall, WJ, Rheault, W, Stoecker, J. Mobility criteria for upright sitting with patients in the neuro/trauma intensive care unit: an analysis of length of stay and functional outcomes. Neurohospitalist 2011;1:172–7.Google Scholar
Allum, JHJ, Bloem, BR, MG, Carpenter, et al. Proprioceptive control of posture: a review of new concepts. Gait Posture 1998;8:214–42.Google Scholar
Richardson, DLA. The use of the tilt-table to effect passive tendo-Achilles stretch in a patient with head injury: Physio Theory Pract 1991;7:4550.Google Scholar
Bourdin, G, Barbier, J, Burle, J-F, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care 2010;55(4):400–7.Google ScholarPubMed
Krewer, C, Luther, M, Koenig, E, Muller, F. Tilt table for patients with severe disorders of consciousness: a randomized controlled trial. PLoS One 2015;10(12):e0143180.Google Scholar
Langhammer, B, Stanghelle, JK. Can physiotherapy after stroke based on the bobath concept result in improved quality of movement compared to the motor relearning programme. Physiother Res Int 2011;16:6980.Google Scholar
Pope, PM, Bowes, CE, Booth, E. Advances in seating the severely disabled neurological patients. Physio Ireland 1994;15(1):914.Google Scholar
Williams, AT, Leslie, GD, Bingham, R, Brearley, L. Optimizing seating in the Intensive care unit for patients with impaired mobility. Am J Crit Care 2011;20(1):1927.Google Scholar
Rousseau, K, Harrison, A, Rochette, A, Routhier, F, et al. Impact of wheelchair acquisition on social participation. Disability Rehab Assist Technol 2009;4(5):344–52.Google Scholar
Herman, JH, Lange, ML. Seating and positioning to manage spasticity after brain injury. Neuro-rehabilitation 1999;12:105–17.Google Scholar
Halper, AS, Cherney, LR, Cichowski, K, Zhang, M. Dysphagia after head trauma: the effect of cognitive-communicative impairments on functional outcomes. J Head Trauma Rehabil 1999;14(5):486–96.CrossRefGoogle ScholarPubMed
Mackay, LE, Morgan, AS, Bernstein, BA. Swallowing disorders in severe brain injury: risk factors affecting return to oral intake. Arch Phys Medi Rehabil 1999;80:365–71.Google ScholarPubMed
Logemann, JA, Pepe, J, Mackay, LE. Disorders of nutrition and swallowing: intervention strategies in the trauma center. J Head Trauma Rehabil 1994;9(1):4356.Google Scholar
Mayer, V. The challenges of managing dysphagia in brain-injured patients. Br J Commun Nurs 2004;9(2):6773.Google Scholar
Logemann, J. Evaluation and treatment of swallowing disorders. Austin, TX: Pro-Ed; 1998.Google Scholar
Mackay, LE, Morgan, AS, Bernstein, BA. Factors affecting oral feeding with severe traumatic brain injury. J Head Trauma Rehabil 1999;14(5):435–47.CrossRefGoogle ScholarPubMed
Ward, EC, Green, K, Morton, A-L. Patterns and predictors of swallowing resolution following adult traumatic brain injury. J Head Trauma Rehabil 2007;22(3):184–91.Google Scholar
Kelly, AM, Hydes, K, McLaughlin, C, Wallace, S. Fibreoptic endoscopic evaluation of swallowing (FEES): the role of speech and language therapy. Royal College of Speech and Language Therapists Policy Statement; 2007.Google Scholar
Schurr, MJ, Ebner, KA, Maser, AL, Sperling, KB, Helgerson, RB, Harms, B. Formal swallowing evaluation and therapy after traumatic brain injury improves dysphagia outcomes. J Trauma 1999;46(5):817–23.Google Scholar
Hamdy, S, Jilani, S, Price, V, Parker, C, Hall, N, Power, M. Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury. Neurogastroenterol Motili 2003;15:6977.Google Scholar
McDonald, S. Pragmatic language skills after closed head injury: ability to meet the informational needs of the listener. Brain Lang 1993;44:2846.CrossRefGoogle ScholarPubMed
King, KA, Hough, MS, Walker, MM, Rastatter, M, Holbert, D. Mild traumatic brain injury: effects on naming in word retrieval and discourse. Brain Inj 2006;20:725–32.Google Scholar
