Continued Medical Management

Medical management focuses on the treatment of intercurrent illnesses such as diabetes, cardiovascular and respiratory diseases, psychiatric disorders and on any factors that may impair recovery. Choice of medications will be important in view of the several pharmaceutical preparations that have been incriminated in delayed recovery [23]. Medical personnel need to be alert to late complications of head injury such as hydrocephalus and chronic pain syndromes, sympathetic dys-synergia following spinal cord injury and reflex sympathetic dystrophy following peripheral nerve damage and seek expert advice where necessary.

Illustrative Case 2

A 24-year-old male sustained extensive head injuries in a road traffic accident. He had diffuse brain injury with traumatic subarachnoid hemorrhage. He recovered gradually and was admitted for rehabilitation. On admission to the rehabilitation unit, he still had difficulty with communication due to cognitive impairment. He was able to stand with the assistance of two people but his balance was grossly impaired. He required assistance with all activities of daily living but was continent and able to request a bottle for emptying his bladder. His progress in the rehabilitation program was less than optimal and he failed to reach simple goals. His mobility began to deteriorate and he was unable to stand, even with assistance. On a few occasions, he had been incontinent and was also unaware of bladder emptying. He was then re-investigated and a CT scan showed hydrocephalus with periventricular low-density and effacement of the cortical gyri. He was treated with a ventriculo-peritoneal shunt, following which he improved rapidly. At the conclusion of the rehabilitation program, he was walking unaided and fully independent in his personal care. His cognitive functions had also improved markedly.

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