Table 2 Recommendations for early neurorehabilitation tailored to African settings

1

Setting up transdisciplinary neurorehabilitation teams that could consist of physicians, physiotherapists, psychiatrists, and clinical psychologists. This is extremely important as the implementation of the below recommendations depends on establishing neurorehabilitation teams

2

Assessments of TBI patients by the neurorehabilitation teams at the hyperacute stage (ICU) and acute stage (Neurosurgical ward or hospitalization)

3

In hyperacute care where intracranial pressure (ICP) is unstable: education of family or caregivers, application of electrotherapy through transcutaneous electro-neurostimulation (TENS) of the lower limbs are necessary to ensure proper circulation and prevent muscle wasting and retractions of soft tissues

4

In hyperacute care where intracranial pressure is stabilized: In addition to TENS application, education, regular changing of positions, and airway clearance (manual chest vibrations and percussion), passive joint mobilization, chest proprioceptive neuromuscular facilitation)

5

In acute care (hospitalization or neurosurgical ward): education, thoracic expansion, and thoracic mobilization exercises; active assisted range of motion to active range of motion of the upper and lower limbs; static stretching of the hamstrings, quadriceps; isometric contractions of the quadriceps, gluteal muscles, hamstrings, anterior and posterior lodge muscles of the leg, biceps and triceps; bed mobility; ambulation out of bed with a wheelchair. Psychologic or psychiatric intervention, depending on the patient’s cognitive behaviour

6

In the subacute phase, where patients are discharged to physiotherapy services, or neurorehabilitation centres; depending on their physical ability, the following may be considered: continuation of active range of motion, continuation of strengthening programme for the limbs and trunk with gradually increasing intensity, verticalization using a tilt table, or standing up, coordination exercises, proprioceptive exercises, functional electrical stimulation, integration of neurophysiologic techniques (Bobath, PNF), gait re-education. These exercises must be done bearing in mind that repetition is key to the induction of neuroplasticity

7

Post-acute phase or chronic phase when patients are within their communities. Community-based rehabilitation programs (CBR) should be established and implemented with the primary objective of reintegrating TBI survivors into the community as much as possible. According to the Campbell systematic reviews [38], CBR has shown beneficial effects on physical disabilities in stroke patients, and on mental disabilities in patients with schizophrenia. In SSA, most community rehabilitation programs are implemented by missionary hospitals or rehabilitation centres. We recommend that centres managing TBI who do not yet have CBR collaborate with Mission centres that already run these programs

8

Training more Physiotherapists in neurorehabilitation is needed to spearhead the physical care of heterogeneous and life-threatening neurological disorders like TBI