Assessment of Traumatic Brain Injury: Difference between revisions
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== Areas of Assessment == | == Areas of Assessment == | ||
==== Abnormal Muscle Tone ==== | ==== Abnormal Muscle Tone ==== | ||
The major abnormalities in muscle tone encountered in this popularion are 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<ref name=":0">Sunnerhagen KS, Opheim A, Alt Murphy M.Onset, T'''ime 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] | 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<ref name=":0">Sunnerhagen KS, Opheim A, Alt Murphy M.Onset, T'''ime 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] |
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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]
The major abnormalities in muscle tone encountered in this popularion are 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. A recent study concludes that "Signs of spasticity can often be noted within the first 4 weeks after brain injury and is more common in the upper than lower extremity. Impaired sensorimotor function is a predictor"[2]
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]
Add text here...
References[edit | edit source]
- ↑ Bohman LE, Schuster JM. Decompressive craniectomy for management of traumatic brain injury: an update. Curr Neurol Neurosci Rep. Nov 2013;13(11):392
- ↑ 2.0 2.1 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]
- ↑ Prodip Bose, Jiamei Hou, and Floyd J Thompson Traumatic Brain Injury (TBI)-Induced Spasticity Chapter 14 Neurobiology, Treatment, and Rehabilitation
- ↑ 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
- ↑ Corrigan J.D, Selassie A.W, Orman J.A. The epidemiology of traumatic brain injury. J Head Trauma Rehabil. 2010;25:72–80
- ↑ McGuire L. The epidemiology of traumatic brain injury, National Centers for Disease Control and Prevention. 2011.
- ↑ Ivanhoe, CB, Reistetter, TA, 2004. Spasticity: the misunderstood part of the upper motor neuron syndrome. Am. J. Phy. Med. Rehabil. 83, S3-S9
- ↑ Kleffelgaard I, Soberg H, Bruusgaard K, Tamber A, Langhammer B. Vestibular Rehabilitation After Traumatic Brain Injury: Case Series. Physical Therapy. 2015