Demystifying brain injury recovery: Why timing, method and persistence are equally important?

Author: Zhang Hao, Chief Physician, China Rehabilitation Research Center (Beijing Boai Hospital)

Reviewer: Hu Wenli, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Brain trauma, like stroke, is a common emergency disease of the nervous system and also requires timely and professional rehabilitation treatment.

In the past, rehabilitation treatment was mostly focused on stroke patients, but in recent years, with the development of social economy and people's improved understanding of rehabilitation, patients with brain trauma have gradually become an important target of rehabilitation treatment. Especially today, with the increasing development of transportation, traffic accidents have become one of the main causes of brain trauma. Despite this, many patients did not receive the proper rehabilitation intervention after receiving life-saving treatment, resulting in the failure to solve the functional disorder problem in a timely manner.

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The Neurorehabilitation Department of the China Rehabilitation Research Center (Beijing Boai Hospital) has established a special brain injury rehabilitation department since 2009, aiming to provide professional rehabilitation services for these patients. The goal of rehabilitation treatment is not only to promote the recovery of damaged nerve function and prevent the occurrence of complications, but also to lay a solid foundation for the patient's further rehabilitation in the future. Therefore, the best time for rehabilitation treatment should be as early as possible to the intensive care stage, that is, to intervene when the patient's vital signs are relatively stable. Early rehabilitation intervention helps reduce the risk of complications such as infection, shorten the patient's stay in the intensive care unit, reduce the economic burden, and create favorable conditions for subsequent treatment.

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According to the different rehabilitation processes, brain trauma rehabilitation treatment is usually divided into three levels: Level 1 rehabilitation is acute rehabilitation, which mainly occurs in general hospitals, starting from the intensive care unit to the general ward of neurology and neurosurgery; Level 2 rehabilitation refers to the recovery period treatment after the patient is transferred to a professional rehabilitation hospital or rehabilitation medical institution; Level 3 rehabilitation is rehabilitation treatment at home or in the community after the patient's condition is relatively stable. However, although Level 1 rehabilitation in my country has been included in the service scope of most Level 3 hospitals, there are still many deficiencies due to limited resources. Level 2 rehabilitation centers have not yet been popularized nationwide, and Level 3 rehabilitation faces many challenges, especially at the community level, where rehabilitation facilities and services are far from ideal.

Patients of different ages present different characteristics during the rehabilitation process. For example, children are in the growth and development period, have strong learning ability, and have greater potential for brain function recovery, so their prognosis is better; while elderly patients have more complications after surgery, which makes rehabilitation more difficult, so their prognosis is relatively poor. Therefore, when formulating a rehabilitation plan, the individual differences of patients and their specific conditions should be fully considered.

For patients who have suffered severe brain trauma and are in a state of impaired consciousness, the road to recovery is particularly difficult. Depending on the level of consciousness, it can be divided into multiple stages, including coma, vegetative state, minimally conscious state and awakening. Coma means that the patient has no conscious activity and lacks a wake-sleep cycle; although the vital signs of patients in a vegetative state remain normal, they lack the ability to communicate with the outside world; patients in a minimally conscious state show initial reactions to the environment, such as tracking moving objects or executing simple commands, but are still unable to carry out complex communication. For such patients, rehabilitation treatment is not only a technical challenge, but also a huge test of medical resources and patience.

The treatment of consciousness disorders remains a difficult problem in the medical field. Although there is no conclusive evidence to support that a certain treatment method can significantly improve the patient's awakening rate, various methods such as transcranial magnetic stimulation, hyperbaric oxygen therapy, music therapy, and traditional Chinese medicine acupuncture have been used in clinical practice to try to find effective treatment methods. In addition, the emotional support and interaction of family members have also been proven to have positive significance for patients. For example, repeatedly calling the patient's name or playing their favorite music can stimulate potential brain activity, thereby helping the patient to recover consciousness.

In addition to brain trauma, there are many other reasons that may also lead to severe impaired consciousness, such as gas poisoning, severe cerebrovascular disease, drowning, hypoxic-ischemic encephalopathy, etc. These diseases also require timely rehabilitation treatment and long-term attention. Therefore, we need to enhance the public's awareness and understanding of rehabilitation medicine, increase patients' attention to rehabilitation treatment, and provide more patients with timely and effective rehabilitation treatment services.