1. Traumatic brain injury
Fazan zaffar kashoo

2. INTRODUCTION
Definition: Traumatic brain injury (TBI, also called intracranial injury) occurs when an external force traumatically injures the brain.
Epidemiology:
million /year
Motor vehicle accidents accounts for more than half
9-10 billion $ annual economic impact.

3. Pathophysiology Focal injury: coup-contercoup injury
Diffuse axonal injury: shearing and retraction of damaged axons.
Hypoxic-ischemic injury: lack of oxygenated blood flow.
Increased intracranial pressure: epidural subdural hemorrhage (4-15 mm Hg)

4. diagnosis
CT scan.
MRI scan.

5. Complications after TBI
Neuromuscular impairment:
Abnormal tone
Primitive posturing
Decorticate (UL Flex –LL exten above superior colliculus ) and decerebrate rigidity (UL, LL exten between Superior colliculus and vestibular nucleus)
All sensations impaired
Monoplegia, hemiplegia, tetraplegia
Cordination timing and sequence of movement

6. Complications after TBI
Cognitive impairment
Altered level of consciousness- Glasgow coma scale
Coma- cant arose
Stupor- can arose with difficulty
Obtunded- arose easily
Memory deficit: post traumatic amnesia- time of injury and person makes new memories.
Types of memories: declarative and procedural
Declarative memory: conscious recollection of task to do activity
Procedural memory: unconscious performance of activity

7. Complications after TBI
Communication impairment: aphasia
Visual-perceptual impairment: spatial neglect, left right discrimination neglect,
Swallowing impairment: dysphagia
Indirect impairment:
soft tissue contractures
Ulcer
DVT
Decreased bone density
Muscle atrophy
Infection
Pneumonia

8. Clinical rating scale Glasgow coma Scale: 3-15 score
Galveston orientation and amnesia test: measure of Post traumatic Amnesia
Rancho los Amigos level of cognitive functioning: cognitive and behavioral recovery of patient.
Glasgow outcome Scale: outcome measure of after TBI
FIM: functional independence measure.

9. Prognosis and goal setting
Initial severity of injury
Duration of coma
Length of PTA
Coma less than one week – good recovery
PTA less the 12 weeks – good recovery

10. Medical management
Stabilization of cardio-vascular and respiratory system.
Stabilize the vital signs.
CT scan.
ICP monitoring (4-12 mm Hg) Below 20mm Hg.
30 degree head position and sedatives.

11. Rehabilitation team Physician Speech language pathologist
Occupational therapist
Rehabilitation nurse
Case manager
Medical social worker.
Neuropsychologist
Physiotherapist

12. examination Information from the medical records Posture
Eyes closed or open
Track visual and auditory stimulus
Can speak
Active movements
Reaction to tactile stimulus
Change in vital signs with external stimulus
Examine tone with ashworth scale.

13. INTERVENTION AT HOSPITAL
Preventing indirect impairment
Positioning
Head neural position, neck movement (stable ICP)
Trunk scapula mobilization
Upper extremity cone in hand, wedge between fingers
Lower extremity: hip rotation prevention with roll
PROM
Respiratory Care:
Arousal through sensatory stimulus: auditory, gustatory, visual, tactile, kinesthetic and vestibular.
Early transition to sitting position.

14. INTERVENTION AT REHAB CENTRE
Learn new skills
Locomotion training with body weight support
Constraint induced movement therapy
Prone on elbow, quadruped,bridging etc.
Sitting on therapy ball
Serial casting