Guidelines for rehabilitation of patients with traumatic brain injury

Posljedice traumatske ozljede mozga (skr. TOM) predstavljaju jedan od najvažnijih zdravstvenih problema u Hrvatskoj. Najčešći uzrok TOM-a su prometne nesreće (70%), a u trenutku zadobivanja TOM-a pod utjecajem alkohola je 22% osoba. Rehabilitacija osoba s TOM-om u Hrvatskoj se provodi kao bolnička, ambulantna ili rehabilitacija u kući. Rehabilitacija osoba s teškim ili srednje teškim TOM-om se za većinu pacijenata provodi u Specijalnoj bolnici za medicinsku rehabilitaciju Krapinske Toplice. Tijekom rehabilitacije pacijenti s TOM-om su uključeni u kompleksni rehabilitacijski proces uz multidisciplinarni tim i interdisciplinarnu timsku suradnju. Rehabilitacijski proces planira, preporuča i regulira specijalist-fizijatar u suradnji sa članovima multidisciplinarnog tima. Bolnički rehabilitacijski tim čine specijalist-fizijatar, klinički psiholog, logoped, fizioterapeut, radni terapeut, medicinska sestra, a u središtu je pacijent sa svojom obitelji. Po potrebi timu se pridružuje drugi liječnici specijalisti (npr. neurolog, psihijatar, neurokirurg, internist, radiolog, ortoped, oftalmolog), kao i pravnik i /ili socijalni radnik. Akutno liječenje pacijenata s teškim TOM-om traje u prosjeku 100 dana (kod 85% pacijenata), a bolnička medicinska rehabilitacije traje u prosjeku 200 dana za 70% pacijenata, prosječno 400 za 20% pacijenata, a za 10% pacijenata i duže (600-1000 dana). Po završetku bolničke medicinske rehabilitacije, preporuča se u slučaju indikacije nastavak rehabilitacije ambulantno, rehabilitacija u kući, ili se bolesnici smještavaju u državne ili privatne ustanove u kojima im je omogućen smještaj i neophodno potrebna tuđa pomoć i njega. Doktor obiteljske medicine po preporuci fizijatra, psihijatra i/ili neurologa upućuju pacijenta na ocjenu radne sposobnosti, a ponekad i određivanje privremenog ili trajnog skrbnika, najčešće educiranog i odgovornog člana obitelji. Ukoliko je potrebno, pacijentu se propisuju ortopedska pomagala koja su pacijentu potrebna za kvalitetnije funkcioniranje kako kod kuće tako i u zajednici.The consequences of traumatic brain injury (TBI) make for one of the most important health problems in Croatia. The most common cause for TBI is traffic accidents (70%), and at the time of obtaining TBI 22% of patients are under the influence of alcohol. Rehabilitation of persons with TBI in Croatia is implemented as a hospital, outpatient or rehabilitation at home. Rehabilitation of people with severe or moderate TBI for most patients is spent in the Special Hospital for Medical Rehabilitation Krapinske Toplice. During the rehabilitation patients are involved in the complex rehabilitation process with a multidisciplinary team and interdisciplinary team collaboration. The rehabilitation process is planned, recommended and regulated by a specialist in physical and rehabilitation medicine (PRM) in collaboration with members of the multidisciplinary team. Hospital rehabilitation team consists of a physician – PRM specialist, clinical psychologist, speech therapist, physiotherapist, occupational therapists, a nurse, and the patient who is, with his/her family, in the center of the rehabilitation process. Occasionally, if necessary other specialists join the team (e.g. neurologist, psychiatrist, neurosurgeon, specialist of internal medicine, radiologist, orthopedic surgeon, ophthalmologist), as well as a lawyer and/or social worker. Acute treatment of patients with severe TBI takes on average 100 days (for 85% of patients), hospital medical rehabilitation for these patients lasts on average 200 days for 70% of patients, 400 days for 20% of patients, and even longer for 10% of patients (6000-1000 days). Upon completion of the hospital’s medical rehabilitation in case of indications is recommended to continue outpatient rehabilitation, rehabilitation at home, or are placed in public or private institutions in which they have accommodation and essential nursing care. A PRM specialist or psychiatrist or neurologist recommends to the general practitioner to send patients for assessment of work capacity and sometimes determining a temporary or permanent guardian, most often an educated and responsible family member. If necessary, prior to discharge orthopedic devices required for better patient functioning, both at home and in the community, are ordered