Brain Injury Flashcards
Concussion (mTBI)
mild TBI with functional changes but without structural damage
Contusion
more serious than a concussion. Involves bruising or bleeding along the brain surface.
Extent of damage depends on size and location of the contusion
Seizure Disorders (Epilepsy)
explosive episodes of uncontrolled and excessive electrical activity in the brain leading to sudden change of behavior or level of consciousness
Glasgow Coma Scale
- Used to objectively describe the extent of impaired consciousness in all types of traumatic brain injuries
- The lower the score, the worse the injury
Glasgow Coma Scale Scoring
- A score of 15 means you’re fully awake, responsive and have no
problems with thinking ability or memory - A score of 13-14 means a mild head injury
- A score of 9-12 would indicate a moderate head injury
- Having a score of 3 - 8 means you’re in a coma and have a severe brain injury. Immediate emergency care is required
How concussion can occur
direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain.
What is initiated during a concussion?
Neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain.
Neurometabolic cascade should resolve within
4-6 weeks
Post-concussion syndrome
If symptoms persist beyond that time (4-6 weeks) (and cannot be explained by other means), the person is said to be experiencing persistent post-concussion syndrome
PPCS symptoms develop in 20-30% of concussed patients
Coup-contrecoup
a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit.
Need to lose consciousness with concussion?
You do not need to lose consciousness to have a concussion
most likely to lead to loss of consciousness and is the most likely to lead to persistent post concussion symptoms
Rotational force
Concussion Treatment
- Imaging can be done to rule out structural damage
- MRI, and CT scans
- Rest
- Sleep at night and naps throughout the day if needed
- Rest breaks during the day
- Avoiding vigorous activity
- NSAIDs to control headaches
- Avoid bright lights and electronics
- Limit activities that require heavy concentration or intense focus
- In severe cases: physical therapy, speech therapy, recreation therapy and occupational therapy may be needed
Post Concussion Syndrome Signs and Symptoms:
- Autonomic dysfunction
- Headaches
- Dizziness
- Loss of concentration and memory
- Ringing of the ears
- Emotional and psychological changes
- Sleep changes
- Vision changes
Concussion and PPCS
Massage considerations
Remove noxious stimuli
Position and pillow for comfort (be aware of dizziness and/or
onset of symptoms with neck movement (cervicogenic
dizziness))
Avoid rocking/shaking
Promote relaxation
Encourage and support light aerobic exercise
Refer to chiro/physio/MD that are well trained in concussion
assessment and treatment (BTT, VOM)
Focal (partial) Seizures
Seizure is limited to a single area of the brain (60% of cases)
categories of focal seizures
- Without loss of consciousness
* May experience changes in the way thing look, feel, smell, taste or sound.
* Can result in involuntary movements or abnormal sensations like dizziness - With impaired awareness
* Change or loss of consciousness
* Appear to have a blank stare or have a repetitive movements like hand rubbing or
smacking, or start walking in circles
Generalized Seizures
Involves more of a diffuse area and is seen approximately 30% of cases
Generalized seizures 2 types
- Absence (petit mal) – brief loss of awareness and often facial movements lasting up to 10 seconds
- Often people have no memory of what happens during the seizure
- Tonic-clonic (grand mal) – intermittent contract-relax pattern in muscles and are associated with loss of consciousness
- Can last for several minutes
Treatment of seizures
- Antiseizure medication and cannabinoids are used to reduce the frequency of seizures
- Mild sedatives
- Understanding triggers if there are any (flashing lights,
smells/odors)
Seizures - Massage considerations
Understand and remove triggers
Follow first aid (left) if seizure occurs
It is sensible to work from a template of gentle, relaxing massage techniques
Adjust face rest to ensure comfort
Limit position changes if client is experiencing dizziness
If client has difficulty communicating establish a form of
communicating
Avoid techniques that cause the client to rock or shake
