OPTA 222 (Brain Injury)
BI Causes
Fall and Traffic accidents
Signs and Symptom
- Loss of consciousness
- Headache that persists or worsens
- Confusion
- Dilation of one or both pupils
- Spinal fluid coming out of ears or nose
- Seizures
- Loss of coordination
- Slurred speech
- Numbness in extremities
- Unusual behavior
Patho: Primary Damage
- Object hits face/head or vice versa
- Damage suffered can be to any area of the brain
- Lacerations of blood vessels within the brain or that feed the brain
- Contusions or lacerations can injure cranial nerves
- Diffuse axonal injury
- “bruising”
- Penetrating objects
Patho: Secondary Damage
- IIP- due to swelling or hematoma, can cause distortion because the brain is held in the skull, a rigid structure. So increased pressure can lead to herniation of parts of the brain or brainstem
- Hydrocephalus- when blood accumulates in the ventricular system, expanding the size of the ventricles causing increased pressure
- Cerebral hypoxia or ischemi, lack of blood to the brain or lack of oxygen from secondary to chest injuries
Intracranial hemorrhage-causing hypoxia to tissues fed by the hemorrhaging blood vessels as well as added pressure and distortion. Metabolic products from damaged cells and blood bathe the brain, cell death occurs iwthin minutes after injury from ischemia, edema, necrosis and toxic effects of blood on neural tissues
- Electorlyte imb.-caused by swelling and then bursting of the membrane or destruction from within the cell (apoptosis), can occur days, weeks or months after injury
- Infection- cause swelling and cell death
- Seizures-most common immediately after injury and between 6 mo and 2 years post. They can cause additional brain damage due to high oxygen and glucose requirements.
Effect of Brain Injury
-autonomic
-motor, functional, sensory and perceptual
-changes in consciousness/coma
-cognitive, personality and behavioral
-other
Autonomic Nervouse System Changes
Pulse
Respiratory rates
Temperature elevations
Blood pressure changes
Excessive sweating
Salivation
Tearing
Sebum secretion
Motor changes
-Great variability
-Monoplegia
-Hemiplegia
-Abnormal reflexes
-Daily changes in tone
-Stimulated by internal or external variants
-Motor disturbances in timing, sequencing, and coordination
-Primitive reflexes can return
-Cranial nerve involvement
Bladder and Bowel
-Loss of bladder or bowel control
-Increased urgency to urinate
-Incomplete bladder or bowel emptying
-constipation
Sensory Changes
Touch
Smell
Taste
Hearing
Loss of taste and smell has been reported to be as high as 25 percent after traumatic brain injury.
Changes in consciousness/coma
- Defined as a complete paralysis of cerebral function, a -state of unresponsiveness
-Eyes are closed and there is no response to painful stimuli
-Within 2-4 weeks most patients wake
-Pupillary signs are valuable in ax damage
Glasgow Outcome Scale
Looks at:
Eye opening
verbal response
motor response
Cogn, Personality and behavior Changes
-Shortened attention span
-Concentration problems
-Perseveration
-Reduced problem solving
-Loss of initiative
-Loss of reasoning
-Poor abstract thinking
-Inappropriate social behaviors
-Temporary or permanent disorders of intellectual function and memory are frequent
-Anger
-Irritability
-Memory loss
-Retrograde and anterograde amnesia
Types TBI Rehab?
-memory book
-at home strategies: post its etc
-notebook
-connect with brain injury worker
More likely to lack declarative memory BUT Can still exhibit procedural memory so can benefit from rehab
Medical Treatment
-Surgery:Decrease intracranial pressure
-Pharmacological Intervention: drugs that decrease pressure, control blood pressure, treat behavioral and cognitive functions ex diazepam, control pain
Motor Rehab
-Rehab is key to improved motor control: Recovery can continue to occur as long as the brain is challenged
-Early intervention is very important
-Task should resemble real life situation as much as possible
-Rehab for cognition is also important: Think holistically
Cognitive Rehab
What are some tasks you could do to improve the following?:
-Concentration
-Attention
-Calculation
-Memory
-Emotional regulation
-Multitasking
ADLs
-BADLs
-IADLs
-Possible practice in community
What Brain Injury Deficits be most disabling
The test reports social and family problems will be most devastating in the long term. Studies showed that patients who had low level motor skills but high cognitive skills did better at integrating back into society. There are adaptive devices for poor motor function, not cognition.
Motivation, attention skills, emotional instability, memory, learning and social deficits are all cognitive processes that prevent or slow client’s progress in therapy as well as at home and at work.
Motivation- work on client goals to assist in establishing motivation
Attention- remove distracting stimuli then slowly reintroduce
Physical-many repetitions needed (speed of movement, reaction time, endurance, sensory)
The ability to “fix” an impairment doesn’t only depend on therapist skill but also on physical damage, cognition, family support, motivation.