Major Traumatic Brain Injury

Page 1: Introduction to Brain Trauma

• Major Traumatic Brain Injury (TBI)

Page 2: Objectives

• Understand the pathology, clinical manifestations, medical treatment, and physical therapy considerations for brain injuries.

• Apply knowledge to create a plan of care for brain injuries.

Page 3: Topics Covered

• Major Traumatic Brain Injury (TBI)

• Epidural Hematoma

• Subdural Hematoma

• Diffuse Axonal Injury

• Minor Traumatic Brain Injury (mTBI)

• Concussion

Page 4: Mechanisms of Brain Trauma

• Direct or indirect forces to the head

• Brain movement inside the skull

• Coup/contrecoup injury mechanism

• Rotational forces causing axonal shearing

Page 6: Risk Factors for Brain Injury

• Motor Vehicle Accidents (MVA)

• Bicycling without helmet

• Contact sports

• Other high-risk activities

• Falls

• Excessive alcohol use

• Low socioeconomic status

• Residence in inner cities

• Use of firearms

Page 7: Multiple Pathologies from Major TBI

• Skull fracture

• Hemorrhage

• Subdural and Epidural Hematomas

• Cerebral contusion

• Vascular damage, infarction, cell death

• Axonal injury

• Edema and increased intracranial pressure

• Brain herniation

• Reduced perfusion

Page 10: Epidural Hematoma

• Caused by injury to meningeal artery

• Results in bleeding outside the dura

• Symptoms: Brief loss of consciousness, lucid interval, sudden mental deterioration

• Treatment: Surgical decompression

Page 11: Subdural Hematoma

• Tearing of veins in dura and arachnoid space

• More common in rotational injuries

• Often does not show loss of consciousness

• High mortality rate (60-70%)

Page 12: Chronic Subdural Hematoma

• Common in elderly, especially on anticoagulants

• Insidious onset, minor trauma possible

• Symptoms: Decreasing consciousness, headaches, gait and balance issues, neurologic deficits

Page 13: Diffuse Axonal Injury

• Major cause of persistent vegetative state (PVS)

• Prolonged loss of consciousness, severe white matter injury

• Affects corpus callosum and brainstem

Page 14: Clinical Manifestations of TBI

• Altered consciousness

• Cognitive impairments

• Behavioral changes (e.g., judgment, impulsivity)

• Emotional issues, personality changes, depression

• Motor and sensory deficits

• Heterotopic ossification

Page 15: Glasgow Coma Scale Overview

• To assess consciousness:

  • Eye opening (1-4)

  • Verbal response (1-5)

  • Motor response (1-6)

• Score ranges from 3 (unresponsive) to 15 (fully responsive)

Page 16: Medical Management of TBI

• Hospital ICU procedures:

  • Monitor intracranial pressure

  • Assess consciousness using Glasgow Coma Scale

  • Use of diagnostic imaging (CT, MRI)

  • Neuropsychological evaluations

  • Involvement of various therapies (Speech, OT, PT)

Page 17: Clinical Implications in ICU for PTs

• Team approach required (hospitalist, neuro, PT, etc.)

• Focus on positioning, ROM, and neurological changes

• Vital monitoring and safe movement during therapy

Page 18: Clinical Implications in Acute/Subacute

• Begin long-term rehab for neurological deficits

• Adapt strategies for patient-specific outcomes

• Community re-entry support necessary

Page 19: Stages of Neurological Recovery

• Coma

• Vegetative state

• Minimally conscious state

• Confusional state

• Post-confusional independence

• Community re-entry

Page 20: Physical Issues Post-TBI

• Common symptoms:

  • Headaches, nausea, dizziness

  • Balance issues

  • Sleep disturbances

  • Motor/sensory deficits

  • Skin integrity issues

Page 21: Cognitive Impairments After TBI

• Disinhibition/impulsiveness

• Personality changes

• Impaired memory and judgment

• Potential for intermittent explosive disorder

Page 22: Emotional and Behavioral Changes

• Common issues:

  • Confusion and agitation

  • Substance abuse

  • Noncompliance with rehab

  • Disruptive behaviors and emotional instability