Up until very recently in historical terms there was literally nothing anyone could do for brain injury, whether from trauma, stroke, hypoxia, or other cause. Physicians of past centuries could provide little more than comfort for the neurologically damaged.

Modern medicine has made an important advance in learning, in some but not all situations, interventions that minimize the damage or provide the best opportunity for recovery. So for acute stroke we know we need to optimize blood pressure and treat fevers, and if we get to patients quickly enough we can even give a powerful drug (TPA) to break up a blood clot and restore blood flow. For trauma we know we need to minimize swelling. We are also getting better at preventing such events from happening in the first place – such as anti-platelet therapy to reduce the risk of stroke, or just modifying risk factors.

But these interventions serve to prevent neurological damage. They do nothing to help fix the damage once it occurs. The current state of the art in terms of fixing damage is rehabilitation. Rehab is extremely important, but it is difficult to tease out from the evidence if physical therapy and similar intervention sare actually promoting neurological regeneration, rewiring, and recovery or are they simply improving functional strength and mobility while natural recovery is occurring at its own pace. Without getting into this complex and thorny area, I would just summarize my opinions by saying that there is no definitive evidence that any intervention leads to greater neurological (as opposed to functional) recovery.

Continue Reading »