[Outcome after an intensive, holistic and multidisciplinary rehabilitation program after traumatic brain injury. Medico legal values]. / Eficacia de un programa de tratamiento intensivo, integral y multidisciplinar de pacientes con traumatismo craneoencefálico. Valores médico legales.

INTRODUCTION: This paper was designed to evaluate the integral rehabilitation treatments for patients with traumatic brain injury; data about efficiency of the C.RE.CER. intensive, holistic and multidisciplinary rehabilitation program is given. PATIENTS AND METHODS: The study was done keeping in mind not only the clinical aspects of rehabilitation, but also setting it within the judicial realm in which a great number of brain injury cases are found, mainly when caused by traffic accidents. A sample of 10 severe traumatic brain injury patients was studied, aged between 19 and 39. All the patients were assessed at the beginning and the end of the treatment, using a neuropsychological test battery, meanwhile were treated with the C.RE.CER. intensive, holistic and multidisciplinary rehabilitation program. RESULTS AND CONCLUSIONS: The results show a high efficiency of treatments in the majority of the patients, with reductions of more than 70% in emotional deficits and more than 60% in the global recovery of the patients that carried out the programs. This paper also shows some limitations of the criteria for compensation in Spanish legislation.

Executive functioning as outcome in patients after traumatic brain injury.

The present study was designed to determine how traumatic brain injury affect executive functioning, to know whether different treatments in the acute phase improve this functioning, and to check whether the severity of the neurocognitive impairment is detected by the Glasgow Outcome Scale (GOS). Ability for problem solving and executive functioning within 2 years after Traumatic Brain Injury (TBI) was examined in 35 conscious survivors. Two groups were formed. One group consisted of 13 patients who needed neurosurgery. The other group was made up of 22 patients without neurosurgical treatment. All were treated in the Neurosurgical Intensive Care Unit and in the Rehabilitation Service. The following variables were registered: Secondary Lesions, Glasgow Coma Scale (GCS), CT, subacute CT, and Glasgow Outcome Scale. Neuropsychological tests administered were Wisconsin Card Sorting Test (WCST) and the Tower of Hanoi/Sevilla. Comparing both groups' test performance (man Whitney U) we found that a severe traumatic brain injury, whatever the treatment applied in the acute phase, impairs the executive functioning of the patients; this impairment is related to acute pathophysiological events. The neurosurgical intervention does not improve the executive functioning. The Glasgow Outcome Scale does not detect more than 25% of the patients with severe impairment. It is suggested that the Tower of Hanoi/Sevilla could be a good tool to evaluate the executive functioning routinely in TBI patients as outcome. It also suggested that mild TBI patients must be referred for a complete neuropsychological examination.