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Traumatic brain injury 

Traumatic brain injury
Chapter:
Traumatic brain injury
Author(s):

Anthony B. Ward

, Michael P. Barnes

, Sandra C. Stark

, and Sarah Ryan

DOI:
10.1093/med/9780199550524.003.0019
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date: 21 September 2019

Background and epidemiology 290

Glasgow Coma Scale 292

Prognosis 294

Minor head injury 296

Organization of services 298

Physical disability 300

Minimally conscious and vegetative states 302

Cognitive problems 304

Behavioural and emotional problems 306

Later-stage rehabilitation 308

Head injury is one of the most challenging disorders faced by the rehabilitation team. An individual with traumatic brain injury will often have a complex range of physical, behavioural, emotional, cognitive, and social problems. However, there is now good evidence that a multidisciplinary rehabilitation team can make a real difference to outcome and that such a team is clearly preferable to management on a general medical or surgical ward. Regrettably few people in the UK or elsewhere in the world yet have access to such a team. Most people receive good-quality immediate neurosurgical care but most are then discharged back to the local district general hospital or straight back home without any rehabilitation support or follow-up. There are now a few regional specialist neurological rehabilitation centres that cater for such individuals but they are still insufficient to cater for the needs of all those with severe brain injury, let alone those with moderate or milder problems. More importantly there are very few good quality community head injury teams that work with the person after the acute phase when they have returned home....

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