Brain Damage

In the 1990s, the Clínica San Vicente was created in Burgos in order to rehabilitate people affected by acquired brain injury (brain trauma, stroke) due to the high number of people affected annually, its growing trend, and the serious sequelae these pathologies triggered.

It was not an easy task, because references on what to do and how to do it practically did not exist, and there was a lack of protocols and therefore medical evidence with which to start working. All that existed at that time was the work developed in European and North American centres, which had already started neurorehabilitation programmes. Although suspected, they did not know the extent of the brain plasticity and that the brain contains cells that could mature, differentiate into neurons, and therefore recover a damaged brain. Today it is the basic principle of Neurorehabilitation.

Furthermore, we firmly believed that much could be done for people suffering from brain damage, to get their old life back and in any case improve their quality of life and their environment.

Constant work, technological advances, research and knowledge management have provided us with the necessary experience so that today, and after more than 5,000 treated patients, the developed protocols have led us to significant successes, recognizing that only through total and absolute dedication, and the use of other areas of knowledge, are we capable of providing a pathway of hope to people who have suffered brain damage.

Today, after 20 years of working day in, day out, a Neurorehabilitation Unit has been achieved with the following principles and characteristics:

1. Specialized, ethical, excellent and innovative.
2. With professionals that are experts in their field.
3. The latest technology to rehabilitate deficits after brain damage.
4. A centre with teaching skills and academic guidance to train future professionals in neurorehabilitation through knowledge management.
5. A dynamic social centre that covers not only the pathologies of the patient but also their family and their environment.
6. A sustainable and committed centre, that has a high level of respect for people.
7. A unit that goes beyond our borders and participates in international forums to promote the dissemination of knowledge and developed protocols.

Stroke (Cerebral Vascular Accident)

Cerebral Vascular Accident may be Ischaemic or Haemorrhagic. Haemorrhagic cases represent 20% of all cases and ischaemic cases the remaining 80%, and is known as Stroke, Embolism or Cerebral Thrombosis. Around 200 new cases per 100,000 inhabitants appear each year in Spain. 10% die in the first attack, representing the primary cause of death among women and the secondary cause in men in Spain. 30% of survivors have a disability and a third of them will be severe cases with a high degree of dependency. It should be noted that the 10% of cases occur between 35 and 45 years of age. Brain injury involves a high degree of individual, family, social, labour and economic effort.

Stroke Units of public hospitals are managing to save a considerable number of lives of people who would have undoubtedly died just 10 years ago.

Neurological Rehabilitation should begin from the moment of discharge from the ICU or stroke units, and should begin early in an intensive, individual and multidisciplinary manner, taking advantage of the greater neuroplastic response capacity of the brain.  The Monograph Centres, with experience and recognized prestige, are the most appropriate places to improve results and reduce disability and dependence.

Mobility, cognition and behaviour are the aspects that we rely on to maintain normality and which are affected when we suffer a stroke. Depending on the degree of the impairment of these functions, we need a different type of treatment, a different number of daily therapies, and a longer or shorter time duration with respect to the recovery process. It is the treatment that adapts to the type of patient and injury and not the other way around.

Head traumas

DEFINITION AND FIGURES.                                                   

Traumatic Brain Injury (TBI) is defined as the impact or jolt produced in the head, or injury that disrupts the normal functioning of the brain.

The severity of the injury leads to a temporary change to the state of consciousness. In severe cases, a traumatic brain injury can cause long periods of unconsciousness or amnesia, which can be more or less prolonged. Its effects cause problems sustained over time, impeding or preventing functional independence.

It is the leading cause of death and disability in the population under the age of 45, with an incidence of 200 cases per 100,000 inhabitants per year. 90% of them received hospital care. It affects one woman for every three men, mostly between 15 and 30 years of age, and those over 65. Almost 75% of the time accidents are the cause of the injuries.

TYPES OF INJURIES

Primary Lesion. It is the direct injury that occurs in the brain, the skull and other tissues of the head.

