Recovering from Traumatic Brain Injury: Insights on Rehabilitation and Care

Intracranial hemorrhage due to a car accident, right hemisphere surgery?

Hello Doctor, my brother was hit by a car while walking on the road early in the morning on April 18th, resulting in a Glasgow Coma Scale score of 4 and intracranial hemorrhage on the right side of his brain, which required surgery.
After spending seven days in the intensive care unit, he was transferred to a general ward, where he is currently on the ninth day.
He can recognize close family members but is not very verbal (which is different from before); he requires repeated questioning to provide brief responses, and his facial expression is also flat.
He has weakness in both his right hand and leg, cannot lift himself, and has not yet been weaned off the nasogastric tube, urinary bag, and adult diapers.
I consulted with the neurosurgeon who performed the surgery, and he explained that the CT scan at the time of the incident showed midline shift and right-sided brain hemorrhage, necessitating emergency surgery.
However, the doctor indicated that the subsequent impact on various functions still needs to be observed.
Based on your experience, I have the following questions:
1.
Currently, when my brother attempts to stand on both feet (which is merely a motion, as he lacks the strength to stand), his legs tremble.
The doctor mentioned this is due to brainstem injury.
Is there a chance for recovery from brainstem injury? What other functions or personality traits might be affected in the future?
2.
We have attempted to feed him small amounts of pudding and steamed eggs (as he chokes on liquid), how much longer do you estimate it will take before he can be weaned off the nasogastric tube?
3.
He sometimes expresses the urge to urinate and defecate, but due to his unclear consciousness and weakness, when do you anticipate he will be able to stop using the urinary bag and adult diapers?
4.
When asked to lightly grip our hands, he can do so, but when shown pictures or text and asked to identify them, he either takes a long time to respond or refuses to answer.
Does this indicate damage to his recognition of words and images?
5.
Given his current condition, when can we begin rehabilitation for his limbs and brainstem? What else can we do to help him regain his memory? This incident has been a significant source of pain and anguish for our family, but we want to do everything possible to help him regain his independence and recover what has been lost.
We hope you can provide us with the best advice.
Thank you very much.

TT, 30~39 year old female. Ask Date: 2013/05/02

Dr. Ding Xianwei reply Neurosurgery

Since your brother's injury has not been more than a month, many of the functions that have not yet recovered are still uncertain regarding how much they can improve.
To be honest, recovering from a coma scale of 4 to a level where he can follow commands (as per your description, he should have reached this level) is already considered quite fortunate! I even suspect that his initial coma scale may not have been that severe.
Therefore, I believe that actively participating in rehabilitation and patiently waiting is the best approach!

Reply Date: 2013/05/02

More Info

Recovering from a traumatic brain injury (TBI) is a complex and often unpredictable process that can vary significantly from one individual to another. Your brother's situation, following a severe injury with a Glasgow Coma Scale (GCS) score of 4 and subsequent surgery for intracranial hemorrhage, presents a challenging path to recovery. Here are some insights based on your questions and the current understanding of TBI rehabilitation.

1. Recovery from Brainstem Injury: The brainstem is a crucial area that controls many involuntary functions, including breathing, heart rate, and consciousness. Damage to the brainstem can lead to significant impairments, but recovery is possible. The extent of recovery often depends on the severity of the injury and the specific areas affected. Rehabilitation efforts, including physical therapy and occupational therapy, can help improve motor function and coordination over time. It's essential to maintain a hopeful outlook, as many patients show gradual improvement in their abilities.

2. Transitioning from Nasogastric Tube to Oral Feeding: The timeline for removing a nasogastric tube varies widely among patients. Factors influencing this include the patient's ability to swallow safely, their level of consciousness, and their overall neurological status. Since your brother is currently able to tolerate small amounts of soft food like pudding and steamed eggs, this is a positive sign. A speech-language pathologist can conduct a swallowing assessment to determine when he might be ready for a more substantial diet and to ensure he can eat safely without the risk of aspiration.

3. Urinary and Bowel Control: The ability to express the need to urinate or defecate is a good sign of cognitive awareness. However, the timeline for regaining full control over bladder and bowel functions can vary. Rehabilitation specialists will work with your brother to develop a routine and strategies to help him regain independence in this area. It may take weeks to months, depending on his progress and the extent of his neurological recovery.

4. Cognitive and Communication Challenges: The difficulty your brother experiences in recognizing images or responding to questions may indicate impairments in cognitive processing and language comprehension, often associated with TBI. This can be due to damage in areas of the brain responsible for language and visual processing. Speech therapy can be beneficial in addressing these issues, focusing on improving communication skills and cognitive functions.

5. Rehabilitation Timeline and Strategies: Rehabilitation should ideally begin as soon as the patient is stable, even if it starts with passive movements and simple exercises. Physical and occupational therapists can help design a program tailored to your brother's needs, focusing on strengthening, coordination, and functional mobility. Engaging him in cognitive activities, such as memory games or simple problem-solving tasks, can also aid in recovery. Family involvement is crucial; providing a supportive environment and encouraging participation in therapy can significantly impact recovery.

In conclusion, the road to recovery from a traumatic brain injury is often long and requires patience, persistence, and a multidisciplinary approach. Regular follow-ups with healthcare providers, including neurologists, rehabilitation specialists, and therapists, will be essential in monitoring progress and adjusting treatment plans as needed. Your family's support and involvement will play a vital role in your brother's rehabilitation journey. Stay hopeful and proactive in seeking the best care and resources available.

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