The effect of cranioplasty in cognitive and functional improvement: Experience of post traumatic brain injury inpatient rehabilitation

Abstract

To investigate the effect of cranioplasty on rehabilitation of post-traumatic brain injury (TBI) patients, 37 patients with TBI were arranged by retrospectively assessment study. Those TBI patients receiving in-hospital rehabilitation in the Department of Rehabilitation in a medical center of South Taiwan from 2010 to 2015 were assigned into two groups: A and B. All patients entered the multidisciplinary holistic in-patient rehabilitation training for about 1 month. Patients in Group A received decompressive craniectomy (DC), patients in Group B received DC and cranioplasty. All assessments were arranged right on admission and before discharge. The functional activity evaluation included muscle power and Barthel index (BI), and cognitive function evaluation, including the Rancho Los Amigo Scale, Mini Mental State Examination (MMSE), Community Mental State Examination (CMSE), and the Luria-Nebraska Neuropsychological Battery-Screening Test Short Form (LNNBS). The results showed that there were synergetic effects of cranioplasty on post-TBI patients with rehabilitation training, especially in the BI score, and cognitive improvement in CMSE and LNNBS.

Timing for cranioplasty to improve neurological outcome: A systematic review

“…However, neurorehabilitation programs (if performed) might affect outcomes after longer times (Jolliffe, Lannin, Cadilhac, & Hoffmann, 2018), reinforcing cranioplasty effects on spontaneous cognitive recovery. Su et al (2017) observed synergetic effects of cranioplasty on TBI patients with rehabilitation training, both in the motor and in the cognitive domains.…”

“…After reading them, one article was excluded because reported duplicate patients (Honeybul, Janzen, Kruger, & Ho, ), who were included in a more recent and larger simple size study (Honeybul, Janzen, Kruger, & Ho, ), whereas two articles were excluded for inadequate study design (Huang et al, ; Liang et al, ). Although we contacted eight authors for further information regarding missing data (Bender et al, ; Di Stefano et al, ; Honeybul et al, ; Jasey, Ward, Lequerica, & Chiaravalloti, ; Shahid, Mohanty, Singla, Mittal, & Gupta, ; Songara, Gupta, Jain, Rege, & Masand, ; Stelling, Graham, & Mitchell, ; Su et al, ), only four of them were able to provide original individual data useful for our meta‐analysis (Di Stefano et al, ; Honeybul et al, ; Jasey et al, ; Songara et al, ). At the end of selection, six articles and two systematic reviews (Malcolm et al, ; Xu et al, ) have been included in the present study.…”

“…However, neurorehabilitation programs (if performed) might affect outcomes after longer times (Jolliffe, Lannin, Cadilhac, & Hoffmann, ), reinforcing cranioplasty effects on spontaneous cognitive recovery. Su et al () observed synergetic effects of cranioplasty on TBI patients with rehabilitation training, both in the motor and in the cognitive domains. Moreover, it is well known that an early neuropsychological rehabilitation that has been performed for an adequate time can affect the outcomes in both severe brain injured and patients with disorder of consciousness (Sancisi et al, ).…”

“…Similarly, many recent studies recommend early cranioplasty because of its association with clinical improvement (Bender et al, ; Chibbaro et al, ; Liang et al, ; Quah et al, ), which can be performed as early as 2 weeks postcraniectomy (and in any case not later than 6 months) to lower the overall cost of care by eliminating the need for additional hospital admissions (Beauchamp et al, ). Indeed, it would seem that the majority of neurocognitive changes tend to be at their maximum initially and then decline gradually (Di Stefano et al, ), given that ipsilateral low cerebral blood flows increased and reached normal levels after CP (Erdogan et al, ), raising the recovery of motor and cognitive functioning (Su et al, ).…”

O impacto na cognição em pacientes submetidos à cranioplastia

“…Importante ressaltar que há estudiosos 61 quanto ao efeito da cranioplastia em pacientes submetidos a CD por TCE grave, que alertam que a melhoria da qualidade da atividade diária funcional e a função cognitiva são muito mais refinadas com a intervenção da cranioplastia durante a reabilitação hospitalar.…”