In civilian life, the vast majority of head injuries are due to acceleration / deceleration forces resulting in closed head injuries. Risk factors for sustaining a head injury include male sex, younger age (peak 15–24 years with a secondary peak in the elderly) alcohol, lower socioeconomic status and a history of psychiatric disorder. The sequelae of head injury are often long-term and can be profound, with significant psycho-social and socio-economic consequences. Early, appropriate rehabilitation provides the opportunity to actively manage the consequences of the primary brain injury and reduce secondary complications thereby improving outcome.

MDT: Inpatient clinical management considerations (acute phase)

• optimisation of respiratory function
• nutrition, hydration and swallowing
• 24 hour postural management (incorporating pressure care and spasticity management)
• heterotopic ossification
• pain management
• bladder and bowel management
• communication
• the potential for autonomic storming (also known as paroxysmal autonomic instability with dystonia (PAID))
• management of prolonged disorders of consciousness
• management of cognitive and neuro-psychiatric issues including
• post traumatic amnesia (inability to lay down new memories)
• executive dysfunction
• agitation and aggression
• disorientation and wandering
• disinhibition
• assessment under the Mental Capacity Act / Deprivation of Liberty safeguards
• family and carer support

Other actions:

• Communication can be made with the trauma rehabilitation co-ordinator for advice and information.
• Refer to the Directory of Services to provide guidance on potential transfer of care options. Patients with severe injuries are likely to require Level 1 specialised rehabilitation services.