The intensity of rehabilitation in acquired brain damage. More than necessary, it is essential

Acquired Brain Damage (ABD) is a consequence of brain injury. The majority of these lesions and consequent sequelae are due to cerebral vascular accidents (more commonly known as CVA), thrombosis or cerebral haemorrhage and also Traumatic Brain Injury (TBI). Hereditary, congenital or degenerative disability and trauma at birth are excluded.

ABD causes physiological and mental disability, movement limitations and restrictions when participating in social activities. The degree will depend on several factors, type of lesion, location and extent of the injury. Recovery depends not only on these factors but also on age, other diseases, sex and treatment by a multidisciplinary team, frequency and intensity of the rehabilitation sessions.

Although the death rate due to strokes has decreased in recent years, strokes remain one of the leading causes of death and the leading cause of dependency and disability, with the highest prevalence being observed in men aged between 65 and 74.

On the other hand, although a decrease in the prevalence and severity of Brain Traumatic Injury (BTI) has been observed, mainly due to road improvements and occupational safety, BTI remains the main cause of mortality among young adults, especially males.

Due to the fact that the consequences of these two conditions are varied and very different but also extensive and deep, the medical and rehabilitation treatment requires the interaction of an interdisciplinary team, each treating a specific area of the disability according to his or her professional qualifications.

This reality has also required that the scientific community agree on various points such as which techniques and programmes are more effective in neurological rehabilitation with the object of providing the patient with autonomy and independence.

The intensity of the various types of therapy, both in terms of duration of each session and number of sessions, has in this context meant greater advantages for the patient.

Longer sessions have proven to have better results. There is also the general consensus that the minimum time of each session should be 45 minutes per day, but should continue for longer periods until such time that the patient can tolerate it.

The repetition of exercises or tasks is another important aspect which is based on the Hebbian learning theory. The connections between the neurons, the cells of the nervous system, are strengthened when they are activated simultaneously, thus promoting synaptic plasticity (how these cells communicate better with each other). However, it is important to introduce small variations in the repetition of the exercises or tasks for higher cell stimulation including other adjacent body structures.

The available evidence also concluded that the intensity of the exercise has beneficial effects in terms of motor function of the limbs, balance and strength of the lower limbs – resulting in improved functionality when walking and also when performing basic daily tasks.

It is also suggested that improved functionality also has a positive outcome as far as depression and anxiety of these patients is concerned.

The HPA Health Group has a multidisciplinary team in neurological rehabilitation, working in accordance with the patient’s and the family’s needs and aspirations (Figure 1), respecting the Golden Standard of neurological rehabilitation.
Bearing this in mind, the parameters that our team uses to potentiate the final results of patients suffering from Acquired Brain Damage (ABD) is the implementation of an intensive and interdisciplinary programme.

During the first consultation and after an intensive assessment of the weaknesses, limitations and restrictions of the individual, an intensive rehabilitation plan is proposed that may be as much as six hours a day, five days a week for eight weeks.

The results obtained and the overall satisfaction of patients and their families have been extremely positive as have been the motivation and dedication of the team, who on a daily basis investigate and analyse technological and therapeutic innovations able to offer a better quality of life, autonomy and independence to patients with ABD.

By Dr Luis Malaia