Current status of post-traumatic brain injury rehabilitation care in LMI Southeast Asian Countries: A mini systematic review


  • Juwei Ong Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
  • Alina Arulsamy Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
  • Mohd. Farooq Shaikh Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.



post-injury care, TBI, rehabilitation, quality of life, LMIC


Low-to-middle income countries (LMICs) in Southeast Asia (SEA) had the highest global traumatic brain injury (TBI). However, post-TBI rehabilitation care may be limited in these countries, thereby contributing to the poorer quality of life (QoL) of patients with TBI. The present systematic review aimed to elucidate the current status of post-TBI rehabilitation care in the LMICs in the SEA region and to discuss the limitations that may hinder the advancement of TBI rehabilitation within this region. A literature search was carried out using five databases (PubMed, Ovid MEDLINE, EMBASE, CINAHL and Scopus), and the final number of articles were selected according to the PRISMA guidelines. This review selected four relevant research articles from Malaysia and Thailand for critical appraisal. These articles showed that the status of post-TBI rehabilitation care in these regions remains unclear based on the scarcity of available literature. Only early rehabilitation care strategies have been discussed in the literature, such as individualised structured cognitive rehabilitation, utilisation of humanoid robots and the implementation of sensory stimulation programs. This review also suggested that TBI rehabilitation improvements may be hindered by a lack of government funding, unequal distribution of care services and reliance on traditional care. Thus, more research into TBI rehabilitation care is significantly needed within the SEA region to overcome these barriers, leading to the preservation of patients’ QoL.


Andelic, N., Bautz-Holter, E., Ronning, P., Olafsen, K., Sigurdardottir, S., Schanke, A. K., . . . Roe, C. (2012). Does an early onset and continuous chain of rehabilitation improve the long-term functional outcome of patients with severe traumatic brain injury? J Neurotrauma, 29(1), 66-74.

Armstrong, M., Chung, K., Himmler, M., Mortimer, D., & Tonkin, B. (2019). Chapter 2 - TBI Classifications and Rehabilitation Intensities. In B. C. Eapen & D. X. Cifu (Eds.), Rehabilitation After Traumatic Brain Injury (pp. 13-22). Elsevier.

Arulsamy, A., & Shaikh, M. F. (2020). Current status of traumatic brain injury research in Malaysia: A systematic review. Neuroscience Research Notes, 3(4), 1-21.

Bank, T. W. (2018). Current health expenditure (% of GDP)

Bashford, T., Myint, P. P. N., Win, S., Thu, M., Naing, M. M., Burnstein, R., . . . Clarkson, J. (2018). A systems approach to trauma care in Myanmar: from health partnership to academic collaboration. Future Healthcare Journal, 5(3), 171.

Bright, T., Wallace, S., & Kuper, H. (2018). A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries. Int J Environ Res Public Health, 15(10).

Brotfain, E., Gruenbaum, S. E., Boyko, M., Kutz, R., Zlotnik, A., & Klein, M. (2016). Neuroprotection by Estrogen and Progesterone in Traumatic Brain Injury and Spinal Cord Injury. Current neuropharmacology, 14(6), 641-653.

Chua, K. S., Ng, Y. S., Yap, S. G., & Bok, C. W. (2007). A brief review of traumatic brain injury rehabilitation. Annals of the Academy of Medicine of Singapore, 36(1), 31-42.

De Silva, M. J., Roberts, I., Perel, P., Edwards, P., Kenward, M. G., Fernandes, J., . . . Patel, V. (2009). Patient outcome after traumatic brain injury in high-, middle- and low-income countries: analysis of data on 8927 patients in 46 countries. International Journal of Epidemiology, 38(2), 452-458.

Dewan, M. C., Rattani, A., Gupta, S., Baticulon, R. E., Hung, Y. C., Punchak, M., . . . Park, K. B. (2018). Estimating the global incidence of traumatic brain injury. Journal of Neurosurgery, 1-18.

Eldar, R., Kullmann, L., Marincek, C., Sekelj-Kauzlarić, K., Svestkova, O., & Palat, M. (2008). Rehabilitation medicine in countries of Central/Eastern Europe. Disability & Rehabilitation, 30(2), 134-141.

EPHPP. (1998). Quality assessment tool for quantitative studies. In. Canada.

Figaji, A. A. (2017). Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care [10.3389/fneur.2017.00685]. Frontiers in Neurology, 8, 685.

Frost, R. B., Farrer, T. J., Primosch, M., & Hedges, D. W. (2013). Prevalence of Traumatic Brain Injury in the General Adult Population: A Meta-Analysis. Neuroepidemiology, 40(3), 154-159.

Gimigliano, F., & Negrini, S. (2017). The World Health Organization "Rehabilitation 2030: a call for action". European Journal of Physical & Rehabilitation Medicine, 53(2), 155-168.

Grüner, M. L., & Terhaag, D. (2000). Multimodal early onset stimulation (MEOS) in rehabilitation after brain injury. Brain Injury, 14(6), 585-594.

