Medically reviewed by Dwayne Myers.
A non-traumatic brain injury (NTBI), also known as an acquired brain injury, occurs when internal factors disrupt normal brain function. The most common causes of an NTBI include a lack of oxygen to the brain, brain bleeds, stroke and metabolic disruption. Inpatient rehabilitation can help patients regain physical, cognitive and behavioral functions after an NTBI.
What is a non-traumatic brain injury?
"Traumatic means any trauma to the brain, like a motorcycle accident, car injury or hitting your head on the ground," said Dr. Patrick Donovan, medical director of Encompass Health Rehabilitation Hospital of City View in Fort Worth, Texas. "Non-traumatic can be anything that is not traumatic that affects the brain."
NTBI is a common condition treated at Encompass Health Fort Worth, but Donovan said the need for inpatient rehabilitation can also be overlooked for these patients, especially those who are critically ill and require treatment in the ICU. Their symptoms are typically in three areas — physical, cognitive and behavioral — all of which inpatient rehabilitation could address.
Common causes of non-traumatic brain injuries
Non-traumatic brain injuries come in many forms. The common denominator is that all NTBIs are caused by internal factors that affect the brain. These could include:
- Stroke
- Substance abuse
- Lack of oxygen to the brain
- Brain tumors
- Viruses or infections
- Encephalopathies
- Brain aneurysms
Critical illness encephalopathy and non-traumatic brain injury
Many patients who are hospitalized for an extended period could experience a condition known as critical illness encephalopathy. Encephalopathy refers to a group of conditions that affects brain function, classifying it as an NTBI.
Types of encephalopathy include:
- Anoxic occurs when cardiac arrest causes a lack of oxygen to the brain.
- Metabolic relates to underlying issues and condition of the metabolism.
- Toxic is caused by medication, substance and alcohol abuse.
- Uremic relates to disrupted kidney function and urinary tract infections.
Patients most at risk
Those most at risk for critical illness encephalopathy, myopathy and neuropathy include:
- Patients who have been in the ICU for more than a week
- Patients who have been intubated or have sepsis
- Those who have been on antibiotics, neuromuscular blocking agents or steroids for an extended time
Symptoms patients may experience
Patients with critical illness encephalopathy and other non-traumatic brain injuries often have trouble concentrating, remembering information or organizing tasks. They could have significant challenges performing Activities of Daily Living (ADLs) for six to eight months after leaving the ICU. Weakness is common, too, and can lead to critical illness myopathy or neuropathy. This could be considered a worsening, or advancing, of the patient's NTBI condition into further neurological impairment.
Myopathy is a neuromuscular condition that causes muscle weakness and dysfunction. Neuropathy causes nerve damage and pain, typically in the feet and hands.
Care offered at inpatient rehabilitation hospitals such as Encompass Health can help treat the wide variety of symptoms many patients experience after an NTBI. Those symptoms include:
- Physical: Paralysis, spasticity, speech disturbance, seizures, double vision
- Cognitive: Attention and concentration, initiation and goal direction, judgment and perception, speed of information processing
- Behavioral: Exacerbates pre-existing traits, social inappropriateness, impulsiveness and distractibility
The different therapies work together in the inpatient rehabilitation setting to address these symptoms.
"Basically, the PT, OT and speech therapists would be working together on cognitive dysfunction," Donovan said. "Patients definitely could get better quicker if they have all three therapy modalities."
Benefits of inpatient rehabilitation for non-traumatic brain injury
The brain has an incredible ability to adapt and reorganize itself after injury, a process known as neuroplasticity. This means healthy areas of the brain can create new pathways to take over lost functions. Neuroplasticity happens most rapidly in the weeks and months after an NTBI, which is why early, consistent rehabilitation plays such an important role in recovery.
People experiencing an NTBI could benefit from the intensive therapy and medical care provided in an inpatient rehabilitation setting. Donovan noted that before sending a patient with encephalopathy or another NTBI home, consider whether this level of care could help them recover more safely and effectively.
"Many of these patients are very weak and confused, and if you send them home, they might not be able to function," he said. "Even if they have someone at home or home health, they don't have someone who could treat them daily like they would in an inpatient rehabilitation hospital."
Recognizing a patient's need and finding them care at an inpatient rehabilitation hospital can be the right intervention to prevent ongoing and chronic debility beyond their acute illness, Donovan added.
What to expect with inpatient rehabilitation for non-traumatic brain injury
In the inpatient rehabilitation setting, patients receive at least three hours of therapy a day in two of the three disciplines: physical, occupational and speech therapy. They also have 24/7 nursing care and physician visits several times a week. Their care team includes pharmacy, respiratory care, case management, dietary services and other medical specialists.
The average length of stay at an inpatient rehabilitation hospital is around two weeks, but it can vary depending on the complexity of the patient.
At an Encompass Health rehabilitation hospital, care is individualized to the patient. Therapy is spread out throughout the day, giving patients time to rest and recover. With skilled medical staff and case management, their care team can also help them manage any chronic conditions and connect them with resources within their community. The goal is to set patients up for success after they leave the rehabilitation hospital.