Rehabilitation needs after haemorrhagic brain injury: are they similar to those after traumatic brain injury?

Abstract

A retrospective survey of 78 patients with spontaneous haemorrhagic brain injury admitted to a regional neurorehabilitation centre over a three-year period is described. Residual neuropsychological impairments and the need for assistance in activities of daily living (ADL) were assessed. Little difference was found in terms of impairment or extent of disability between the 53 subarachnoid haemorrhage and 25 intracerebral haemorrhage survivors who comprised the study population. This population is compared to the findings in traumatically brain-injured patients managed in the same unit. Although there were some neuropsychological differences between the two groups, these were not reflected in the degree of dependence in ADL, which was remarkably similar. The length of stay for haemorrhagic brain injury patients on the unit was longer than that of the head injured. Haemorrhagic brain injury therefore, represents a major demand on rehabilitation services and similar provisions should be made for them as are advocated for the traumatically brain injured.

References

Bamford J. , Sandercock P. , Dennis M. , Burn J. , Warlow C. A prospective study of acute cerebrovascular disease in the community: J Neurol Neurosurg Psychiatry 1990; 53: 16-22.

Adams H. , Kassel NF , Torner JC , Nibblelink DW , Sahs AL Early management of aneurysmal subarachnoid haemorrhage. J Neurosurg 1981; 43: 141-45.

Auer LM Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 1984; 15: 57-66.

Flamm E. The timing of aneurysm surgery. Clin Neurosurg 1985; 33: 147-58.

Gilsbach JM , Harders AG , Eggert HR , Hornyak ME Early aneurysm surgery: a 7 years clinical practice report. Acta Neurochir 1988; 90: 91-102.

Sieler RW , Reulen HJ , Huber P. , Grolimund P. , Ebeling U. , Steiger HJ Outcome of aneurysmal subarachnoid haemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine and transcranial doppler ultrasound. Neurosurgery 1988; 23: 598-604.

Bailes JE , Spetzler RF , Hadley MN , Baldwin HZ Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 1990; 72: 559-66.

Artiola I. , Fortuny L. , Prieto-Vaiente L. Long term prognosis in surgically treated intracranial aneurysms. J Neurosurg 1981; 54: 35-43.

Ropper AH , Zervas NT Outcome 1 year after SAH from cerebral aneurysms: management morbidity, mortality and functional status in 112 consecutive good-risk patients. J Neurosurg 1984; 60: 909-15.

10.

Saveland H. , Sonesson B. , Ljunggren B. et al. Outcome evaluation following subarachnoid haemorrhage. J Neurosurg 1986; 64: 191-96.

11.

Scottish Home & Health Department. Medical rehabilitation: the pattern for the future. Edinburgh: HMSO, 1972.

12.

Medical Research Council Co-ordinating Group. Research aspects of rehabilitation after acute brain damage in adults. Lancet 1982; ii: 1034-36.

13.

Jennett B. , Bond MR Assessment of outcome after severe brain damage. Lancet 1975; i: 480-48.

14.

Henderson EJ , Morrison JA , Young EA , Pentland B. The nurse in rehabilitation after severe brain injury. Clin Rehabil 1990; 4: 167-72.

15.

Pentland B. , Miller JD Head injury rehabilitation: 4 years' experience in Edinburgh. Br J Neurosurg 1988; 2: 61-65.

16.

Lishman WA In: Organic psychiatry, second edition. Oxford: Blackwell, 1987: 319-69.

17.

Oder W. , Bianco PD , Kollegger H. , Zeiler K. , Binder H. , Deecke L. Spontaneous subarachnoid haemorrhage: prognostic factors for social readjustment . Scand J Rehabil Med 1990; 22: 85-91.

18.

Oddy M. , Bonham E. , McMillan T. , Stroud A. , Rickard S. A comprehensive service for the rehabilitation and long-term care of head injury survivors. Clin Rehabil 1989; 3: 253-59.