There are believed to be an estimated two million people that experience a brain injury or brain accident annually in America, frequently landing them in the emergency room. A large percentage of these injuries are believed to be mild and moderate cases that often are left untreated, however, many of these patients are admitted to the hospital and require neurological care, due to being traumatic brain injuries. The paper is a reflective account of holistic approaches that can be used to improve the care of brain-injured and brain accident patients.
According to many experts, brain injuries are never identical and impact people in a variety of ways, but never the same. Brain injury challenges start the disease process for many patients requiring a full continuum of treatments that are medically necessary and requires the support of the entire community and the patient’s family and friends (Biausa.org, 2016; Truelle et al., 2010). Treatments for these patients are frequently a pattern of entry, exit, and re-entry, as well as a range of trauma care to community integration, along with intermittent occurrences (Biausa.org, 2016). Patients are typically admitted to the intensive care unit of a hospital to attain medical stability and management, as well as to prevent a medical crisis. Ventilation is necessary, catheters are often required, EKG testing, and medications are part of the care process.
With patients experiencing such a broad range of brain injuries, providers, researchers, and families are looking at more alternative and holistic care options us separately or jointly with traditional methods of care (Flanagan, Cantor, & Ashman, 2008; Klonoff and Dawson, 2004). The National Institutes of Health (NIH) and the National Center for Complementary and Alternative Medicine (NCCAM) describe complementary and alternative medicine (CAM) “as a group of diverse medical and healthcare systems, practices, and products that are not considered part of conventional medicine” (NCCIH, 2015). Integrative medicine combines both complementary and alternative medicine approaches. CAM includes a natural products approach, which consists of a variety of herbal medicines or botanicals, vitamins, minerals, dietary supplements, and other natural products, such as microorganisms and probiotics (NCCIH, 2015). A 2007 study conducted by NIH identified that approximately 17.7 percent of adults in the United States takes a non-vitamin and or non-mineral natural products, with two of the most common being fish oil and Echinacea (NCCIH, 2015; Hasadsri et al., 2013).
Mind and body medicine is another CAM format that focuses on interactions between the brain, body, and behavior with the purpose of impacting physical functions and promoting overall health; the approach uses meditation which focuses on specific poses and postures to relax and find psychological balance and to manage all types of illnesses; yoga is another technique in this area that combines physical poses, breathing motions, and meditation to improve health issues; and acupuncture, which is a traditional Chinese Medicine (TCM) approach to heal specific health conditions using needles to penetrate the skin in various body pressure points that are frequently enhanced with heat or hand motions (NCCIH, 2015). The same 2007 NIH study found that approximately 12.7 percent of American adults participate in one or more of these approaches (NCCIH, 2015).
Manipulative and body-based practices use spinal manipulation and massage therapy that concentrates on the circulatory and lymphatic systems, and bones and joints, as well as other soft tissue manipulation (NCCIH, 2015). These forms of treatment are used to relieve pain, improve physical functionality, reduce stress, and to relax, along with creating a sense of general well-being (NCCIH, 2015). These techniques have been used by international cultures for centuries, and currently an estimated nine percent of adults use one of these techniques on a regular based as well as almost the same number children and young adults (NCCIH, 2015). CAM practices include other types of therapies as well including movement therapies, such as Pilates; manipulation of energy fields is used to impact health with such techniques as magnet therapy, light therapy, Reiki; there is an estimated one percent of adults and children using these forms of CAM (NCCIH, 2015).
Hyperbaric Oxygen (HBOT) therapy is another form of alternative medicine, which allows oxygen to be delivered in “supraphysiological amounts to traumatic brain injured patients” (Rockswold et al., 2010). The five year randomized clinical trial conducted by Rockswold et al. “compared the effect of hyperbaric to normobaric hyperoxia on cerebral metabolism, intracranial pressure, and oxygen toxicity” in 69 severe traumatic brain injury patients (Rockswold et al., 2010). The individuals were randomized to one of three groups within 24 hours of injury with HBO2 immediately administered, and then administered once daily over a continuous three-day period; various vitals were monitored including micro-dialysis, intracranial pressure, cerebral blood flow, etc. (Rockswold et al., 2010).
