Professional Documents
Culture Documents
Letter To The
Injury
Editor
Muhammad Hafiz Hanafi
To cite this article: Hanafi MH. Acute rehabilitation in traumatic brain injury. Malays J Med Sci. 2017;24(3):101–
103. https://doi.org/10.21315/mjms2017.24.3.13
There is insufficient evidence in the use was some evidence that the beta-blockers,
of pharmacology agents to improve disordered propranolol and pindolol, can reduce aggressive
consciousness; however, these agents may be behavior. However, the authors concluded that
used to optimise cognitive recovery for traumatic there was insufficient evidence on which to base
brain injury patients (7). A systematic review firm recommendations regarding the use of these
evaluated pharmacological interventions for treatments, although beta-blockers had the best
patients in the vegetative or minimally conscious evidence for efficacy.
states, revealing some supporting evidence for Any pharmacological treatments for
the use of dopaminergic agents, amantadine traumatic brain injury should be individually
and levodopa (n = 6), hypnotic agent zolpidem tailored and commenced at the initial, minimum
(n = 21) and intrathecal baclofen for spasticity dosage in order to reduce the risk of possible,
(n = 5), in improving consciousness levels for adverse effects (1).
a very small number of patients. Considerable Patients in RLA Level VI and above are
limitations were noted within this literature, ready to be independent in self-care and daily
as it included a case series, a lack of cohort living activities. These patients should be
(or blinded), controlled study designs and trained and guided in inpatient or outpatient
considerable heterogeneity regarding patient rehabilitation center in preparation for their
characteristics (7). return to their studies, driving and mobility or
Another systematic review of large, their return to work.
retrospective studies (n = 209) suggested that Family members and caregivers should
amantadine might improve cognition, arousal be given training on patient care during the
and other behavioural or functional responses patient’s hospital stay and before the patient
following traumatic brain injury; however, returns to the community (5). Optimum
the authors also suggested that additional, preparation for family members and caregivers
prospective, controlled studies are required (8). should include the following topics (5):
An amantadine dosage of 200 mg–400 mg can
be used safely in even severe traumatic brain i. Assessment of a safe discharge environment,
injury, and it may facilitate faster behavior and including available support.
conscious level improvement (9). ii. Equipment prescription and adaptation to
Other awakening agents have been optimise patient care.
investigated, including bromocriptine,
iii. Training for family members and caregivers
methylphenidate, levodopa and amitryptaline.
in the use of equipment and in patient
However, considerable methodological issues, as
management for daily and emergency
well as the heterogeneity of outcome measures,
situations.
have led to conflicting results between various
studies (1). iv. Education for the family members and
Patients within RLA Levels IV and V display caregivers regarding formal and informal
alertness, but are still in the confused stage. They resources, support groups and how to access
do not require a lot of stimulation (from sound, them.
light or smell), as this will further increase their
agitation. Brief, quiet visits from familiar faces
are the most helpful type of stimulation.
Correspondence
Any medical, remediable causes that can
Dr Muhammad Hafiz bin Hanafi
cause agitation should be addressed, including
NeuroRehabilitation Medicine Specialist,
pain from the injury site, infection, thrombosis, Department of Neurosciences,
sleep disorders, constipation or medication that School of Medical Sciences,
may affect cognition and alertness (1). Family Universiti Sains Malaysia,
members, carers and nursing staff should be 16150 Kubang Kerian,
educated on the appropriate management of Kelantan, Malaysia.
agitation and stimuli to the patient (1). Tel: +609 7676300
Agitation in RLA Level IV patients should E-mail: drmdhafiz@outlook.com
be addressed properly. A systematic review,
including six randomised control trials,
evaluated the effectiveness of propranolol and
pindolol, methylphenidate or amantadine in
managing post-traumatic agitation (7). There
102 www.mjms.usm.my
Letter To The Editor | Traumatic brain injury rehabilitation
www.mjms.usm.my 103