Traumatic Brain Injury in Patients with Spinal Cord Injury: Neuropsychological Consequences and Rehabilitation, pp. 611-622
Authors: Anu Tolonen
Abstract: Traumatic brain injury (TBI) is more frequent in traumatic spinal cord injury (SCI) patients than clinical diagnoses at hospital admission reflect. As SCI and TBI typically result from similar, high kinetic accidents, these neurotraumas are often present concomitantly. In SCI, because the enormous physical injury sustained is the main focus of attention, the basic indicators of TBI, e.g., loss of consciousness, posttraumatic amnesia (PTA), and neurological symptoms and signs due to TBI, may go undetected and undocumented. Moreover, patients with a Glasgow Coma Score (GCS) of 13–15 may also suffer from severe TBI, and structural damage cannot often be detected in conventional MRI. Altered mental status, e.g. fatigue, information processing problems, and changes in behavioural and emotional regulation, may be misinterpreted as effects of medication, or a psychological reaction to a massive life change. TBI is a major concern in the rehabilitation of traumatically spinal-cord-injured patients. SCI is one of the most devastating injuries that may affect an individual. However, from the perspectives of vocational planning, supportive interventions, and psychosocial outcome, concomitant TBI is a central factor to be considered. TBI produces significant impairments in cognitive, emotional, and executive functions, which has a far reaching effect on many levels of the life of an individual. With SCI patients suffering from concomitant TBI, there is a risk for a complicated rehabilitation process and unfavorable outcome if TBI is not recognized and the rehabilitation approach modified. To avoid secondary complications, necessary tools such as enhanced diagnostics of TBI, specific treatment and rehabilitation methods, including neuropsychological interventions and a careful follow-up, are needed.