HEAD INJURY

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HEAD INJURY

• PHYSIOTHERAPY INTERVENTION AND MANAGEMENT

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HEAD INJURY

• Mechanism of injury is generally a blow to the
  head
• Varies in presentation from concussion through
  loss of consciousness to coma and death
• Primarily MCA, MBA, pedestrians, falls from a
  height and sport

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HEAD INJURYPRIMARY LESIONS

• Diffuse Axonal Injury (DAI)
• Contrecoup lesions
• Intracranial/ Intracerebral Haemorraghes

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HEAD INJURYSECONDARY LESIONS

• Intracerebral Oedema
• Increased Intracranial Pressure
• Hypoxia
• Seizures

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HEAD INJURY

• Impact
• Loss of consciousness
• Post-Traumatic Amnesia (PTA)
• Persistent Amnesic state

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HEAD INJURY

• Given the widespread nature of the injury, it is
  vital that a team approach is employed
• Physiotherapists most often play a key role in
  the patients management

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CONSEQUENCES OF HEAD INJURY

• Altered tonal state
• Spasticity
• Ataxia
• Paralysis
• Muscle and Joint contractures
• Heterotrophic Ossification
• Dyspraxia

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CONSEQUENCES OF HEAD INJURY

• Reduced balance and co-ordination
• Fatigue
• Cognitive problems
• Behavioural problems
• Speech and Language problems
• Impaired Swallow, Gag or Cough reflex

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EFFECTS OF TRAUMA

• Orthopaedic injuries
• Fracture management
• Soft tissue injuries
• Nerve lesions
• Chest injuries

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PHYSIOTHERAPYACUTE CARE

• Chest care
• Positioning
• Spasticity management
• Maintain Joint ROM / Muscle Length
• SOOB
• Educate Family

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Glasgow Coma Scale
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Glasgow Coma Scale
Jennett Teasdale, 1977
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HEAD INJURYREHABILITATION

• Rehabilitation phase commences as soon as the
  patient is medically stable
• May still have tracheostomy, gastrostomy,
  naso-gastric or IV tubes in
• May or may not be awake

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HEAD INJURY POST-TRAUMATIC AMNESIA

• Period following Loss of Consciousness until
  orientated
• Patients may be confused, confabulating,
  agitated, verbally or physically aggressive
• Patients are not responsible for their actions
• Patients are unable to learn new information

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HEAD INJURY POST-TRAUMATIC AMNESIA

• Length of PTA is the most valid measure of
  severity of injury
• PTA is measured by the Westmead scale
• PTA is a normal part of the brains recovery
  process

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Westmead Scale

• How old are you?
• What is your date of birth?
• What month is it?
• What time of day is it?
• What day of the week is it?
• What year is it?
• What is the name of this place?
• Have you seen me before?
• Do you remember my name?
• 3 pictures

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SEVERITY OF HEAD INJURY
Jennett Teasdale (1981)
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MANAGING THE PATIENT IN PTA

• Avoid restraint
• Reduce stimulation
• Avoid sedation
• No formal neuro-psychology assessment
• Brief therapy sessions, simple instructions
• Familiarize environment

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PHYSIOTHERAPYREHABILITATION

• Continue Acute Care
• Complete assessment as arousal level and
  cognitive state allows
• Assessment may take many days
• Document dependence/supervision/ independence
  with transfers and mobilty

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PHYSIOTHERAPYREHABILITATION

• Decide on location of physiotherapy
• Tone management including positioning, serial
  casting, splinting, drug therapy, tilt-tabling
• Maintain/improve ROM
• Assess for seating/wheelchair requirements

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PHYSIOTHERAPY

• Promote normal movement at all times
• No / minimal use of aids and appliances
• Each functional goal achieved should be achieved
  with the next functional goal in mind
• Staff (especially nursing) and family education
  is vital

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COGNITIVE AND BEHAVIOURAL PROBLEMS

• Reduced insight
• Poor STM
• Poor concentration
• Easily distracted
• Poor problem solving
• Adynamic or reduced initiative
• Impulsive

• Rigidity
• Agitated / Irritable
• Verbose
• Socially inappropriate behaviour
• Egocentric
• Lability
• Depression

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COGNITIVE AND BEHAVIOURAL PROBLEMS

• Have an organic basis
• Stressful and often difficult to manage
• If you do not manage the patient cognitively and
  behaviourally you will be unable to manage them
  effectively physically
• If inadequately addressed, the patient is
  unlikely to manage socially

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BEHAVIOUR MODIFICATION

• Frequent and consistent feedback
• Meaningful to patient
• Immediate and Obvious
• Involve the whole treating team and family members

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BEHAVIOUR MODIFICATIONCONSIDER

• Change of therapist
• Change of treatment time or venue
• Videotape session
• Avoid sedation

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TREATMENT OUTCOME

• Head injury is unlike any other field of medicine
  or rehabilitation
• Recovery is measured in months and years
• Population generally young so mobility is
  extremely important

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