Assessment of Traumatic Brain Injury

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Preparation for Physiotherapy Assessment[edit | edit source]

Physiotherapy assessment commences once the patient is medically stable.

In view of the complexity of many patients with TBI, the assessment is frequently unable to be completed within a single session so is ongoing for the first few physiotherapy sessions. Close liaison with other members of the multidisciplinary team is extremely beneficial, and on occasion joint assessments by 2 or even 3 therapists from different disciplines can be beneficial.

Handling during Ax[edit | edit source]

In the initial stages following TBI, careful handling is essential when assessing patients, especially if they are in a minimally conscious state.

Information required before starting the assessment[edit | edit source]

The following information should be provided by the medical team before beginning the physiotherapy assessment:

  • State of consciousness of the patient - for further information see the Coma Recovery Scale page
  • Areas of the brain injured, including diffuse and secondary injury
  • Site of Decompression Craniotomy, if this has been performed on the patient[1]
  • Any other injuries sustained - patients who have TBI from road traffic accidents frequently also have a range of musculoskeletal, abdominal and chest injuries
  • Any impact on cognition of the patient - neuropsychological assessment is indicated

Areas of Assessment[edit | edit source]

Abnormal Muscle Tone[edit | edit source]

particularly hypertonicity and spasticity.

It is noticeable that, in contrast to Stroke when there is often a period of low tone before high tone develops, in cases of severe TBI hypertonicity and spasticity can develop very quickly, sometimes as early as one week post TBI[2][3]. The symptoms may start to occur as sedation is reduced, or as the patient emerges from coma.

Approximately 18% to 30% of all TBI patients suffer from spasticity that requires treatment[4]. Studies show that in the region of 85% of people with severe TBI demonstrate significant spasticity at a level which induces contracture[5][6].

Muscle Paresis[edit | edit source]

Muscle paresis very common following TBI[7]

Movement Disorders[edit | edit source]

Ataxia, dyspraxia, dyskinesia, or reduced motor control

Balance and vestibular dysfunction[edit | edit source]

This is very common in TBI, and varies enormously in degree[8]

Sub Heading 3[edit | edit source]

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References[edit | edit source]

  1. ↑ Bohman LE, Schuster JM. Decompressive craniectomy for management of traumatic brain injury: an update. Curr Neurol Neurosci Rep. Nov 2013;13(11):392
  2. ↑ Sunnerhagen KS, Opheim A, Alt Murphy M.Onset, time course and prediction of spasticity after stroke or traumatic brain injury. Ann Phys Rehabil Med. 2018 May 16. pii: S1877-0657(18)30059-9. doi: 10.1016/j.rehab.2018.04.004. [Epub ahead of print]
  3. ↑ Prodip Bose, Jiamei Hou, and Floyd J Thompson Traumatic Brain Injury (TBI)-Induced Spasticity Chapter 14 Neurobiology, Treatment, and Rehabilitation
  4. ↑ Verplancke, D, Snape, S, Salisbury, CF et al. 2005. A randomised controlled trial of botulinum toxin on lower limb spasticity following acute acquired severe brain injury. Rehabil. 19, 117-125
  5. ↑ Corrigan J.D, Selassie A.W, Orman J.A. The epidemiology of traumatic brain injury. J Head Trauma Rehabil. 2010;25:72–80
  6. ↑ McGuire L. The epidemiology of traumatic brain injury, National Centers for Disease Control and Prevention. 2011.
  7. ↑ Ivanhoe, CB, Reistetter, TA, 2004. Spasticity: the misunderstood part of the upper motor neuron syndrome. Am. J. Phy. Med. Rehabil. 83, S3-S9
  8. ↑ Kleffelgaard I, Soberg H, Bruusgaard K, Tamber A, Langhammer B. Vestibular Rehabilitation After Traumatic Brain Injury: Case Series. Physical Therapy. 2015
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