Individuals should be assessed for common impairments. Clinical assessments and protocols based on the Glasgow Coma Scale Score can guide the initial management. In some instances, relatives are able to offer clinicians information regarding the patient’s level of awareness that is more accurate than a patient’s self-report measure (Sohlberg, Mateer, Penkman, Glang, & Todis, 1998; Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010). In an observational study, patients and relatives who completed functional assessment questionnaires focused on the patient following a rehabilitation program, both scored similarly (Svendsen, Teasdale, & Pinner, 2004).
The transition from post-traumatic coma to post-traumatic delirium (PTD) or PTA is characterized by impairments in selective and sustained attention (Arciniegas, 2010). During the period of PTA, impairments in executive functioning, language and declarative learning are prominent. When emerging from PTA, executive function deficits manifest in problem solving, abstract thinking and cognitive flexibility. Emotional lability is also present during PTA expressed as agitation and aggression (Ponsford & Sinclair, 2014). Neuropsychologists/psychiatrists have found the following outcome measures valuable in determining PTA duration and TBI severity: Glasgow Coma Scale and the Galveston orientation and amnesia test (Arciniegas, 2010).
When an individual emerges from PTA, cognitive function should be evaluated. Throughout this process, caregivers should receive information and education regarding the patient’s injury and care to reduce the burden of care (Calvete & de Arroyabe, 2012) and maintain their mental health (Doyle et al., 2013).
It is also important to assess individuals with other forms of poly trauma and particular spinal cord injury because the concomitant injuries have an impact on clinical recovery and costs of care. Individuals with traumatic SCI and TBI had worse cognitive function and higher rehabilitation costs compared to those without TBI (Bradbury et al., 2008). Sharma et al. (2014) found a 58.5% frequency of missed traumatic brain injuries in a sample of 92 individuals with traumatic spinal cord injury.
Arciniegas, D. B. (2010). Neuropsychiatric Assessment of Traumatic Brain Injury During Acute Neurorehabilitation* Neuropsychiatric disorders (pp. 123-146): Springer.
Bradbury, C. L., Wodchis, W. P., Mikulis, D. J., Pano, E. G., Hitzig, S. L., McGillivray, C. F., . . . Green, R. E. (2008). Traumatic brain injury in patients with traumatic spinal cord injury: clinical and economic consequences. Arch Phys Med Rehabil, 89(12 Suppl), S77-84.
Calvete, E., & de Arroyabe, E. L. (2012). Depression and grief in Spanish family caregivers of people with traumatic brain injury: The roles of social support and coping. Brain Injury, 26(6), 834-843.
Doyle, S. T., Perrin, P. B., Diaz Sosa, D. M., Espinosa Jove, I. G., Lee, G. K., & Arango-Lasprilla, J. C. (2013). Connecting family needs and TBI caregiver mental health in Mexico City, Mexico. Brain Injury, 27(12), 1441-1449.
Ponsford, J., & Sinclair, K. (2014). Sleep and fatigue following traumatic brain injury. Psychiatr Clin North Am, 37(1), 77-89.
Sharma, B., Bradbury, C., Mikulis, D., & Green, R. (2014). Missed Diagnosis of Traumatic Brain Injury in Patients with Traumatic Spinal Cord Injury. Journal of Rehabilitation Medicine, 46(4), 370-373.
Sohlberg, M. M., Mateer, C. A., Penkman, L., Glang, A., & Todis, B. (1998). Awareness intervention: Who needs it? J Head Trauma Rehabil, 13(5), 62-78.
Spikman, J. M., Boelen, D. H., Lamberts, K. F., Brouwer, W. H., & Fasotti, L. (2010). Effects of a multifaceted treatment program for executive dysfunction after acquired brain injury on indications of executive functioning in daily life. Journal of the International Neuropsychological Society, 16(01), 118-129.
Svendsen, H., Teasdale, T., & Pinner, M. (2004). Subjective experience in patients with brain injury and their close relatives before and after a rehabilitation programme. Neuropsychological Rehabilitation, 14(5), 495-515.