Updates in Management of Adults with Traumatic Brain Injury: A Rehabilitation Perspective

Review Article

Phys Med Rehabil Int. 2019; 6(1): 1160.

Updates in Management of Adults with Traumatic Brain Injury: A Rehabilitation Perspective

Lee SY1,2,3*, Vasudevan V1,3, Amatya B1,2,3 and Khan F1,2,3

¹Department of Rehabilitation, Royal Melbourne Hospital, Parkville, Victoria, Australia

²Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, Australia

³Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia

*Corresponding author: Lee SY, Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34- 54 Poplar Road Parkville, Melbourne VIC 3052, Australia

Received: November 23, 2018; Accepted: January 11, 2019; Published: January 18, 2019


Introduction: TBI results in significant mortality and morbidity worldwide and represents a global health problem with huge economic burden for healthcare systems due to increased demand for health care, social and vocational services. It is complex and variable, requiring integrated multidisciplinary care. Empirical evidence for various rehabilitation interventions commonly trialed in TBI survivors are growing.

Objective: This review provides an overview of common TBI-related issues and an update on evidence-based overview of the effectiveness of various types of rehabilitation interventions in the treatment of TBI impairments.

Discussion: Majority of patients with mild TBI have non-specific symptoms that may settle within three months, whereas moderate to severe TBI impairments such as motor function, cognition, language, sensory processing and emotional disturbances can be lifelong, requiring long-term management plan. Overall, there was moderate evidence to recommend a multidisciplinary rehabilitation for management for patients with moderate to severe TBI. There are some beneficial effects of CBT to individuals with acute stress disorder or anxiety symptoms following mild to moderate TBI, and beta blockers to improve aggression in adults with ABI. However, for the majority of rehabilitation interventions used for the management of TBI, such as fitness training, cognitive rehabilitation, psychotherapy for depression, cranial electrotherapy stimulation, perceptual intervention, spasticity interventions, sensory stimulation, HBOT and acupuncture, the evidence is still low or inconclusive. This is mainly due to limited number of robust, methodologically strong studies.

Conclusion: Even though rehabilitation interventions are often routinely provided, many are difficult to standardise, and measuring the settings and intensity of different types of approaches that are effective are still a challenge. The limitation in the methodologically robust studies in TBI rehabilitation needs to be addressed, with more focus on longitudinal data to ascertain long-term care needs, and on patient perspective and caregiver burden. More research is needed in understanding components comprising the ‘black box’ of TBI rehabilitation, mainly on participatory limitations due to psychological issues, work, family and social re-integration.

Keywords: Traumatic brain injury; Brain injury; Rehabilitation; Rehabilitation intervention


ABI: Acquired Brain Injury; ADLs: Activities Of Daily Living; BI: Barthel Index; CBT: Cognitive Behavioural Therapy; CCT: Controlled Clinical Trial; CPG: Clinical Practice Guideline; FIM: Functional Independence Measure; GCS: Glasgow Coma Scale; GOS: Glasgow Outcome Scale; GRADE: Grade of Recommendation, Assessment, Development and Evaluation Working Group grade of evidence; HBOT: Hyperbaric Oxygen Therapy; ICF: International Classification of Functioning, Disability and Health; LCF: Level of Cognitive Functioning; PTA: Post-Traumatic Amnesia; PTSD: Post-Traumatic Stress Disorder; QoL: Quality Of Life; RCT: Randomised Controlled Trial; rTMS: Repetitive Transcranial Magnetic Stimulation; TBI: Traumatic Brain Injury; TCA: Tricyclic Antidepressant; US: United States.


Traumatic brain injury (TBI) is defined as “blow to the head, or a penetrating head injury, that disrupts the function of the brain” [1]. TBI severity can be graded as mild, moderate or severe and more detailed TBI severity classification can be seen in Table 1 [2].