University Works

External cranial project

Dr Harry Mee, Rehabilitation medicine registrar and clinical researcher, Cambridge University
Hospitals NHS Foundation Trust
In collaboration with PhysiGo Ltd

In the first few days after a severe traumatic brain injury (TBI) or a large stroke, patients can develop swelling in the brain which, in turn, can lead to brain damage or even death. A craniectomy is a surgical procedure in which part of the skull is removed to relieve brain swelling. Patients who survive undergo an operation, known as a cranioplasty, in order to have their skull reconstructed a few months later. Traditionally, cranioplasties were undertaken around 10-12 months after the craniectomy, as it was thought that an early cranioplasty could increase the risk of infection.

However, recent reviews have challenged this view. Several small studies have suggested that an early cranioplasty may enhance recovery.

There is, however, a substantial period between the craniectomy and cranioplasty when the patient has a piece of skull missing. Although the skin is covering the area, it still leaves a marked change in appearance. The risk of injury is very low, and helmets or other protection are not routinely prescribed unless someone has recurrent seizures. Our experience suggests that patients who have a skull piece missing may find it challenging to engage in rehabilitation, become socially reserved, which, may have an effect on their clinical recovery and mental health.

This project aims are to better understand the patients challenges about the skull defect following a craniectomy and to explore ways in which to enhance recovery. The project will adopt an external prosthesis, with an electronic device inserted into it in order to allow patients walking, balance, and general movement to be monitored during their rehabilitation. This could provide the rehabilitation team ‘real-time’ and detailed information on how the patient is moving, which will aid the rehabilitation planning and monitor progress. Also, we will use outcome measures commonly used in the rehabilitation environment and explore ways in which we could use them with the addition of technology to aid therapists in their clinical decision making.

The research is supported by the National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative based at Cambridge University Hospitals NHS Foundation Trust and University of Cambridge. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care