Hough, MS, Barrow, I. Descriptive discourse abilities of traumatic brain-injured adults. Aphasiology 2003;17:183–91.Google Scholar
Dahlberg, C, Hawley, L, Morey, C, Newman, J, Cusick, CP, Harrison-Felix, C. Social communication skills in persons with post-acute traumatic brain injury: three perspectives. Brain Injury 2006;20:425–35.Google Scholar
Snow, P, Ponsford, J. Assessing and managing changes in communication and interpersonal skills following TBI. In: Ponsford, J, Sloan, S, Snow, P, eds. Traumatic brain injury: rehabilitation for everyday adaptive living. Sussex, UK: Psychology Press; 1995.Google Scholar
Togher, L, McDonald, S, Code, C. Communication problems following traumatic brain injury. In: McDonald, S, Togher, L, Code, C, eds. Communication disorders following traumatic brain injury. Sussex, UK: Psychology Press; 1999.Google Scholar
Borgaro, SR, Prigatano, GP, Kwasnica, C, Alcott, S, Cutter, N. Disturbances in affective communication following brain injury. Brain Injury 2004;18:33–9.Google Scholar
Body, R, Perkins, M, McDonald, S. Pragmatics, cognition, and communication in traumatic brain injury. In: McDonald, S, Togher, L, Code, C, eds. Communication disorders following traumatic brain injury. Sussex, UK: Psychology Press; 1999.Google Scholar
Martin, I, McDonald, S. Weak coherence, no theory of mind, or executive dysfunction? Solving the puzzle of pragmatic language disorders. Brain Lang 2003;85:451–66.Google Scholar
Myers, PS. Profiles of communication deficits in patients with right cerebral hemisphere damage: implications for diagnosis and treatment. Aphasiology 2005;19(12):1147–60.Google Scholar
Snow, P, Douglas, J, Ponsford, J. Conversational discourse abilities following severe traumatic brain injury: a follow-up study. Brain Injury 1998;12:911–35.Google Scholar
Murdoch, BE, Theodoros, DG. Dysarthria following traumatic brain injury. In: McDonald, S, Togher, L, Code, C, eds. Communication disorders following traumatic brain injury. Sussex, UK: Psychology Press; 1999.Google Scholar
Braverman, SE, Spector, J, Warden, DL, et al. A multidisciplinary TBI inpatient rehabilitation programme for active duty service members as part of a randomized clinical trial. Brain Injury 1999;13:405–15.Google Scholar
Cicerone, KD, Mott, T, Azulay, J, Friel, JC. Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury. Arch Phys Med Rehabil 2004;85:943–50.Google Scholar
Brooks, N, McKinlay, W, Symington, C, Beattie, A, Campsie, L. Return to work within the first seven years of severe head injury. Brain Injury 1987;1:519.Google Scholar
Brooks, N, Campsie, L, Symington, C, Beattie, A, McKinlay, W. The effects of severe head injury on patient and relative within seven years of injury. J Head Trauma Rehabil 1987;2:113.Google Scholar
Hammond, FM, Hart, T, Bushnik, T, Corrigan, J, Sasser, H. Change and predictors of change in communication, cognition and social function between 1 and 5 years after traumatic brain injury. J Head Trauma Rehabil 2004;19:314–28.Google Scholar
Royal College of Occupational Therapists. Definitions of occupational therapy –essential briefing; 2015. Scholar
Kielhofner, G. Conceptual foundations of occupational therapy. 2nd edn. Philadelphia: F. A. Davis; 1997.Google Scholar
Malley, D, Rowland, D, Royal College of Occupational Therapists, Specialist Section Neurological Practice. Acquired brain injury: a guide for occupational therapists; 2013.Google Scholar
Wheeler, S, Acord-Vira, A. Occupational therapy practice guidelines for adults with traumatic brain injury. Bethesda, MD: American Occupational Therapy Association; 2016.Google Scholar
Gill-Thwaites, H, Munday, R. The sensory modality assessment and rehabilitation technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients. Brain Injury 2004;18(12):1255–69.Google Scholar

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