Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
How Long Should Rehabilitation Be Continued For Patients With Head Injury?
Question: My son sustained the head injury on 01.01.2014 when my car met an accident. He was on the rear seat and it appears that he had an impact with the car's roof. He was operated for left fronto temporo parieta extra dural hematoma and was recovering but on 05/01/2014, he suffered from left fronto temporo parieta sub dural hematoma with left parietal bleed with left middle cerebral artery infarct. His decompressive cranectomy was done on 05/01/2014. His cranioplasty was tried on 222/04/2015 but due to occurence of infection, again crainectomy done. Presently, he is at small hospital under nursing care.He his condition and is steadily improving. His tracheostomy tube has been removed. He is still bed-ridden and unable to move and speak. But able to communicate with his eye blinks. His memory seems to be OK. He is also able to understand whatever we talk to him. Feeding is still going through PEG tube. However, we are giving him milk, khichdi, paste of dal & rice etc. through mouth also (around 300 to 400 ml twice a day). Syrups are also being given through mouth. Physiotherapy and wheel chair mobilisation is in place.Presently, he is free from infections and following medicines are being given : • Riclofen – 1 TD • Levipril- 1 BD • Telwas- 1 OD • Amlong – 1 OD • Oxcetol 600- 1 TD • Syp. Zincovit- 15 ml OD • Syp. Livogen- 10ml OD • Syp. Neurocetam- 15 ml BD • Syp. Ostocalcium -10ml BD • Syp. Strocit- 2.5 ml BD
Brief Answer:
Rehabilitation should continue.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
Rehabilitation after severe head injury is a long and difficult process.
Since your son is still conscious and interacts with you and the environmental stimuli, there's hope that he will improve further.
Since he is free from infections, cranioplasty should be done first ( his own bone or allografts such metilmetacrilate, plexiglass).
After cranioplasty is done the rehabilitation should continue in a rehabilitational specialized center and consists on two main directions:
1. Physical rehabilitation ( working on muscles strengthening, preventing arthrosis and improving abilities about self service)
2. Mental rehabilitation ( working on improvement of speech, memory)
One important thing in this stage of rehabilitation is to avoid as much as possible medicaments and to pass gradually to full natural feeding.
Hope this helps. I remain at your disposal for further questions and clarifications.
Best regards.
Rehabilitation should continue.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
Rehabilitation after severe head injury is a long and difficult process.
Since your son is still conscious and interacts with you and the environmental stimuli, there's hope that he will improve further.
Since he is free from infections, cranioplasty should be done first ( his own bone or allografts such metilmetacrilate, plexiglass).
After cranioplasty is done the rehabilitation should continue in a rehabilitational specialized center and consists on two main directions:
1. Physical rehabilitation ( working on muscles strengthening, preventing arthrosis and improving abilities about self service)
2. Mental rehabilitation ( working on improvement of speech, memory)
One important thing in this stage of rehabilitation is to avoid as much as possible medicaments and to pass gradually to full natural feeding.
Hope this helps. I remain at your disposal for further questions and clarifications.
Best regards.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Cranioplasty was done on 22/04/2015 but due to occurence of infection / pus observed in the blood oozing out of the operated area, it was reverted to cranioctomy on 11/05/2015 and infected pus was removed. The infection was due to presence of Acinetobacter baumannii bacteria. Now, the doctor says to wait for six months to have sufficient immunity in the patient to again undergo surgery. Also, he suggests to use Titanium plate for cranioplasty as his bone is not sufficient. Pl. advise what precautions should be taken next time to avoid the infection and what should be the minimum time from now to go for cranioplasty.
The patient is on PEG feeding through jojunostomy. What should be done to improve his intake from mouth and removal of PEG tube? Will speech therapy help in this?
The patient is on PEG feeding through jojunostomy. What should be done to improve his intake from mouth and removal of PEG tube? Will speech therapy help in this?
Brief Answer:
Titanium cranioplasty can be done anytime.
Detailed Answer:
Welcome back.
Titanium cranioplasty is done after the infection subsided as well as immediately after old cranioplasty and infection focuses debridement with a success rate about 83%.
So, titanium cranioplasty can be done at anytime, the decision is dependent on your son's Doctor opinion.
Since its tracheostomy tube was removed, parallel to PEG tube feeding, can be used and by mouth feeding, increasing the amount of by mouth feeding and decreasing gradually the PEG amount feeding.
As I mentioned before, there is need for a multimodal rehabilitation about your son's condition,not just only separated improvement focus.
Hope I helped you. Wishing good health about your son's and you as well.
Titanium cranioplasty can be done anytime.
Detailed Answer:
Welcome back.
Titanium cranioplasty is done after the infection subsided as well as immediately after old cranioplasty and infection focuses debridement with a success rate about 83%.
So, titanium cranioplasty can be done at anytime, the decision is dependent on your son's Doctor opinion.
Since its tracheostomy tube was removed, parallel to PEG tube feeding, can be used and by mouth feeding, increasing the amount of by mouth feeding and decreasing gradually the PEG amount feeding.
As I mentioned before, there is need for a multimodal rehabilitation about your son's condition,not just only separated improvement focus.
