Early rehabilitation after severe brain injury: a French perspective

Severely brain-injured patients often suffer from disabilities and psycho-social handicaps. Early rehabilitation aims at improving their motor and functional recovery while preventing or treating complications as soon as possible. In this review we look at some issues encountered in early rehabilitation. We illustrate our discussion with data from 876 French traumatic brain injury patients admitted over the course of 1 year at 18 rehabilitation units that were asked for details of their current practice. Preservation of vital functions follows standardized protocols, but rehabilitation is more controversial. Few controlled trials are available. Good agreement exists among clinicians about prevention of orthopedic complications and treatment for spasticity. However, little consensus exists concerning treatment of non-pyramidal hypertonia and spasms or about procedures that can be undertaken to improve arousal from a coma or vegetative state. Finally, we look at other specific issues of early rehabilitation, namely prediction of outcome, psychological difficulties of patients and their families, efficiency and cost-effectiveness.