Cognitive impairments following traumatic brain injury. Etiologies and interventions

Brain injury is a dynamic process that continues for weeks. Recovery is also a lengthy process, proceeding in overlapping stages along with injury. The outcome for many patients with TBI is an inability to fully participate in life events because of cognitive impairments. Physiologic responses throughout the injury and recovery are punctuated by neuroprotective and neuroplastic events. The time course of these injury and recovery activities requires that medical and nursing therapies are targeted across the trajectory of injury as damage and recovery processes are occurring. Prevention of secondary injury using medical and nursing strategies should be of paramount importance. Altering the environment by providing meaningful yet novel sensory stimulation may enhance plasticity and lead to reorganization of structures that support cognitive processes. Administration of neuroprotective agents in an effort to control damage from neurochemical processes should proceed as these agents become approved for clinical use. Active participation in rehabilitation programs and neuropsychologic testing provide additional avenues for identifying and addressing cognitive impairments. The complex relationship between injury and cognitive impairment is slowly being unraveled. Through an understanding of the brain structures and networks associated with information processing as well as the pathophysiologic consequences of brain injury, critical care nurses can design evidence-based regimens of care that preserve cognitive function and result in improvement of long-term cognitive outcomes and fuller participation in everyday life activities.