Clinician's Handbook

The Brain Injury Rehabilitation Clinician Handbook is intended to be a learning resource for residents. It is a product that compliments the Evidence-Based Review of Acquired Brain Injury (ERABI). It is a new resource available with the 10th edition of ERABI.
The rehabilitation of patients with acquired brain injury (ABI) involves a comprehensive effort by several members of an interdisciplinary team including but not limited to physicians, nurses, physiotherapists, speech language pathologists and occupational therapists. Considering the incidence and consequences of ABI, it is important to understand the effectiveness of rehabilitation.
The primary cause of motor impairment and movement dysfunction post acquired brain injury (ABI) is upper motor neuron syndrome (UMNS). The former results in both positive symptoms of enhanced stretch reflexes (spasticity), released flexor reflexes in the lower limbs, such as the Babinski sign and mass synergy patterns, as well as negative symptoms including loss of dexterity and weakness (Mayer 1997).These symptoms of UMNS have physiologic implications for muscles that may subsequently develop stiffness and contracture, thereby negatively affecting effective movement even further (Mayer 1997).
This section reviews measurement tools used to assess individuals after a brain injury. The list of tools was derived by a consensus of experts working on the Evidence-Based Review of Acquired Brain Injury literature. This module reviews evidence for each tool and assesses their practicality, reliability, validity and responsiveness.
Community reintegration is the ultimate goal of acquired brain injury (ABI) rehabilitation. The transition back to the community from acute care or post-acute rehabilitation requires diverse supports in the community, often for extended periods of time. Returning to a full range of activities within the community can prove difficult for brain injury survivors and their families. This module reviews major topics in this area such as life satisfaction, independence and caregiver burden.
Although mood is an internal subjective state, it is often inferred from our posture, behaviours, and the way we choose to express ourselves. Mood disorders such as agitation, major depression, and various anxiety disorders including post-traumatic stress disorder, and obsessive compulsive disorder may occur following an acquired brain injury (ABI) and are associated with suffering, worsening of other ABI sequela, and poorer outcomes (Bedard et al. 2003; Berthier et al. 2001; Jorge 2005; Jorge & Starkstein 2005).
Fatigue is one of the more commonly reported symptoms associated with brain injury (Duclos et al. 2014; Elovic et al. 2005) and can exacerbate other co-morbidities. One of the greatest challenges is in properly defining fatigue; a clear definition is integral to determining how it should be measured and managed. It is believed that fatigue is a subjective experience and thus is not easily assessed by objective measures (Lewis & Wessely 1992). This section reviews fatigue and sleep disorders in more depth.
Heterotopic ossification is the formation of pathologic bone within soft tissues, often muscle tissues, where bone formation does not usually occur (Watanabe & Sant 2001). Heterotopic ossification and venous thromboembolism may present post injury. This section reviews the prevalence of each post ABI, the diagnostic methods used to detect each, and the interventions used to treat each complication.
Research indicates that neuroendocrine disorders vary in frequency following traumatic brain injury and what was once thought to be a rare occurrence is now increasingly diagnosed. This sections reviews information on the pathophysiology of neuroendocrine disorders, the existing evidence for different diagnostic tools used to identify these disorders, and discusses the different methods of treatment.
Post-traumatic seizures are a serious consequence of traumatic brain injury and remain an understudied problem. This section reviews the evidence regarding risk factors, complications, and treatment of post-traumatic seizures.
After a traumatic brain injury (TBI) a wide range of swallowing disorders may occur. TBI associated with focal and diffuse cortical and brainstem damage may impair swallowing ability and lead to the development of dysphagia and aspiration. Both are reviewed in this section.