Experts call for long-term monitoring after neurotrauma — News-Medical

An international group of specialists has proposed revising the approach to traumatic injuries of the brain and spinal cord in adults, viewing them as chronic multisystem conditions with health risks that may persist for years or decades. This is stated in an article published in The Lancet Neurology, News-Medical reports.

Risks after rehabilitation ends

The authors note that brain and spinal cord injuries are often perceived as isolated events with time-limited consequences. At the same time, many people who have experienced such injuries may develop or continue to have cardiovascular, metabolic, endocrine, neurological, psychiatric and functional complications years later.

According to the authors, after discharge from acute care and completion of rehabilitation, medical follow-up is often fragmented or stops altogether. As a result, complications may be detected only after hospitalization, deterioration in functional status or other potentially preventable harm.

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Long-term care model

While developing the model, the researchers reviewed English-language studies from 2020–2026 focused on prospective assessments of the long-term consequences of such injuries, and also consulted international experts and stakeholders. They compared these data with models for long-term patient management after stroke, with diabetes and in follow-up programs for cancer survivors.

The proposed model provides for a preventive approach: care coordinators for patients with neurotrauma, scheduled multisystem assessments, the use of telemedicine and direct referrals to specialized services. Other priorities include official recognition of chronic neurotrauma, changes in healthcare funding, long-term patient registries, access to specialized rehabilitation and stronger links with services for stroke, memory disorders, psychiatric disorders and epilepsy.

The authors emphasize that the model has several levels: from a basic package for systems with limited resources to intensive multidisciplinary care for people with complex needs. For lower-resource settings, they propose using a minimum data set, community-level health workers, mobile health tools and teleconsultations.