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Traumatic Brain Injuries: Case Study Presentation

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Jonathan Nicholas

on 19 November 2014

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Transcript of Traumatic Brain Injuries: Case Study Presentation

Tra
Brain
In
ju
ry
uma
tic
Case Study Presentation
Jonathan Nicholas
Physiotherapist
Introduction
Objectives

Incident, cause/pathology & effect

Assessment & Treatment

My Case Study

Therapist's Role
Background
Types
1. Traumatic Brain Injury (TBI)
2. Acquired Brain Injury (ABI)
Statistics/Incident
1 million people attend A&E each year following a head injury with many more going unreported and not assessed.
135,000 of these are admitted to hospital.

In the UK it is estimated there are half a million adults living with long-term disabilities as a result of a TBI

85% of these are classed as minor, 10% as moderate, 5% as severe.

M:F ratio is 2-3:1 but this is 5:1 in 15 - 29 years
Anatomy
Pathology of Injury
Secondary Damage
1. Intracranial Haematoma
a) Extradural
b) Intradural
2. Cerebral Swelling
3. Tentorial or Tonsillar Herniation
4. Cerebral Ischaemia
5. Infection
Primary Damage
1. Cortical Contusions & Lacerations
2. Diffuse Axonal Injuries
Case Study
The Therapists Role
References
Assessment
Management
Guidelines
Assessment
Treatment/ Management
loss of consciousness
post-traumatic amnesia
cause & circumstance
of injury
headaches & vomiting
lacerations &
brusing
basal skull
fractures
conscious level
pupil
response
limb
weakness
eye movements
1. Conservative Management
2. Surgical Management
evacuation
burr holes / craniotomy
scans
NICE (2007) Guidelines on Head Injury
BSRM & RCP (2003) Rehabilitation
following acquired brain injury
DOH (2005) NSF for
Long-term Conditions
RCP (2012) National Clinical
Guidelines for Stroke
Injury
fell backwards after
avoiding a cyclist
and hit head
GCS
15
12
6
to
to
CT Scan 1
CT Scan 2
Treatment
ITU
23 Days
Trachy
NIPs
24 Days
Neuro Rehab Ref
Therapy
Ax
The WHIM
Case Study
Research
Crossman AR & Neary D (2005) Neuroanatomy. Churchill Livingstone, London.Department for Health (2005) The National Service Framework for Long-term Conditions. Accessed at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4105369.pdf .Headway (2012) Key Facts and Statistics. (accessed on 15.12.12 at https://www.headway.org.uk/key-facts-and-statistics.aspx)HEllweg S & Johannes S (2008) Physiotherapy after traumatic brain injury: A systematic review of the literature. Brain Injury. 22 (5); 365 - 373.Lindsay K.W & Bone I (2001) Neurology and Neurosurgery Illustrated (3rd Ed). Churchill Livingston, Edinburgh)Martial Van der Linden SM & Shiel A (2000) Wessex Head Injury Matrix and Glasglow/Glasgow-Liege Coma Scale: A Validation and Comparison Study. Neuropsychological Rehabilitation. 10 (2); 167 - 184.NICE (2007) Head Injury: Triage, assessment, investigation and early management of head injury in infants, children and adults. London.Shiel A, Horn SA, Wilson BA, Watson MJ, Campbell MJ & Mclellan DL (2000) The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clinical Rehabilitation. 14; 408 - 416.Shiel A, Burn JPS, Clark DH, Wilson BA, Burnett ME and Mclellan DL (2001) The effects of increased rehabilitation therapy after brain injury: results of a prospective controlled trial. Clinical Rehabilitation. 15; 501 - 514.Stokes M (2006) Physical Management in Neurological Rehabilitation (2nd Ed). Elsevier Mosby, London.
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