Treatment for a Traumatic Brain Injury

Someone with signs of moderate or significant traumatic brain injury, or TBI, should obtain medical care as quickly as possible. Little can be done to change or alter the initial damage caused by trauma to the brain. Medical professionals may try to stabilize an individual with TBI and focus on preventing further injury. Major concerns include ensuring proper oxygen supply to the brain and the body, controlling blood pressure, and maintaining necessary blood flow.

Film studies help in determining the diagnosis and prognosis of a TBI patient. Those with mild to moderate injuries should receive neck, or cervical X-rays, as well as a skull X-ray to look for bone fractures or spine injury.

For moderate to severe cases, a computed tomography, or CT scan, should be obtained. Moderately or worse, injured individuals frequently receive rehabilitation that involves specific treatment programs such as physical therapy, physiatry (physical medicine), occupational therapy, speech/language therapy, psychology/psychiatry, and social support.

Cognitive rehabilitation, as explained below, is often helpful for people with mild brain injuries.

Cognitive rehabilitation is part of a comprehensive treatment approach for those who have suffered a traumatic brain injury. Because brain injuries are unlike any other, the treatment needs to be well-rounded. In addition to emergent medical care, which could include emergency surgery, cognitive rehabilitation helps individuals regain as much of their baseline level of functioning as possible. 

Cognitive rehabilitation is a systematic treatment approach that focuses on practical, therapeutic, cognitive activities. These activities aid in reversing an individual’s brain and behavior deficits. Some of the goals of cognitive rehabilitation include reinforcing behavior that had been learned previously and establishing new patterns of cognition to replace those that might have been lost.

Cognitive rehabilitation is one of the new treatment options for those who have suffered traumatic brain injuries. This treatment idea arose from a feeling of helplessness in the medical community when treating those with a TBI. Over time, the treatment has evolved, and the evidence has shown that this is an effective treatment option for those with neurological damage. Research studies have demonstrated that cognitive rehabilitation can reverse functional deficits, reduce disabilities, and help individuals participate meaningfully in their community. This translates into an improved quality of life. 

While older treatment models had focused on reversing physical ailments, it quickly became apparent that something needed to be done to change the cognitive issues. Early research studies focused on individuals who had suffered a stroke, which can lead to similar deficits to those following a TBI. The treatment's early success in this area led to cognitive rehabilitation being applied to those who had suffered a TBI, with similar achievements. 

As the field has evolved, treatment models now focus on individualizing cognitive rehabilitation sessions to the individual's problems, tailoring every treatment to the patient and his or her specific issues. Much of this was published in the Cognitive Rehabilitation Manual, released in 2012 and by Trexler.

Cognitive rehabilitation can be divided into several different sections that guide the treatment process. These include:

• Memory
• Attention
• Vision and Coordination
• Language
• Executive Functioning
• Motor Planning (Apraxia)

Treatment approaches are developed and tailored to the various deficits (or lack thereof) in the domains described above. Once the deficiencies are identified, the next step is to determine whether or not the goal is to restore function that has been lost or develop new skills to compensate for those which have been lost. These are termed the restorative versus the compensatory approach:

• Restorative: In this treatment approach, the goal is to restore the specific cognitive processes. Repetitive drills are performed to activate and stimulate the various lost functions and restore them to use.
• Compensatory: In this strategy, the treatment approach is to develop new ways to cover up old deficits. For example, someone who has memory difficulties might be taught to use mnemonics to remember certain things. These strategies can take many different forms depending on the severity of the injury.

While the treatment may take different forms for different people, the goal is the same. Individuals should find functional improvement of their losses during treatment. Over time, the treatment strategies could change as individuals gain new milestones and different goals are set.

Cognitive rehabilitation can be provided by different professionals depending on the deficits. Examples of providers who can perform cognitive rehab include speech-language pathologists, occupational therapists, and neuropsychologists. The treatment typically starts as soon as possible after the injury. The sooner it starts, the better the outcome (in general); however, individuals can benefit from this rehabilitation at any time following their injury. In general, therapy is divided into three different stages. These include:

• Acquisition: Individuals learn their treatment plan, why it matters, and the steps involved
• Application: Individuals use the strategies in their treatment plan under the supervision of professionals
• Adaptation: The treatment plan and procedures are used by the patient outside of a supervised setting.

Over time, the treatment plan could evolve as the patient improves. It is essential for the therapist and the patient to work closely so that the treatment can be adjusted based on the individual's progress.

Several factors might influence the outcome of cognitive rehab. Some of these include:

• The severity of the deficits at the start of the therapy
• The presence or absence of family support, which is essential in the recovery process
• Whether or not the individual takes their medicines as prescribed
• The time in between the injury and the beginning of therapy
• The financial status of the individual
• Whether or not the individual attends follow-up visits
• Mood and behavioral changes

All of these factors could play a role in how well an individual performs using cognitive rehabilitation.

As cognitive rehabilitation has grown in popularity, many studies have looked at its effectiveness in treating traumatic brain injuries. Some of the evidence shows that:

• Those who have had issues with executive functioning have demonstrated some improvement in their ability to carry out daily living activities.
• Individuals who have had difficulty with language skills have improved their ability to speak and communicate after cognitive rehabilitation.
• Patients with significant memory problems who have undergone cognitive rehabilitation have shown an improvement in their memory capabilities.
• Cognitive rehabilitation has also proved to help individuals who have struggled with vision and spatial awareness.
• More research studies are being completed to see if cognitive rehabilitation can help individuals with traumatic brain injuries with deficits in other areas.

Ultimately, cognitive rehabilitation plays a vital role in the recovery process following a traumatic brain injury. Neurological damage is unique and, therefore, the treatment plans should be tailored to the individual patient. With a treatment plan that includes cognitive rehabilitation, individuals could regain a significant amount of their lost function after a traumatic brain injury.

I'm Ed Smith, a Sacramento Brain Injury Lawyer. If you or a loved one has suffered a head or brain injury and would like to discuss your legal options, contact us online or reach out to us at 916.921.6400 or 800.404.5400 for free, friendly advice with an experienced injury lawyer.

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 4.7.21]