Brain Injury Treatment: Acute, Rehabilitative & Long-Term Management

Traumatic brain injury (TBI) management is **phase-specific, multidisciplinary, and individualized** by severity (GCS), mechanism, and patient factors.

1. Acute Medical / Surgical (Hours–Days)

• ABCs: Airway (intubation if GCS ≤8), breathing, circulation; prevent secondary injury (hypoxia, hypotension, hyperthermia).
• ICP management: Monitoring (EVD, bolt), sedation, osmotherapy (mannitol/hypertonic saline), CSF drainage, barbiturate coma, decompressive craniectomy.
• Surgical: Hematoma evacuation, depressed fracture elevation, ICP monitor placement.
• Medical: Seizure prophylaxis (levetiracetam 7d), DVT prophylaxis, nutritional support (early enteral), glycemic control, normothermia.

2. Subacute / Inpatient Rehabilitation (Weeks–Months)

Domain	Interventions
Physical	Mobility, balance, spasticity management (BoNT-A, baclofen), tone, contracture prevention
Cognitive	Attention, memory, executive function, processing speed (computerized + functional)
Speech/Language	Aphasia, dysarthria, apraxia, cognitive-communication, dysphagia
Occupational	ADLs, IADLs, adaptive equipment, community re-entry
Neuropsychological	Assessment, psychoeducation, compensatory strategies
Psychological	Adjustment, depression, anxiety, PTSD, behavioral dysregulation

3. Community / Long-Term (Months–Years)

• Vocational rehab: Job analysis, accommodations, supported employment, retraining.
• Outpatient therapies: Continued PT/OT/SLP, neuropsychology, counseling.
• Medical management: Spasticity, seizures, sleep, pain, neuroendocrine (hypopituitarism), heterotopic ossification.
• Caregiver support: Education, respite, counseling, legal/financial planning.
• Community integration: Day programs, adaptive sports, peer mentoring.

Prognostic Factors

• Initial GCS, pupil reactivity, age, CT findings (Marshall score), hypotension/hypoxia episodes.
• Duration of PTA (post-traumatic amnesia) — strongest functional predictor.
• Access to specialized rehabilitation.

Recovery is nonlinear. **Neuroplasticity** enables gains years post-injury. Early, intensive, coordinated care maximizes outcome.