Hamasaki, C., Nishio, M., Nakayama, M., & Komazawa, O. (2020). Pioneering an Integrated Rehabilitation System and Human Resource Development to Improve Rehabilitation Services in Cambodia, Lao PDR, and Viet Nam (ERIA Research Project Report Issue.

Hamzah, N., Narayanan, V., Ramli, N., Mustapha, N. A., Mohammad Tahir, N. A., Tan, L. K., . . . Mazlan, M. (2019). Randomised controlled clinical trial of a structured cognitive rehabilitation in patients with attention deficit following mild traumatic brain injury: study protocol. BMJ Open, 9(9), e028711.

Iaccarino, C., Carretta, A., Nicolosi, F., & Morselli, C. (2018). Epidemiology of severe traumatic brain injury. Journal of Neurosurgical Sciences, 62(5), 535-541.

Iaccarino, M. A., Bhatnagar, S., & Zafonte, R. (2015). Chapter 26 - Rehabilitation after traumatic brain injury. In J. Grafman & A. M. Salazar (Eds.), Handbook of Clinical Neurology (Vol. 127, pp. 411-422). Elsevier.

Intan Sabrina, M., & Defi, I. R. (2021). Telemedicine Guidelines in South East Asia—A Scoping Review [10.3389/fneur.2020.581649]. Frontiers in Neurology, 11, 1760.

Jafni T.I., Bahari M., Ismail W., & M.H., H. (2019). Exploring Barriers that Affect Telerehabilitation Readiness: A Case Study of Rehabilitation Centre in Malaysia. In Saeed F., Gazem N., Mohammed F., & B. A. (Eds.), Advances in Intelligent Systems and Computing (Vol. 843). Springer, Cham.

Jesus, T. S., Landry, M. D., Dussault, G., & Fronteira, I. (2017). Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century. Human Resources for Health, 15(1), 8.

Kitamura, Y., Hayashi, M., & Yagi, E. (2018). Traffic problems in Southeast Asia featuring the case of Cambodia's traffic accidents involving motorcycles. IATSS Research, 42(4), 163-170.

Laxe, S., Zasler, N., Selb, M., Tate, R., Tormos, J. M., & Bernabeu, M. (2013). Development of the International Classification of Functioning, Disability and Health core sets for traumatic brain injury: an International consensus process. Brain Injury, 27(4), 379-387.

Li, L., & Liu, J. (2013). The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review. Developmental Medicine and Child Neurology, 55(1), 37-45.

Lippert-Grüner, M., Maegele, M., Pokorný, J., Angelov, D. N., Svestková, O., Wittner, M., & Trojan, S. (2007). Early rehabilitation model shows positive effects on neural degeneration and recovery from neuromotor deficits following traumatic brain injury. Physiological Research, 56(3), 359-368.

Lui, S. K., Ng, Y. S., Nalanga, A. J., Tan, Y. L., & Bok, C. W. (2014). A Pilot Project of Early Integrated Traumatic Brain Injury Rehabilitation in Singapore. Rehabilitation Research and Practice, 2014, 950183.

Mahamood, S. F., & Hanapiah, F. A. (2017). Merging the research on halal concept using humanoids for patient with brain-impairment: Its maqasid and principles. Pertanika Journal of Social Science and Humanities, 25, 209-216.

Mazlan, M., Ghani, S. Z. S. A., Tan, K. F., & Subramanian, P. (2016). Life satisfaction and strain among informal caregivers of patients with traumatic brain injury in Malaysia. Disability and Rehabilitation, 38(22), 2198-2205.

Mazlan, M., Rahman, Z. A., Chan, S. C., & Hamzah, N. (2021). Functional outcome at one year following moderate to severe traumatic brain injury: A prospective study in Malaysia. Neurology Asia, 26(1), 135-143.

Ministry of Health Singapore. (2017). Health manpower.

Moattari, M., Alizadeh Shirazi, F., Sharifi, N., & Zareh, N. (2016). Effects of a Sensory Stimulation by Nurses and Families on Level of Cognitive Function, and Basic Cognitive Sensory Recovery of Comatose Patients With Severe Traumatic Brain Injury: A Randomised Control Trial. Trauma Monthly, 21(4), e23531-e23531.

Mohammad, E., Hamidreza, K., & Abbas, E. (2020). The importance of early rehabilitation in traumatic brain injury. Nursing Practice Today, 7(2).

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., . . . Group, P.-P. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1.

Naicker, A. S., Htwe, O., Tannor, A. Y., De Groote, W., Yuliawiratman, B. S., & Naicker, M. S. (2019a). Facilitators and Barriers to the Rehabilitation Workforce Capacity Building in Low- to Middle-Income Countries. Physical Medicine and Rehabilitation Clinics of North America, 30(4), 867-877.