Hope I helped you. Wishing good health about your son's and you as well.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks sir. You have suggested for multimodal rehabilitation. Since I live at a very small place where there is no centres for neurosugery / neurology, not even a specialist in this field. Can you suggest some centres in XXXXXXX where I can take my son? Otherwise, what are the techmiques / methods which I can follow myself for my son's recovery / rehabilitation?
Sometimes, he tightens and make his body very stiff. During such time, his left foot vibrates vigorously, head shakes & left hand includin elbow & arm also vibrate. What can be the reason or it is usual in neuro patient?
Sometimes, he tightens and make his body very stiff. During such time, his left foot vibrates vigorously, head shakes & left hand includin elbow & arm also vibrate. What can be the reason or it is usual in neuro patient?
Brief Answer:
Vibrating extremities could be seizures.
Detailed Answer:
Hello again.
Shaking of the head and one side extremities (left extremities in your son's case) in a patient who sustained head injury, most likely is a seizure.
To confirm this possibility your son should be observed by a trained Doctor during this crisis, there is need for a brain function test or EEG with a Neurologist evaluation.
If seizures confirmed, treatment should be started with antiseizure drugs.
Regarding to rehabilitation, there is no need for a Neurosurgeon and Neurologist, these centers function with doctors trained about rehabilitation, usually Physical therapists, Psychologysts etc. as well as equipment needed for this purpose.
I am not resident in XXXXXXX neither have information about these centers location, but I guess there should be information on-line and at your Health Ministry.
Hope I helped you.
Wishing fast improvement about your son's condition.
Vibrating extremities could be seizures.
Detailed Answer:
Hello again.
Shaking of the head and one side extremities (left extremities in your son's case) in a patient who sustained head injury, most likely is a seizure.
To confirm this possibility your son should be observed by a trained Doctor during this crisis, there is need for a brain function test or EEG with a Neurologist evaluation.
If seizures confirmed, treatment should be started with antiseizure drugs.
Regarding to rehabilitation, there is no need for a Neurosurgeon and Neurologist, these centers function with doctors trained about rehabilitation, usually Physical therapists, Psychologysts etc. as well as equipment needed for this purpose.
I am not resident in XXXXXXX neither have information about these centers location, but I guess there should be information on-line and at your Health Ministry.
Hope I helped you.
Wishing fast improvement about your son's condition.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Sometimes, only his left foot vibrates slowly and he tries to straighten his foot fingers. Is that also a seizure or is he trying to move his leg?
Also, pl. tell whether alternate medical therapies like acupressure / acupuncture, suzok, use of nerve stimulators, use of digital therapy machines will help in his recovery?
Is there any possibility of regrowth / regeneration of new cell / tissues of damaged / removed part of the brain?
Also, pl. tell since, there is no damage visible in his right side brain, why it is not functioning and controlling / moving left part of the body? Because his right limbs seem to be in good shape and also gives reflex actions even though left part of the brain is damaged. whereas riht limbs have low sensation and also seems to be distorted and stiff. His left knee does not bend more than 30 degrees. Pl. explain.
Also, pl. tell whether alternate medical therapies like acupressure / acupuncture, suzok, use of nerve stimulators, use of digital therapy machines will help in his recovery?
Is there any possibility of regrowth / regeneration of new cell / tissues of damaged / removed part of the brain?
Also, pl. tell since, there is no damage visible in his right side brain, why it is not functioning and controlling / moving left part of the body? Because his right limbs seem to be in good shape and also gives reflex actions even though left part of the brain is damaged. whereas riht limbs have low sensation and also seems to be distorted and stiff. His left knee does not bend more than 30 degrees. Pl. explain.
Brief Answer:
Explanations below.
Detailed Answer:
Hello again.
If the vibration of an extremity is related to movement, or is done voluntarily, it is not a seizure, if there is vibration/shaking out of the blue, ( spontaneously, not related to movement), probably it is seizure.
Acupuncture, su jok etc. are stimulation therapies and could help in a certain degree the recovery.
If brain tissue is damaged there is no regeneration of it, but in young people brain plasticity exists, in other words, healthy parts of brain could adopt a part of functions of damaged parts.
This is only a possibility, and not a definitive process.
The best thing to do in reawakening nonfunctional healthy parts of brain is physical therapy and rehabilitation.
The knee confined movement is probably related to ankylosis is stiff knee joint, this requires physical therapy and if physical therapy fails, surgery may be necessary to correct movement.
Hope I helped you. Best regards.
Explanations below.
Detailed Answer:
Hello again.
If the vibration of an extremity is related to movement, or is done voluntarily, it is not a seizure, if there is vibration/shaking out of the blue, ( spontaneously, not related to movement), probably it is seizure.
Acupuncture, su jok etc. are stimulation therapies and could help in a certain degree the recovery.
If brain tissue is damaged there is no regeneration of it, but in young people brain plasticity exists, in other words, healthy parts of brain could adopt a part of functions of damaged parts.
This is only a possibility, and not a definitive process.
The best thing to do in reawakening nonfunctional healthy parts of brain is physical therapy and rehabilitation.
The knee confined movement is probably related to ankylosis is stiff knee joint, this requires physical therapy and if physical therapy fails, surgery may be necessary to correct movement.
Hope I helped you. Best regards.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
