In this ppt covered the basic treatment strategies for a traumatic brain injury patient and presented a case study and treatment protocol according to that patient condition on assesment glasgow coma scale is important in TBI

1. TRAUMATIC BRAIN
INJURY
S.CHRISTY SOPNA
PHYSIOTHERAPIST

2. TRAUMATIC BRAIN INJURY
 Traumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the
brain from an external mechanical force, possibly leading to permanent or
temporary impairment of cognitive, physical, and psychosocial functions, with
an associated diminished or altered state of consciousness.

3. GLASGOW COMA SCALE

4. GCS VALUE RANGE INTERPRETATION
13-15 Mild TBI
9-12 Moderate TBI
1-8 Severe TBI

5. SEVERITY OF TRAUMATIC BRAIN INJURY
GCS PTA LOC
Mild 13–15
<1
day
0–30
minutes
Moderate 9–12
>1 to <7
days
>30 min to
<24 hours
Severe 3–8 >7 days
>24
hours
GCS – Glasgow coma scale
PTA – post traumatic amnesia
LOC – Loss of consciousness

6. ALTERED CONSCIOUSNESS
 Coma
 Vegetative state
 Minimally conscious state
 Brain death

7. WAKEFULLNESS AWARENESS
Coma - -
Vegetative state + to ++ -
Miniamally conscious state + to ++ +
Emerged from minimally
conscious state
++ ++

8. CASE STUDY
 A 50 yr man is shifted to the rehabilitation department with an history of road
traffic accident the patient undergone traumatic brain injury before 2 months
and he had undergone emergency surgery of bifrontal craniotomy and
reevacuation of hematoma and tracheostomy. The patient had a medical
history of hypertension and he was in coma for 1 month and while he is
coming to the department his Glasgow coma scale was E4V1M1 and he was in
PEG (percutaneous endoscopic gastrostomy) tube for feeding . Patient is on
baclofen and Parkinson drugs

9. ON OBSERVATION
 Spontaneous eye opening
 Open wound in the bifrontal craniotomy site
 A wound on the C7 spine area
 Wound on right knee
 Attitude of limb : lower limb in extension and ankle in plantarflexion
 Upperlimb shoulder adduction , elbow flexion ,and wrist neutral
 Patient is on condem cathether and diaper
 Patient is on alpha bed
 On continuos Blood pressure and SPO2 monitoring

10. On palpation
 Tone : hypertonicity
 Modified ashworth grading
LIMB RIGHT LEFT
Upper limb 2 3
Lower limb 3 3

11. ON EXAMINATION
SENSORY
EXAMINATION
MOTOR
EXAMINATION
SUPERFICIAL
DEEP
CORTICAL
MANUAL MUSCLE
TESTING
REFLEX
GRADING

12. PHYSIOTHERAPEUTIC MANAGEMENT
AIMS TREATMENT
To prevent pressure sore
To maintain the ROM(range of motion)
Position changing for every 2 hours .
Use of alpha bed
PROM ( passive range of motion)
exercises to all joints
To maintain flexibility Passive Stretching
Weight bearing exercises
Positioning
To reduce spasticity Sustained stretching
Weight bearing activities
To improve endurance Body supported treadmill
To improve standing Wall supported standing
Standing frame
To improve awareness and alertness All types of stimulation
Auditory , visual, tactile, proprioceptive
Gustatory stimulation

14. Plantigrade position
Passive segmental rolling

15. Weight bearing in
upper limb

16. BODY SUPPORTED
TREADMILL
STANDING FRAME

17. Weight bearing on elbow

18. Quadriped
KNEELING

19. HALF KNEELING

20. THANK YOU