Naicker, A. S., Mohamad Yatim, S., Engkasan, J. P., Mazlan, M., Yusof, Y. M., Yuliawiratman, B. S., . . . Htwe, O. (2019b). Rehabilitation in Malaysia. Physical Medicine and Rehabilitation Clinics of North America, 30(4), 807-816.

Noda, R., Maeda, Y., & Yoshino, A. (2004). Therapeutic time window for musicokinetic therapy in a persistent vegetative state after severe brain damage. Brain Injury, 18(5), 509-515.

Nugraha, B., Setyono, G. R., Defi, I. R., & Gutenbrunner, C. (2018). Strengthening rehabilitation services in Indonesia: A brief situation analysis. Journal of Rehabilitation Medicine, 50(4), 377-384.

Oh, H., & Seo, W. (2003). Sensory stimulation programme to improve recovery in comatose patients. Journal of Clinical Nursing, 12(3), 394-404.

Parker, A., Sricharoenchai, T., & Needham, D. M. (2013). Early Rehabilitation in the Intensive Care Unit: Preventing Physical and Mental Health Impairments. Current Physical Medicine & Rehabilitation Reports, 1(4), 307-314.

Physiotherapy Board of Australia. (2017). Statistics.

Prathep, S., Sriplung, H., Phuenpathom, N., Zunt, J., Hirunpat, S., & Vavilala, M. (2017). Characteristics and Outcomes of Thai Patients Hospitalised with Severe Traumatic Brain Injury between 2009 and 2011. Journal of the Medical Association of Thailand, 100(8), 843.

Rapp, P. E., & Curley, K. C. (2012). Is a diagnosis of "mild traumatic brain injury" a category mistake? Journal of Trauma & Acute Care Surgery, 73(2 Suppl 1), S13-23.

Rassovsky, Y., Satz, P., Alfano, M. S., Light, R. K., Zaucha, K., McArthur, D. L., & Hovda, D. (2006). Functional outcome in TBI I: neuropsychological, emotional, and behavioral mediators. Journal of Clinical & Experimental Neuropsychology, 28(4), 567-580.

Rock, J. P., Prentiss, T., Mo, S. M., Myat Hnin Aye, N. S., Asmaro, K., Win, A. T., . . . Myaing, W. (2020). Traumatic Brain Injury in Myanmar: Preliminary Results and Development of an Adjunct Electronic Medical Record. World Neurosurgery, 140, e260-e265.

Samanamalee, S., Sigera, P. C., De Silva, A. P., Thilakasiri, K., Rashan, A., Wadanambi, S., . . . Haniffa, R. (2018). Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores. BMC Anesthesiology, 18(1), 4-4.

Siripituphum, D., Songwathana, P., Khupantavee, N., & Williams, I. (2020). Caring for Thai Traumatic Brain Injury Survivors in a Transitional Period: What Are the Barriers? Journal of Health Science and Medical Research; 38(1), 43-52.

Tay, E. L., & Wong, C. P. (2018). A Cross-sectional Survey of Rehabilitation Service Provision for Children with Brain Injury in Selangor, Malaysia. Disability, CBR & Inclusive Development, 29(2), 45–58.

Teo, J. H., Chong, S. L., Chiang, L. W., & Ng, Z. M. (2021). Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury. Annals of the Academy of Medicine, Singapore, 50(1), 26-32.

Urbenjaphol, P., Jitpanya, C., & Khaoropthum, S. (2009). Effects of the sensory stimulation program on recovery in unconscious patients with traumatic brain injury. Journal of Neuroscience Nursing, 41(3), E10-E16.

Warden, D. L., Salazar, A. M., Martin, E. M., Schwab, K. A., Coyle, M., & Walter, J. (2000). A home program of rehabilitation for moderately severe traumatic brain injury patients. The DVHIP Study Group. Journal of Head Trauma Rehabilitation, 15(5), 1092-1102.

WHO, W. H. O. (2011). Rehabilitation. In World Report on Disability (Vol. 4).

WHO, W. H. O. (2020). Global spending on health 2020: weathering the storm.

Yu, J., Tam, H. M. K., & Lee, T. M. C. (2015). Traumatic Brain Injury Rehabilitation in Hong Kong: A Review of Practice and Research. Behavioural Neurology, 2015, 274326-274326.

Zainal, N., Al-Hadi, I. A. A.Q., Ghaleb, S. M., Hussain, H., Ismail, W., & Aldailamy, A. Y. (2021). Predicting MIRA Patients’ Performance Using Virtual Rehabilitation Programme by Decision Tree Modelling. In M. Al-Emran, K. Shaalan, & A. E. Hassanien (Eds.), Recent Advances in Intelligent Systems and Smart Applications (pp. 451-462). Springer International Publishing.


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How to Cite

Ong, J., Arulsamy, A. and Shaikh, M. F. (2022) “Current status of post-traumatic brain injury rehabilitation care in LMI Southeast Asian Countries: A mini systematic review”, Neuroscience Research Notes, 5(4), p. 169. doi: 10.31117/neuroscirn.v5i4.169.