Secondary Lesion. It occurs as a result of the changes that occur in the brain during the days following the primary lesion. Blood clots can appear, as well as swelling of the brain tissue and increased brain pressure, etc.

SEVERITY OF THE HEAD TRAUMA

The classification is established in reference to two scales that are known and managed throughout the world, the Glasgow Coma Scale (GCS), and the Traumatic Coma Data Bank ​​(TCDB).

The first refers to the neurological status of the patient and the second to the images found on the Brain Scanner (CT).

80% of injuries are mild, more than 15% moderate, and only 5% severe.

The most important thing during the acute phase is to reduce the effects of the secondary lesion, much more than the damage caused by the primary lesion.

HEAD TRAUMA REHABILITATION

Traumatic Brain Injury (TBI), is also known as Polytrauma Injury, since it is often associated with different musculoskeletal, viscera or organ injuries, which increases the severity of the injury itself or makes it even more relevant and harmful, complicating progress and recovery, both neurologically and generally.

Mild cases. In these cases, the normal scenario is one of full recovery, however, in a small percentage of cases we have what we call post-concussion syndrome, characterized by emotional disorders, depression, irritability, poor concentration, insomnia, etc., and physical disorders such as headache and dizziness, requiring cognitive rehabilitation treatment appropriate to their disorders, with the participation of a psychiatrist and neuropsychologist. A non-invasive electrophysiological test called Bioelectrical Brain Coherence detects it in a very clear way.

Moderate cases. The symptoms, after the acute phase, are prolonged over several months and affect memory, calculation, orientation, social behaviour and mood. It is not uncommon to experience headache and pain in different parts of the body. The Scanner (CT) and magnetic resonance imaging are useful tools in detecting these lesions.

Severe cases. The disorders that these cause are very dramatic: Movement disorders (hemiplegia, musculoskeletal disorders, spasticity), difficulty understanding, speaking, swallowing, bowel control, orientation, deviant behaviour (negativity, opposition, aggressiveness, sadness, depression). The treatment recommended in these circumstances, after discharge from the ICU and stabilization of vital signs, is to transfer the patient to a Monographic Neurorehabilitation Centre, and proceed, upon arrival, to a fast clinico-pharmacological assessment with the purpose of quickly achieving clinical and definitive stability, and initiate therapies once a multidisciplinary assessment has been carried out.

Other Pathologies

The Clínica San Vicente has developed an important activity in the field of neuroscience, both with regard to the diagnosis and therapeutic course. It maintains contact with hospitals and public and private centres, primarily in protocols and research projects, not to mention the increasingly frequent clinical collaborations that have been established with some of them.

Its service has been aimed at the diagnosis and treatment of the most common neurological disorders in adults and children.

Processes and diseases treated at the clinic.

• Diagnosis and treatment after infections of the Nervous System.
• Postoperative recovery of brain tumours after radiosurgery
• Sleep disorders
• Movement and gait disorders
• Behavioural disorders
• Headaches
• Epilepsy
• Degenerative diseases and dementia
• Cerebral anoxia
• Neurological problems in children from the first year
• Developmental disorders
• Peripheral nerve disorders (Trigeminy, Carpal Tunnel, Brachial Plexus, etc.)
• Metabolic encephalopathies
• Chronic patients, minimally conscious states and sclerosis.
• Mental retardation
• Cerebral palsy

At the Clínica San Vicente, we headed Neurorehabilitation towards the improvement of these three aspects: movement, cognition and behaviour. The treatments have to be:

EARLY

The speed at the beginning of the treatment improves the final results and shortens the time in which they are achieved. This precocity requires, at all times, the ability to adapt to the stability and progress of patients according to their clinical improvement and neurological outcome; therefore, to meet this criterion of precocity, the Clínica San Vicente must have hospital staff that can start treatments upon patient discharge from the ICUs regardless of any overlapping between the Neurorehabilitation and the clinical processes. On the other hand, this shortens hospital stays for acute patients which often causes the appearance of nosocomial infections, bedsores and problems resulting from immobility.

