ABSTRACT
Introduction: This article aims to provide an overview of the epidemiology, medical and rehabilitation issues, current evidence for traumatic brain injury (TBI) rehabilitation, recent advances and emerging practices. Special TBI population groups will also be addressed. Materials and Methods: We included publications indexed in Medline and the Cochrane Database of Systemic Reviews from 1974 to 2006, relevant chapters in major rehabilitation texts and Physical Medicine and Rehabilitation Clinics of North America and accessed Internet publications. Results: TBI has been implicated by the World Health Organisation to be a 21st century epidemic similar to malaria and HIV/AIDS, not restricted to the developed world. One third of patients may suffer severe TBI with long-term cognitive and behavioural disabilities. Injuries to the brain do not only damage the cerebrum but may give rise to a multisystem disorder due to associated injuries in 20% of cases, which can include complex neurological impairments, neuroendocrine and neuromedical complications. There is promising evidence of improved outcome and functional benefits with early induction into a transdisciplinary brain injury rehabilitation programme. However, TBI research is fraught with difficulties because of an intrinsically heterogeneous population due to age, injury severity and type, functional outcome measures and small samples. Recent advances in TBI rehabilitation include task-specific training of cognitive deficits, computer-aided cognitive remediation and visual-spatial and visual scanning techniques and body weight-supported treadmill training for motor deficits. In addition, special rehabilitation issues for mild TBI, TBI-related vegetative states, elderly and young TBI, ethical issues and local data will also be discussed.
In 2005, accidents accounted for 4.9% (795) of deaths and were the fifth most common cause of death locally. Traumatic brain injury (TBI) is the most common cause of death and chronic disability in the under-35-year-old age group.1 Accidents were the most common cause for hospitalisation locally, accounting for 404.7 per 100 000 admissions in 2005.1 In modern America, injury is the leading cause of mortality for under-45-year-olds and TBI is responsible for the majority of these deaths.2,3 Each year in the United States (US), around 50,000 people die after a TBI. This accounts for 1/3 of all injury deaths. In addition, 80,000 to 90,000 people experience lifelong disability associated with a TBI.4,5 TBI is also often associated with polytrauma, fractures, spinal cord injuries, peripheral nerve injuries and limb amputations. Hence, the consequences of TBI are vast and encompass physical impairments, cognitive, psychological, behavioural and emotional deficits, with the latter 4 often bearing a heavy, hidden psychosocial and economic burden on this predominantly young population.
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