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Motor Vehicle accidents – 50%
Falls
- 21%
Violence and assault
- 12%
Sports and recreational
injuries
- 10%
SPONTANEOUS
TO SPEECH
TO PAIN
NO RESPONSE
-4
-3
-2
-1
ORIENTED
-5
CONFUSED CONVERSATION – 4
INAPPROPRIATE WORDS
-3
INCOMPREHENSIVE SOUNDS – 2
NO RESPONSE
-1
FOLLOWS MOTOR COMMANDS – 6
LOCALIZES (PAIN)
-5
WITHDRAWS (TO PAIN)
-4
ABNORMAL FLEXION
-3
EXTENSOR RESPONSE
-2
NO RESPONSE
-1
 EYE OPENING
–4
 BEST MOTOR RESPONSE – 6
 VERBAL RESPONSE
-5
TOTAL SCORE - 15
 MILD HEAD INJURY
– 13 – 15
 MODERATE HEAD INJURY – 9 – 12
 SEVERE HEAD INJURY
– 8 OR LESS
I) CLOSED HEAD INJURY
 Skull not fractured
II) OPEN HEAD INJURY
 Skull fractured
III) PENETRATING INJURIES
RIGIDITY
SPASTICITY
ABNORMAL TONE
HYPOTONIA
FLACCIDITY
ABNORMAL POSTURES
 Seen in unconscious patient with severe head
injury
Feature – Sustained contraction and posturing of
trunk and lower limb in extension and upper limb
in flexion
ABNORMAL POSTURES
 Seen in unconscious patient with severe head
injury
Feature – Sustained contraction and posturing of
trunk and limbs in extension
Direct Impairments (Contd)
 Motor Control Impairments
 Cerebellar Involvement
II. Sensory disturbances
III. Cognitive Impairments
IV. Behavioral impairments
V. Communication impairments
VI. Swallowing impairments
VII. Visual impairments
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A) ALTERED LEVEL OF CONSCIOUSNESS
COMA
Coma is defined as” not obeying commands, not uttering words
and not opening the eyes”
GCS Score of 8 or less
Coma lasts only for few weeks at most
VEGETATIVE STATE
Decreased level of awareness
Presence of eye opening and sleep – awake cycles
No ability to follow commands or speak
PERSISTENT VEGETATIVE STATE
Duration greater than 1 year after TBI
No meaningful cognitive or motor function
Complete absence of awareness of self and the environment
B) MEMORY DEFICITS
Memory deficits includes
Post traumatic amnesia (PTA)
PTA describes the time between the injury and
the time when the patient is again able to remember
ongoing events
This includes
 Soft tissue contractures
 Pressure sores
 Deep vein thrombosis
 Heterotropic ossification
 Osteoporosis
 Muscle atrophy
 Decreased endurance
 Respiratory infections ( Pneumonia)
 CT scans are useful in identifying
hematomas, ventricular
enlargements
 Comparison of CT and MRI
confirm that CT is relatively
insensitive to many of the lesions
present after trauma
 MRI provides superior soft tissue
discrimination compared to CT
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To stabilize the vital signs
To perform a complete examination of the injury
To perform neuroimaging studies
Surgical removal of large intracranial hematomas
Intra cranial Pressure (ICP) Monitoring
 Intra cranial Pressure (ICP) Monitoring
 To maintain ICP below 20 mm of Hg (Normal
ICP – 7 – 15 mm of Hg)
 Signs & Symptoms of Increased ICP –
 Decreased responsiveness severe head ache,
vomiting, irritability.
 Severely increased ICP may result in heriniation
of brain
 Management of Increased ICP
 Elevated ICP is treated by sedating
medications and moderate head up positioning
(Head elevated to 30o)
Physiotherapy Management of Unconscious
Patient
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Positioning
Prevention of pressure sores
Respiratory management
Maintenance of range of motion
Coma stimulation
RESPIRATORY MANAGEMENT
 Mostly patient needs – intubation and ventilatory
support
 To loosen the secretions – percussion, vibration and
use of saline water (to reduce the viscosity of the
secretions )
 To remove the secretions – suctioning (ideal duration
– 10 to 15 sec)
MANAGEMENT OF ROM
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Passive ROM is essential and helps
To prevent contractures
To decrease hypertonicity
To provide sensory stimulation
To prevent DVT
IMPROVING AROUSAL THROUGH SENSORY
STIMULATION
(COMA STIMULATION)
The following sensory systems are
systematically stimulated – auditory, olfactory, visual,
tactile, kinesthetic and vestibular.
During stimulation , patient must be closely
monitored for responses such as
 Changes in heart rate, blood pressure, rate of
respiration
 Various motor responses such as eye movements,
facial grimacing, changes in posture, head turning or
vocalization
FAMILY EDUCATION
(GENERAL)
 The goal of family education is to teach the family
about the stages of recovery and what can be
expected in the future
 The therapist should be realistic but provide the hope
for the family
 The family can also become involved in performing
ROM exercises, positioning and sensory stimulation