Combat and non-combat traumatic injuries of the central nervous system: current strategies for treatment and rehabilitation (a literature review)

Abstract

Traumatic injuries of the central nervous system remain one of the most challenging problems in modern neurology, neurosurgery, and medical rehabilitation, as they are associated with a high risk of persistent neurological deficits, loss of independence, and a prolonged need for restorative treatment. The problem is particularly relevant in the context of modern armed conflicts, where gunshot, mine-blast, multiple, and combined injuries predominant and impose increased demands on medical triage, evacuation, and the timing of specialized care. The review systematizes current approaches to the management of patients with traumatic injuries of the brain and spinal cord, including the pathophysiological mechanisms of secondary injury, the importance of timely neurosurgical correction and intensive care, principles of early neurorehabilitation, management of motor, cognitive, and psycho-emotional disorders, and the role of multidisciplinary interaction. Particular attention is paid to function-oriented rehabilitation technologies and the place of resort treatment within the system of continuous restorative care. Medical rehabilitation should be regarded not as a delayed stage, but as an integral component of a unified treatment and rehabilitation strategy, initiated as early as the acute period once the required clinical stability has been achieved. The most substantiated model is a continuous treatment and rehabilitation pathway that includes emergency and specialized care, early and subsequent neurorehabilitation, outpatient follow-up, and, in carefully selected patients, resort treatment.