TBI-TRAUMATIC BRAIN INJURY

1. TRAUMATIC BRAIN
INJURY (TBI)
Dr. Adil Munir, PT
DPT (RIU), MSPT (Peads) (RIU)
Lecturer, Pediatrics Physical Therapist

2. DEFINITIONS
Traumatic Brain Injury is an insult to the brain caused by
an external physical force
Diffuse Axonal Injury the tearing and shearing of
microscopic brain cells
Acquired Brain Injury is an insult to the brain that has
occurred after birth, for example; TBI, stroke, near
suffocation, infections in the brain, anoxia(an absence of
oxygen).

3. ACQUIRED BRAIN INJURY
NON-TRAUMATIC
 Anoxia
 Aneurysms
 Brain Tumors
 Encephalitis
 Meningitis
 Metabolic
Encephalopathy
 Stroke with
Cognitive Disabilities
TRAUMATIC
 Open
 Closed

4. COUP-CONTRA COUP INJURY
A French phrase that
describes bruises that
occur at two sites in the
brain.
When the head is
struck, the impact
causes the brain to
bump the opposite side
of the skull. Damage
occurs at the area of
impact and on the
opposite side of the
brain.

5. DIFFUSE AXONAL INJURY
Brain injury does not require a direct
head impact. During rapid acceleration
of the head, some parts of the brain can
move separately from other parts. This
type of motion creates shear forces that
can destroy axons necessary for brain
functioning.
These shear forces can stretch the nerve
bundles of the brain.

6. DIFFUSE AXON INJURY
IS A VERY SERIOUS INJURY, AS IT DIRECTLY IMPACTS THE
MAJOR PATHWAYS OF THE BRAIN.

7. HEAD INJURY
TYPES OF HEAD
INJURIES
• Scalp lacerations
– Can bleed profusely
• Skull fractures
– Linear or depressed
• Linear is from a low velocity injury
– Simple, comminuted, or compound
– Closed or open

8. HEAD INJURIES
Frontal fracture
• May see air in the forehead tissue, CSF coming out of
their nose
Orbital fracture
• Raccoon eyes, may have optic nerve injury
Parietal fracture
• Battle signs, facial paralysis
Basilar fracture
• CSF out ears, nose, battle signs, trouble hearing or
tinnitus, facial paralysis, conjugate gaze, vertigo.

9.  (also known as panda
eyes) or peri-orbital
ecchymosis is a sign of
basal skull fracture or
hematoma, a craniotomy
that ruptured the
meninges, or (rarely)
certain cancers.
 Battle's sign, also mastoid
ecchymosis, is an indication
of fracture of middle cranial
fossa of the skull, and may
suggest underlying brain
trauma. Battle's
sign consists of bruising
over the mastoid process, as
a result of extravasation of
blood along the path of the
posterior auricular artery.
Raccoon eye/eyes Battle signs

10. HEAD INJURY
• Results from bleeding between the dura and the inner
surface of the skull
• Neurologic emergency!!!
• Venous or arterial origin
Epidural hematoma
Epidural hematoma
• Initial period of unconsciousness
• Headache
• Nausea, vomiting
• Focal findings
Classic signs include

11. HEAD INJURY
 Subdural hematoma
 Occurs from bleeding between the dura mater and
arachnoid layer of the meningeal covering of the brain
 Subdural hematoma
 Acute subdural hematoma
Signs within 48 hours of the injury
Similar signs and symptoms to brain
tissue compression in increased ICP
Patient appears drowsy and confused
Ipsilateral pupil dilates and becomes fixed

12. HEAD INJURY
 Intracerebral Hematoma
 Occurs from bleeding within the parenchyma
 Usually occurs within the frontal and temporal
lobes
 Size and location of hematoma determine patient
outcome
 Most of the time from a bullet (missile injury),
stabbing.

13. HEAD INJURY
• Subarachnoid Hematoma
– Bleeding into the subarachnoid space
• Most common causes are subarachnoid
aneurysm, head trauma, or hypertension

14. EFFECTS: PHYSICAL AND
COGNITIVE
14
Physical Changes
Headaches
Difficulty speaking
Blurry eyesight
Trouble hearing
Loss of energy
Change in sense of taste
or smell
Dizziness or trouble with
balance
Cognitive Changes
 Difficulty concentrating
 Trouble with attention
 Forgetfulness
 Difficulty making
decisions
 Repeating things

15. HEAD INJURY
DIAGNOSTIC STUDIES AND
COLLABORATIVE CARE
CT scan
• Best diagnostic test to determine craniocerebral trauma
MRI
PET
Transcranial Doppler studies
• Looking for vasospasm
Cervical spine x-ray
• You must see from C1 –C7 to see that they have no injury
Glasgow Coma Scale (GCS)

16. SEQUELAE OF TBI

17. SEQUELAE OF TBI

18. RX
 Treatment principles
 Prevent secondary injury in the brain
 Timely diagnosis
 Surgery if necessary
 Assessment
 Airway
 Semi-Fowler’s positioning, really good oral care
 Glasgow Coma Scale score
 Neurologic status
 Presence of CSF leak
 Collaborative problem: Increased ICP

19. ICP MONITORING
 Indications
 severe head injury (GCS < 9)
 abnormal head CT
or
 Coma >6 hrs
 Intracranial hematoma requiring evacuation
 Delayed neurologic deterioration from mild to
moderate (GCS>9) to severe (GCS < 8)
 Requirement for prolonged ventilation
 Pulmonary injury, surgery etc.

20.  Glasgow Coma Scale (GCS)
 Measures level of
consciousness
 Coma is commonly defined
as scores ≤ 8
 Scores ≤ 58 are classified as
severe brain injury

Scores between 9 and 12
are defined as moderate and
13 to 15 are classified as
mild brain injury
CLINICAL RATING SCALES

23. REHABILITATION
 Rancho I, II, III
 Sensory Stimulation.
 Structured program of stimulation
 Stimulating each sense
 Educate family and significant others
 PROM
 Auditory stimulation
 Visual stimulation
 Olfactory stimulation
 Vestibular stimulation

24. REHABILITATION
 Gustatory stimulation
 Tactile stimulation
 Positioning

25. REHABILITATION
 Rancho IV, V,VI
 Sensory regulation.
 To decrease over stimulation
 Sitter and/or Bed Enclosure as needed.
 Behavioral Medicine.
 Set-up Behavioral Modification Program
 Mobility skills.
 Self-care skills.
 Cognition/communication

26. REHABILITATION
 Rancho VII,VIII,XI and X
 Mobility
 Balance
 Task oriented
 Gait

27. PHYSICAL THERAPY EXAMINATION
& TREATMENT