The goal was to evaluate the brain’s metabolism and intracranial pressure, together with whether or not too much oxygen was a concern in this type of therapy treatment; data was analyzed using mixed effect linear modeling analyzing changes in pre and post treatments (Rockswold et al., 2010). The results indicated that HBOT treatment significantly enhanced the brain’s energy production and reduced the intracranial pressure, and HBOT was more robust than normobaric hyperoxia on producing brain tissue; also, there was no pulmonary or cerebral oxygen toxicity identified (Rockswold et al., 2010). The authors caution that the effects are gradual and more research is needed.
The NCCAM is evaluating CAM to tackle brain disorders and diseases, in tangent with scientists and CAM researchers; since 2004, the organization has been studying botanicals and supplements to prevent and treat neurodegenerative disease, including such “extracts as schisandra fruit (Schisandra chinensis) and the tabu-no-ki tree (Machilus thunbergii), which are believed to protect cultured neural cells from oxidative damage, along with possibly “yielding new choices in treating neurodegenerative disorders caused by oxidative stress” (NCCIH, 2015). Brain areas of CAM research include cerebral ischemia, a disorder that results from lack of blood flow to the brain, which increases the risk of stroke; Alzheimer’s Disease, multiple sclerosis, and general pain and traumatic brain injuries (NCCIH, 2015).
The BRAIN Initiative, federally funded research, is also taking place to review other types of neurological and psychiatric conditions; the sequencing of the human genome and the ability to map neuronal connections, along with improved resolution imaging technologies and nano science expansion, provides momentum to discover more information about the brain and what affects behavior and structures to improve the quality of life for patients suffering from brain injuries (Braininitiative.nih.gov, 2015).
Patient, 17-year-old Bobby Ghassemi was involved in a car accident that required doctors to remove a portion of his skull to relieve cranial pressure associated with engorgement after requiring airlifting to the hospital; Ghassemi suffered from axonal injury as well, which happens when bleeding suffusing almost every inch of the brain (Smith, 2012). After ten days, the patient was stable and comatose, leaving the doctors and patient with few options. With the help of friends, the boy’s father came across an army doctor that suggested the use of fish oil, which had been used only on one other occasion in 2006 on a mine disaster survivor (Smith, 2012). Fish oil, which contains high levels of omega-3 fatty acid and is contained in the brain, is believed to be effective because it facilitates the natural healing process of the brain; the acids are thought to inhibit cell death and aid reconnections of damaged neurons, reducing neuro- inflammation (Hasadsri et al., 2013; Smith, 2012). Two weeks after the initial doses, Ghassemi came out of the coma, with hand movements happening by the sixth week; three months after the accident, the boy returned to high school and graduated (Smith, 2012).
Deciding to use complementary and alternative medicine along with traditional medical care for any type of brain injury takes persistence and deliberate efforts, as evidenced by Thomas Hartmann, a traumatic brain injury patient that was in a car accident that left him disorientated, cognitive deficient, suffering from double vision, and limping (Hartmann, 2010). Mr. Hartmann has continued to experience results for the last thirteen years using such occupational therapy, along with CAM therapies of Chinese herbs, acupuncture and acupressure, homeopathy, cranial osteopathic manipulative medicine, and Tibetan medicine (Stephens, Williamson, & Berryhill, 2015; Hartmann, 2010). The patient took part in an intensive individual psychotherapy session as part of a pilot study at MT. Sinai Hospital in New York City, which further increased the ability to function and improved recovery (Hartmann, 2010). The paper presented a reflective account of holistic approaches that can be used to improve the care of brain-injured and brain accident patients.
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- Rockswold, S., Rockswold, G., Zaun, D., Zhang, X., Cerra, C., Bergman, T. and Liu, J. (2010). A prospective, randomized clinical trial to compare the effect of hyperbaric to normobaric hyperoxia on cerebral metabolism, intracranial pressure, and oxygen toxicity in severe traumatic brain injury. Journal of Neurosurgery, 112(5), pp.1080-1094.
- Smith, S. (2012). Fish oil helped save our son – CNN.com. [online] CNN. Available at: http://www.cnn.com/2012/10/19/health/fish-oil-brain-injuries [Accessed Feb. 2016].
- Truelle, J., Fayol, P., Montreuil, M. and Chevignard, M. (2010). Community integration after severe traumatic brain injury in adults. Current Opinion in Neurology, 23(6), pp.688-694.