Post Head Injury Autonomic Complications Treatment & Management

Updated: Jul 05, 2023
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Rehabilitation Program

Physical Therapy

Severe episodes of ADS may preclude or delay any of the components of a contemporary, multidisciplinary rehabilitation program. Physical therapy sessions may have to be held episodically because labile blood pressure, ICP, heart rate, and temperature may prevent participation. Of course, it is preferable to continue not only with passive range of motion (PROM) but also with as much of the functional program as possible; monitor these symptoms during therapy.

A study by Sorek et al found that after 8 weeks of rehabilitation in children with severe TBI, the cardiac autonomic control system (CACS) underwent a partial recovery. Specifically, heart rate variability (HRV) in response to autonomic tests (handgrip and paced breathing tests) increased, although the HRV values at rest did not change from the pre-rehabilitation values. [12]

Occupational Therapy

Continue occupational therapy as regularly as possible, with the same considerations as for physical therapy.

Speech Therapy

Patients with ADS usually have severe impairment of alertness. Thus, speech therapy may not yet be appropriate.


Medical Issues/Complications

Severe muscle rigidity can result in muscle rupture or in rhabdomyolysis. Fever is viewed as a source of secondary injury in individuals with TBI, because marginal cerebral blood flow fails to provide for normal brain cooling. This may result in a brain temperature that is higher than the measured core temperature. The resulting increase in metabolic demand may not be met by increasing blood flow, so local areas of hypoxia and further neuronal dysfunction and death ensue.

Hypertension and tachycardia could theoretically increase the risk of developing hemorrhage from injured blood vessels. Prolonged, severe diaphoresis may result in dehydration and in electrolyte abnormalities.


Surgical Intervention

Surgery is not part of the treatment for ADS.



Consultation from infectious disease experts is appropriate, but it is not always necessary in this context.