PERSONALISED

Treatment planning does not adhere to a predetermined method due to its highly consolidated nature; we start from the specific functions of the patient, and then we concentrate our efforts towards aspects such as attention, memory, orientation, willingness and disease awareness, as well as mobility, walking and communication.

INDIVIDUAL

The therapies must have the quality of focusing the attention of the patient as it is the only way to focus their concentration and therefore their learning. In addition, each patient is different and not homogeneous with lesions with different degrees of severity and requirements. To include more than one person in certain therapy sessions is a conceptual mistake and a practice that should be avoided.

MULTIDISCIPLINARY

Combining conventional Neurorehabilitation, biotechnology, pharmacology and the addition of new specialities in the development of treatment protocols is the method that has been adopted by the San Vicente Clinic since its inception.

INTENSIVE AND PROLONGED

The intensity of the therapies causes earlier brain reactions and improves neuroplasticity.

In the past three years, hospitals and universities in North America, Canada and Europe have recognized that neurorehabilitation treatments require no less than 4 hours per day and up to 1 year in duration in order to achieve the recovery and consolation of many of the lost functions with a minimum guarantee.

TREATMENT PLANNING

In the Service of Brain Injury Rehabilitation, various units participate covering clinical, physical, emotional and cognitive aspects:

Neurorehabilitation treatment planning is conditioned by clinical stability, level of consciousness, degree of dependence and family support of the patient; therefore these factors determine the inpatient or outpatient regime, as well as the objectives of each department, drug treatments, the number of hours and type of daily therapy (time planning) and various complementary treatments: Transcranial magnetic stimulation, botulinum toxin, bioelectrical and biotechnology equipment, etc.

Here we present the role of each component unit of the Brain Injury Service with the functions performed by each professional:

Neurology Unit
Psychiatry Unit
Neurophysiology Unit
Physical Rehabilitation Unit
Speech Therapy Unit
Neuropsychology Unit
Physiotherapy Unit
Department of Occupational Therapy
Nursing Team
Social Work Department

1. Cardiac arrests trolleys for adults and children, with ambu bag, masks, intubation equipment and specific drugs.
2. Vital Signs Monitor.
3. Autonomous portable vacuum cleaners.
4. Portable pulse oximeters.
5. Volumetric respirators.
6. Cubicle area: Microwave, short-wave, gas laser beam, magnetotherapy, ultrasound, electrotherapy and hydrotherapy equipment.
7. Uretero-reno fiberscope with video filming and cold light source.
8. DopplerDuplex Ultrasound colour 3D.
9. Neurophysiology laboratory extensively equipped with capacity for the implementation of numerous tests, even tests on the Autonomic Nervous System.
10. Transcranial Magnetic Stimulation  Diagnosis and Therapy.
11. Computerized spirometer.
12. Electrocardiographs.
13. General Neurological Rehabilitation Gym with equipment sequenced for walking rehabilitation: bobath beds, inclined plane, stabilizer/stander and treadmills for walking with programmable speeds and harness motors.
14. Mechanotherapy and kinesitherapy equipment.
15. Bioelectrical Stimulation Equipment for the recovery of paralysed hands HS300.
16. VitalStim equipment for swallowing
17. Ataxiometer platform for balance
18. Rehabilitation Wii
19. Neuronup Cognitive Rehabilitation Platform
20. Optical mouse technology

1. DIAGNOSTIC UNIT

Assessment of bodily injury and cognitive impairment.

Expert opinions, and the attending of legal hearings.

Detailed emission of reports of diagnostic evaluation.

Second medical opinion.

External Medical Consultations

Neuropsychological assessment

Performing of ultrasound imaging and neurophysiological tests

2. HOSPITALIZATION UNIT

Medical-surgical treatment and comprehensive rehabilitation

Convalescence, chronic patients, palliative care unit

3. OUTPATIENT HOSPITAL DAYCARE TREATMENT CENTRE

Medical-surgical treatment and comprehensive rehabilitation

4. PROGRAMME FOR SEXUALITY AND FERTILITY IN DISABILITY
5. BACK TO HOME AND FAMILY REINSERTION PROGRAMME