Neurological dysfunction due to large skull defect: Implications for physiotherapists.

Given the continued use of decompressive craniectomy in the management of neurological emergencies recognition of complications is important in order for patients to gain maximal benefit during rehabilitation. One complication that has received relatively little attention is the neurological dysfunction that can occur due to distortion of the brain under the scalp as cerebral oedema subsides. The neurological deterioration that may occur can take many forms, probably due to a multifactorial pathophysiology. Recognition of this condition is important in order to avoid delays in the rehabilitation process. This review discusses the historical background, possible pathophysiological mechanisms, clinical incidence and implications for physiotherapists involved in rehabilitation.