Post Head Injury Autonomic Complications Follow-up

  • Author: Stephen Kishner, MD, MHA; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jul 7, 2011
 

Further Inpatient Care

The length of stay in rehabilitation is usually reported as being longer for those patients who experience ADS. Other than this observation, no specific alterations from a typical multidisciplinary, acute inpatient rehabilitation program are expected in this population.

If actual myocardial damage is identified as a result of the syndrome, observe appropriate cardiac rehabilitation principles during the head injury rehabilitation program.

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Further Outpatient Care

The outpatient setting is rarely the context for ADS to present.

The usual outpatient therapy programs and the typical concerns regarding family functioning and community re-integration issues pertain to outpatient care.

Rarely, continued medication use is required long term. Thus, monitoring for common side effects and minimizing medications that impair cognition are required.

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Transfer

Transfer to the neurosurgery service or an ICU setting is rarely necessary for patients with ADS, although it is conceivable in the event of dangerously high blood pressure and tachycardia.

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Complications

Increased sensitivity of neurons to elevated temperature occurs during the acute phase of TBI. In animals, functional differences are discernible between those with temperatures in excess of 38 º C and those whose temperature is maintained below 38 º C. In one study, 73% of patients with dysautonomia had temperatures above 38 º C for 2 weeks after injury, contrasted with only 18% of patients without dysautonomia.[6]

Posturing increases energy expenditure by 150-250%.[6] These features increase the risk that persons with dysautonomia will sustain secondary injury to the brain.

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Prognosis

Although patients who have dysautonomia can make functional gains, their outcomes — as measured by Glasgow Outcome Scale (GOS) and Functional Independence Measure (FIM) scores — have been found to be poorer than those of patients without dysautonomia.[14] Individuals with dysautonomia also have more difficulty with memory and experience longer periods of posttraumatic amnesia (PTA) than do patients without dysautonomia. Research has found that for patients with dysautonomia, the duration of ICU stay is the same as that recorded for controls but that the length of rehabilitation stay is greater. On average, the duration of the dysautonomia (as measured by cessation of sweating) has been found to be about 75 days.

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Patient Education

Explaining ADS to the patient is rarely an issue, because patients are usually cognitively compromised at the time of manifestation of the syndrome. However, reducing the fear of family members is important. The family should understand that this syndrome is seen in persons with brain injury, that it is almost always controllable with medications, and that it does not usually remain a long-term problem.

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Contributor Information and Disclosures
Author

Stephen Kishner, MD, MHA  Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Scott Strum, MD  Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center

Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

Teresa L Massagli, MD  Professor of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Kat Kolaski, MD  Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

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