1. The Neurosurgery Patient: From Surgery Thro’ Rehab Nadia Bhayat Senior Specialist Speech & Language Pathologist

2. TBI leading cause of death - < 45yrs leading cause of disability Causes: 1.Adult = MVA’s, falls, sports injuries 2.Children = MVA’s, bicycle accidents, falls & child abuse Children more susceptible than adults to permanent brain damage

3. Frontal lobe Temporal lobe Parietal lobe Occipital lobe Cerebellum

4. Broca’s area Pars opercularis Motor cortexSomatosensory cortex Sensory associative cortex Primary Auditory cortex Wernicke’s area Visual associative cortex Visual cortex

5. Effects of Brain injury on Brain Function: Central Part = awake & alert – damage => coma Parietal lobe – damage = weakness in limbs on opposite side of the body Left hemisphere or Brainstem – damage = sp & lang imp Hidden disabilities – frontal lobe damage => behav. prob

6. Outcome/Recovery: 1. Post Traumatic Amnesia (PTA) = confused & disorientated, unable to remember conv. or do/say bizarre things stage thro’ which person will pass length is NB = indication of severity of injury 2. Coma – length 1 + 2 = best measure of eventual outcome

7. Types of HI 1.Minor HI = brief unconsc. or feel dizzy/sick Causes: banging head (car/doorway/slipping) 75 % of all HI Effects: nausea, headaches, dizziness, tiredness, intol. to light & noise =>anxiety & depression Persists = Post Concussion Syndrome Recovery = 3 to 4 mths

8. 2. Moderate HI = unconsc. = 15min to 6 hrs & PTA +- 24 hrs kept in hospital overnight for obs Effects: Physical – tired, headache, dizziness Cognitive – thinking, memory planning, attention, organization & wd finding prob Emotional & Behavioral: irritability => anxiety Difficulty returning to work Recovery – 6 to 9 mths

9. Severe HI Coma 6+ hrs & PTA 24+ hrs Serious physical deficits

10. Physical Effects: Damage to Motor Cortex, Brainstem & Cerebellum affects – m/m, balance & coordination R side damage => L side of body affected (weakness/paralysis) Cerebellum – fine motor coordination Balance – damage to vestibular system => dizziness limb dyspraxia – voluntary actions affected – can’t bend arm, but can tell time

11. Sensory Problems: Sensory Cortex damage => loss of sight, hearing, taste & smell Occipital lobe damage => blindness (full/partial) or visual neglect (visual processing) Brainstem damage => Temperature control

12. Emotional & Behavioral Effects; agitation – restlessness, pacing, pulling out tubes – coping mechanism explosive anger & irritability – labile – extreme swings lack of awareness & insight – lack of sensitivity/empathy impulsivity & disinhibition – speak your mind, breech social etiquette self centered – own needs apathy & poor motivation depression Anxiety Inflexibility & obsessiveness

13. Cognitive Effects: affects the way you think, learn & remember memory: Amnesia – retrograde amnesia; ST memory loss attention & conc. - > tired, stressed/worried information processing – slow executive functions of Planning, Organizing & problem solving

14. Visuo Spatial & Perceptual Difficulties =make sense of incoming info from ears & eyes unable to judge distances, spatial relationships & orientation = bump into furniture unilateral neglect – prob. With 1 side = eat ½ food on a plate, read ½ way across a page, draw ½ a person

15. Language Problems: Receptive = make sense of what is heard or read Expressive = unable to find the right words to say or write Referred to as APHASIA Both receptive & expressive areas affected = Global Aphasia ability to make sounds – controlled by muscles & innervated by cranial nerves

16. Dysphagia: = affects ability to chew & swallow food &/ fluid causes choking – aspiration, dehydration, malnutrition if severe ptt fed via NGT, OGT or PEG

17. “Speech therapy is not only a Science but an Art form as well” Effective management = Individual; family & MD Team no ‘cook book’ or rack of remedies to overcome communication difficulties setting specific individual goals, a high level of motivation and active participation by the individual and his/her family.

18. Intervention:  ---------------------------------  Birth Old Age Role = dynamic, diverse and varied; fascinating and a challenging involves a bit of magic added in for good measure and a whole lot of scientific skill!

19. Thank You