Rehabilitation nurses need to understand the epidemiology of brain injuries to identify what factors place individuals at risk and to comprehend the significance of brain injuries on society. Understanding the causes of brain injuries will assist the nurse in identifying the focus of prevention efforts. The epidemiology and causes of brain injury are reviewed.

No two brain injuries are exactly alike. Understanding the mechanism which caused the brain injury is an important prognostic element. Rehabilitation nurses need to understand how the brain injured person’s functional and rehabilitation potential is linked to this etiology. In this chapter, the mechanisms that cause brain injuries are explored.

When a brain injury occurs, the initial insult garners the most attention, yet the effects of the secondary injury can be just as devastating. It is important for rehabilitation nurses to understand and recognize the differences between primary and secondary effects of brain injuries in order to customize appropriate interventions. This chapter will take a closer look at the pathophysiology of primary, secondary, and tertiary brain injuries.

One of the variables that determine the functional outcome of a person with a brain injury is the severity of the insult to the brain. The focus of rehabilitation nursing interventions for someone with a mild brain injury will be quite different as compared to someone with severe damage to the brain. The characteristics that define the different levels of severity of brain injury are discussed.

Assessment instruments are used throughout the continuum of brain injury recovery. These tools, such as the Rancho Los Amigos Levels of Cognitive Functioning scale and FIMTM Functional Independence Measurements, provide an objective scale to assist caregivers in diagnosing the extent of the brain damage and assist in identifying improvements in cognition and function. This chapter will help rehabilitation nurses to recognize the purpose of these tools and understand when and how they should be used.

No two brain injuries are exactly alike. Each lobe of the brain is responsible for certain executive functions. When one of these areas of the brain sustains damage, certain characteristics of behavior and function can be expected. This chapter will provide an understanding of the function of each lobe and how this knowledge can be translated into a patient’s plan of care and expected outcomes.

A brain injury is an insult to the central nervous system, so it is no surprise that this system would be significantly affected. Some of the damage is obvious immediately while other disorders develop over time. The rehabilitation nurse needs to be aware of the symptoms of these conditions; some are life threatening while others can significantly affect future functional outcomes. This chapter discusses immediate medical concerns, such as dysautonomia, as well as paresis, spasticity, and tone, which have long-term functional consequences.

Brain injuries affect all bodily systems to varying degrees, based on the location and extent of the damage in the brain. This chapter will discuss the effects on the cardiovascular, integumentary, and pulmonary systems as well as identify changes to sleep, sensation, perception and sexuality. It is important that rehabilitation nurses are versed in these changes to be able to identify changes from the norm and provide patient and family education to address these.

A person with a brain injury may experience acute or chronic pain that is dependent upon the location within the brain that is damaged, the extent of that damage and the length of time post injury. This chapter will show rehabilitation nurses how to identify the causative factors in order to provide the best intervention for treating that pain.

Dysphagia occurs in a large number of patients with brain injury. This swallowing dysfunction challenges the rehabilitation nurse to ensure that the patient receives adequate caloric and fluid intake. Physical impairments from the brain injury can also affect patients’ abilities to independently feed themselves. This chapter addresses the nurse’s role in the management of dysphagia, transition to oral intake, and the use of adaptive feeding techniques.

Brain injuries can result in communication deficits as patients may suffer from aphasia or dysarthria. The inability to communicate is devastating to people. This chapter discusses the various communication deficits, strategies that rehabilitation nurses can use to communicate with their patients, and techniques that can be used to promote improved speech.

Brain injuries affect all bodily systems to varying degrees based on the location and extent of the damage. This chapter will discuss the effects on the patient’s ability to void by discussing the neurogenic changes affecting the bladder. The rehabilitation nurse will use this information to develop and implement bladder management strategies.

Brain injuries affect all bodily systems to varying degrees based on the location and extent of the damage. This chapter will discuss the neurogenic changes affecting bowel continence. The rehabilitation nurse will use this information to develop and implement bowel management strategies to promote regular emptying.

All patients with brain injury sustain some level of cognitive impairment. The extent of these deficits depends on the location and severity of the brain damage. This chapter addresses typical cognitive impairments and identifies interventions that the rehabilitation nurse can use to improve patient functional outcomes.

Behavior changes are commonly seen in individuals with brain injury. Some behaviors are linked to the phases of brain recovery while others are static and possibly permanent. This chapter focuses on addressing the behavior changes commonly seen and identifying strategies for use by the rehabilitation nurse to improve functional outcomes and promote patient safety.

Periods of agitation challenge even the most experienced rehabilitation nurses. Agitation can be categorized into four different classifications. This chapter will review the characteristics of agitation and identify strategies that the rehabilitation nurse can implement to address agitation to promote patient and staff safety.

Behaviors resulting from a brain injury often raise safety concerns as they place the patient at risk for additional injury. Rehabilitation nurses are challenged to identify measures to keep them and others safe from injury. This chapter discusses how elopement, impulsivity, and aggression can test the creativity of the nurse to promote activity yet minimize the risks of injury to the patient and staff.

Musculoskeletal changes may occur as a result of brain injury. Rehabilitation nurses, in partnership with other members of the interprofessional team, should address these concerns early to minimize problems later in life and improve functional outcomes. This chapter promotes a multimodal treatment approach of medications, orthotics, and exercise to address these musculoskeletal concerns.

Individuals with moderate to severe brain injuries will likely have some functional deficits related to self-care. The ability to perform self-care is an important quality of life indicator. Rehabilitation nurses partner with other members of the interprofessional team to design a plan of care to address these needs throughout the day. This chapter will address the rehabilitation nurse’s role in promoting independence in bathing, dressing, grooming, feeding, and toileting.

Individuals who sustain moderate to severe brain injuries will likely have some functional deficits related to mobility. Rehabilitation nurses partner with other members of the interprofessional team to design a plan of care to address these needs throughout the day. This chapter will address the rehabilitation nurse’s role in promoting bed mobility, transfers, wheelchair mobility, and ambulation.

It is not uncommon for personality changes to occur following a brain injury. Some of these changes are the result of the location within the brain that the injury occurred, and others may be the result of brain chemistry. Regardless of the cause, these personality changes may affect a person’s psychosocial adjustment when integrating into their previous life. This chapter will explore personality changes and mental health issues that can arise as a result of the brain injury and the role of the rehabilitation nurse in addressing these psychosocial challenges.

Brain injury does not just affect the person with the injury but the entire family network, especially in cases where the brain injury is profound. Often roles within families switch as members are required to adjust to this change in structure or possibly take on a caregiver role. This chapter will explore family involvement in the evolution of recovery, using case examples to illustrate some positive and negative consequences.

The recovery from a brain injury can be long and arduous. There is no crystal ball that can look at a newly injured person and predict that person’s potential for a full recovery. This chapter will discuss the transitions of care facing the patient and family as the brain injured person moves beyond the acute hospitalization.

The ultimate goal of rehabilitation is to return individuals back to the community to lead productive and meaningful lives. This chapter reviews how vocational, financial, and community resources promote community reintegration and help the patient and family to move on with their lives.