Fazan zaffar kashoo
 Definition:
Traumatic brain injury (TBI, also
called intracranial injury) occurs when an
external force traumatically injures the
brain.
 Epidemiology:
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1.5 -2 million /year
Motor vehicle accidents accounts for more than
half
9-10 billion $ annual economic impact.
 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)
 CT
scan.
 MRI scan.
 Neuromuscular
 Abnormal
impairment:
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
 Cognitive

Altered level of consciousness- Glasgow coma
scale
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
impairment
Coma- cant arose
Stupor- can arose with difficulty
Obtunded- arose easily
Memory deficit: post traumatic amnesia- time of
injury and person makes new memories.
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Types of memories: declarative and procedural
Declarative memory: conscious recollection of task to
do activity
Procedural memory: unconscious performance of
activity
 Communication
impairment: aphasia
 Visual-perceptual impairment: spatial
neglect, left right discrimination neglect,
 Swallowing impairment: dysphagia
 Indirect impairment:
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soft tissue contractures
Ulcer
DVT
Decreased bone density
Muscle atrophy
Infection
Pneumonia
 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.
 Initial
severity of injury
 Duration of coma
 Length of PTA
 Coma less than one week – good recovery
 PTA less the 12 weeks – good recovery
 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.
 Physician
 Speech
language pathologist
 Occupational therapist
 Rehabilitation nurse
 Case manager
 Medical social worker.
 Neuropsychologist
 Physiotherapist
 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.
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.

 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