EFFICACY OF TEAM HEALTH CARE APPROACH IN BRAIN INJURY

Neurological rehabilitation involves a multi-displinary team approach, often lead by a rehabilitation medicine consultant, with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and expertise. Teamwork is one of the most fundamental factors in traumatic brain injury(TBI) rehabilitation and an essential element of comprehensive patient care, improved patient outcome and including better survival rates. While selecting a team of professionals to work with, we must not forget that the individual who sustains a brain injury and their family are the most important members of the treatment

 

Brain Injury

This is an injury that causes the destruction or deterioration of brain cells. There are two major types of brain injury, and both disrupt the brain’s normal functioning.

1. Traumatic brain injury(TBI):  Its caused by an external force such as a blow to the head that causes the brain to move inside the skull or damages the skull. This in turn damages the brain.
2. Acquired brain injury(ABI): This occurs at the cellular level. It is most often associated with pressure on the brain. This could come from a tumor, neurological illness, as in the case of a stroke or cerebral malaria in a child.

 

Causes of Brain Injury

There are several causes of brain injury. Brain damage can occur as a result of a wide range of injuries, illnesses, or conditions.

In traumatic brain injury, this include:

• Road traffic accidents
• Blows to the head
• Falls or accidents
• Sport injury
• Physical violence

In acquired brain injury, this include:

• Infection
• Strangulation, choking, or drowning
• Stroke
• Tumors
• Poisoning or exposure to toxic substances
• Aneurysms
• Heart attack
• Neurological illnesses

The lesion can be focal(confined to one area of the brain) or diffused(widespread to multiple areas of the brain). Both focal and diffused injuries can cause severe damage, depending on where the lesion is located.

 

Multidisciplinary Health Care Team

Treatment, recovery, and rehabilitation of traumatic brain injury patients takes a dedicated team of health care providers and specialists, often called the Multidisciplinary Team. In any brain injury, there are rehabilitation team who comes together with different expertise, working for a common goal of rehabilitation. This team can include:

1. Neurologist:A neurologist is a physician who specializes in diagnosing and treating conditions related to the nervous system. The brain, spinal cord, and nerves make up the nervous system, so the expertise of a neurologist is paramount in treating brain injuries.
2. Neuropsychologist:A neuropsychologist is a board-certified psychologist with specialized training in brain anatomy, brain function, and brain-behavior relationships. Neuropsychologist’s evaluations provide valuable information about a patient’s ability to manage their own financial, legal, and medical decisions, and their ability to the society or community.
3. Occupational Therapist:An occupational therapist uses functional activities to prevent, reduce, or overcome physical and emotional challenges in everyday activities of an individual. Occupational therapists can assist with varied number of skills/task, including:

• Eating and swallowing
• Grooming, bathing, and dressing
• Getting in and out of beds, chairs, and bathtubs
• Thinking skills
• Sensory training (restoration of normal sensation)
• Driving skills
• Home management skills (shopping, cooking, money management)
• Fine motor skills, such as buttoning a shirt
• Wheelchair positioning and mobility

4. Physiatrist:A physiatrist is a medical doctor with specialized training in physical medicine and rehabilitation. The physiatrist is often the leader of the rehabilitation treatment team and makes referrals to various therapies and specialists as needed. The physiatrist works closely with the patient, the rehab team, and the family and caregivers to develop the best possible treatment plan.
5. Physiotherapist:A physiotherapist evaluates and treats the patient’s ability to move their body. Helps improve physical function by focusing on;

• Muscle strength
• Flexibility
• Endurance
• Balance, and coordination.

The goal of physiotherapy is to increase independent ability with physical tasks, and also provide training with assistive devices such as canes or walkers.

Rehabilitation Nurse: A rehabilitation nurse is responsible for the assessment, implementation, and evaluation of each individual patient’s nursing care and educational needs. They also coordinate with physicians and other team members to move the patient from a dependent to an independent role.

Speech and Language Therapist: Speech-language therapists identify, evaluate, and treat communication, cognitive, and swallowing disorders.

Social Worker: Social workers provide practical advice on issues such as benefits, housing, transport and assistance at home. They are also trained to offer emotional support to individuals and their families.

Family Members: Family members have a very important role to play in helping the survivor make as full a recovery as possible. A good working relationship between the family and the rehabilitation team is essential in making sure that rehabilitation programes are followed correctly. Studies has shown that patients who make the best recovery are those whose family are actively involved and can maintain the skills learned in rehabilitation once the patient has gone home.