Pundlik Jyoti, Perna Robert, Arenivas Ana
The Institute of Rehabilitation Research (TIRR), Houston, Texas, USA.
Baylor College of Medicine, Houston, Texas, USA.
NeuroRehabilitation. 2020;46(2):227-241. doi: 10.3233/NRE-192971.
Traumatic brain injury (TBI) has an estimated prevalence rate of 1.7 million occurrences a year in the United States with over 75% of traumatic brain injuries classified as 'mild.' The majority of individuals with mild traumatic brain injuries resume their daily functioning fairly quickly, and many fully within the first year. However, a minority of persons with mild TBI (mTBI), with estimates ranging between 1% and 20%, develop persistent cognitive, emotional, behavioral, and physical symptoms. Clinicians vary considerably in their clinical opinions regarding these individuals and there is no consensus on the treatment protocol for this population.
This manuscript presents four case studies of mild TBI with persistent symptoms treated by a transdisciplinary team in an outpatient neurorehabilitation setting based on community reintegration. Clinical challenges and insights involved in conceptualizing and effectively treating these individuals are discussed to facilitate future direction.
Four different mild TBI cases, each with persistent symptoms, but different injury mechanisms, dynamics, and factors affecting symptom persistence, expression, course, and outcome were included in the analysis of their treatment course and outcome. The treatment protocol included: brain injury education combined with supportive counseling for cultivation of positive expectancy effects, symptom-based, graded treatment involving most disciplines, frequent treatment team consultations, collaborations, and planning, and consistent team messages about post-injury recovery and expected return to community activities. Treatment outcomes were assessed with self and family reports, as well as the Mayo Portland Adaptability Inventory (MPAI-4) at admission and at discharge.
Each of the individuals made functional progress during rehabilitation, as evidenced by self and family reports and the MAPI-4. The cases posed various challenges to the treatment team, though a transdisciplinary team under the guidance of a rehabilitation physician and rehabilitation neuropsychologist was able to help patients navigate the path to their functional recovery. In addition to the specific treatment protocol, transdisciplinary team collaboration guided by rehabilitation neuropsychology contributed to treatment success.
据估计，美国每年创伤性脑损伤（TBI）的发生率为170万例，其中超过75%的创伤性脑损伤被归类为“轻度”。大多数轻度创伤性脑损伤患者能较快恢复日常功能，许多人在第一年内就能完全恢复。然而，少数轻度TBI（mTBI）患者（估计比例在1%至20%之间）会出现持续的认知、情感、行为和身体症状。临床医生对这些患者的临床意见差异很大，对于该人群的治疗方案也没有达成共识。
本文介绍了一个跨学科团队在基于社区重新融入的门诊神经康复环境中治疗有持续症状的轻度TBI的四个案例研究。讨论了在概念化和有效治疗这些个体过程中涉及的临床挑战和见解，以促进未来的发展方向。
分析了四个不同的轻度TBI案例，每个案例都有持续症状，但损伤机制、动态变化以及影响症状持续、表现、病程和结果的因素各不相同，分析其治疗过程和结果。治疗方案包括：脑损伤教育结合支持性咨询以培养积极的预期效果；基于症状的分级治疗，涉及大多数学科；频繁的治疗团队会诊、协作和规划；以及关于伤后恢复和预期回归社区活动的一致团队信息。治疗结果通过患者和家属报告以及入院和出院时的梅奥波特兰适应性量表（MPAI - 4）进行评估。
患者和家属报告以及MPAI - 4均表明，每个个体在康复过程中都取得了功能进步。这些案例给治疗团队带来了各种挑战，不过在康复医师和康复神经心理学家指导下的跨学科团队能够帮助患者走上功能恢复之路。除了具体的治疗方案外，以康复神经心理学为指导的跨学科团队协作促成了治疗的成功。
