Arousal and Stimulation

Acquired brain injuries can lead to a myriad of deficits, including behavioral changes, impaired arousal, and cognitive deficiencies. Management of these functional deficits can depend on pharmacologic treatments initiated in the acute hospital setting, followed by extensive rehabilitation. An especially challenging clinical problem in managing patients with disorders of consciousness after brain injury is their inability to participate in critical aspects of neurorehabilitation that inform post-acute discharge planning. Furthermore, deficits such as debilitating somnolence and persistent cognitive deficits, as well sleep-wake cycle dysfunction, may significantly affect the early functional recovery curve. Several neurotransmitters may be affected, and imbalances in catecholamines, cholinergic tone, and GABAergic system function may worsen persistent cognition and arousal deficits associated with acquired brain injury. Multiple pharmacologic strategies exist, targeting these neurotransmitters systems, for managing cognition and arousal problems in the acute care setting. Identifying and understanding specific brain regions affected by an injury helps rehabilitation practitioners in the acute care setting successfully plan and implement treatments that improve patient arousal and cognitive abilities and, subsequently, their rehabilitation course.