head injury

1. HEAD INJURY PHYSIOTHERAPY INTERVENTION AND MANAGEMENT

4. HEAD INJURYPRIMARY LESIONS Diffuse Axonal Injury (DAI) Contrecoup lesions Intracranial/ Intracerebral Haemorraghes

5. HEAD INJURYSECONDARY LESIONS Intracerebral Oedema Increased Intracranial Pressure Hypoxia Seizures

6. HEAD INJURY Impact Loss of consciousness Post-Traumatic Amnesia (PTA) Persistent Amnesic state

7. HEAD INJURY Given the widespread nature of the injury, it is vital that a team approach is employed Physiotherapists most often play a key role in the patients management

8. CONSEQUENCES OF HEAD INJURY Altered tonal state Spasticity Ataxia Paralysis Muscle and Joint contractures Heterotrophic Ossification Dyspraxia

9. CONSEQUENCES OF HEAD INJURY Reduced balance and co-ordination Fatigue Cognitive problems Behavioural problems Speech and Language problems Impaired Swallow, Gag or Cough reflex

10. EFFECTS OF TRAUMA Orthopaedic injuries Fracture management Soft tissue injuries Nerve lesions Chest injuries

11. PHYSIOTHERAPYACUTE CARE Chest care Positioning Spasticity management Maintain Joint ROM / Muscle Length SOOB Educate Family

12. Glasgow Coma Scale*

13. Glasgow Coma Scale*

14. HEAD INJURYREHABILITATION Rehabilitation phase commences as soon as the patient is medically stable May still have tracheostomy, gastrostomy, naso-gastric or IV tubes in May or may not be awake

15. HEAD INJURY POST-TRAUMATIC AMNESIA Period following Loss of Consciousness until orientated Patients may be confused, confabulating, agitated, verbally or physically aggressive Patients are not responsible for their actions Patients are unable to learn new information

16. HEAD INJURY POST-TRAUMATIC AMNESIA Length of PTA is the most valid measure of severity of injury PTA is measured by the Westmead scale PTA is a normal part of the brain�s recovery process

17. Westmead Scale How old are you? What is your date of birth? What month is it? What time of day is it? What day of the week is it? What year is it? What is the name of this place? Have you seen me before? Do you remember my name? 3 pictures

18. SEVERITY OF HEAD INJURY

19. MANAGING THE PATIENT IN PTA Avoid restraint Reduce stimulation Avoid sedation No formal neuro-psychology assessment Brief therapy sessions, simple instructions Familiarize environment

20. PHYSIOTHERAPYREHABILITATION Continue Acute Care Complete assessment as arousal level and cognitive state allows Assessment may take many days Document dependence/supervision/ independence with transfers and mobilty

21. PHYSIOTHERAPYREHABILITATION Decide on location of physiotherapy Tone management including positioning, serial casting, splinting, drug therapy, tilt-tabling Maintain/improve ROM Assess for seating/wheelchair requirements

22. PHYSIOTHERAPY Promote normal movement at all times No / minimal use of aids and appliances Each functional goal achieved should be achieved with the next functional goal in mind Staff (especially nursing) and family education is vital

23. COGNITIVE AND BEHAVIOURAL PROBLEMS Reduced insight Poor STM Poor concentration Easily distracted Poor problem solving Adynamic or reduced initiative Impulsive Rigidity Agitated / Irritable Verbose Socially inappropriate behaviour Egocentric Lability Depression

24. COGNITIVE AND BEHAVIOURAL PROBLEMS Have an organic basis Stressful and often difficult to manage If you do not manage the patient cognitively and behaviourally you will be unable to manage them effectively physically If inadequately addressed, the patient is unlikely to manage socially

25. BEHAVIOUR MODIFICATION Frequent and consistent feedback Meaningful to patient Immediate and Obvious Involve the whole treating team and family members

26. BEHAVIOUR MODIFICATIONCONSIDER Change of therapist Change of treatment time or venue Videotape session Avoid sedation

27. TREATMENT OUTCOME Head injury is unlike any other field of medicine or rehabilitation Recovery is measured in months and years Population generally young so mobility is extremely important