CNS tx (TBI, class 5) Flashcards
after concussion, difficulty tolerating ___
medication, drugs, screens, alcohol
lower tolerance
also E.g.
sensitive to alcohol
concussion
mood changes
erratic/withdrawn/impatient
not like themselves
depressed/anxious
avoid screens for ____ after concussion (mTBI)
48 hours
after concussion, physical activity ?
walking & light PA is important for recovery
—> light aerobic exercise
circulation (?)
but avoid rigorous exercise
rocking/shaking for mTBI (concussion) patient
possibly avoid rocking/shaking as it could disturb vestibular system of pt with concussion
if patient has seizure on table?
LOWER TABLE AS FAR AS POSSIBLE
(electric table)
get them as low as possible in case they fall off the table
atypical/other triggers for seizure/epilepsy
illness
lack of sleep & late meal
stress
HOLD-RELAX — where not to use
SPASTIC PT
..
…
TBI
traumatic brain injury
mTBI =
mild traumatic brain injury
mTBI aka
concussion
mTBI (concussion) define
a mild TBI with functional changes but without structural damage
(brain) 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
brain contusion
“A brain contusion is a bruise to the brain that causes bleeding and swelling. It’s a type of traumatic brain injury (TBI) that’s usually caused by a strong blow to the head. “
seizure disorders aka
epilepsy
define Seizure Disorders (Epilepsy)
explosive episodes of uncontrolled and excessive electrical activity in the brain leading to sudden change of behavior or level of consciousness.
classification of TBI
mild
moderate
severe
mild TBI:
—> duration of unconsciousness
—> glasgow coma scale
—> post-traumatic amnesia
<30 mins unconsciousness
13-15 Glasgow coma scale
<24 hours post-trauma amnesia
moderate TBI:
—> duration of unconsciousness
—> glasgow coma scale
—> post-traumatic amnesia
30min to 24 hours duration of unconsciousness
9-12 Glasgow coma scale
1-7 days post-trauma amnesia
severe TBI:
—> duration of unconsciousness
—> glasgow coma scale
—> post-traumatic amnesia
> 24 hours duration of unconsciousness
3-8 Glasgow coma scale
> 7 days post-trauma amnesia
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 csale score
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
concussion (mTBI) is
A traumatic brain injury caused by a direct blow to the head,
neck or body resulting in an impulsive force being transmitted to the brain
This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain.
Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged.
concussion resolution time
The neurometabolic cascade following concussion should
normally resolve within 4-6 weeks
concussion SSx after 4-6 weeks?
If symptoms persist beyond that time (and cannot be explained by other means), the person is said to be experiencing persistent post-concussion syndrome
how common is persistent post-concussion syndrome?
PPCS symptoms develop in 20-30% of concussed patients
coup-contracoup
“Coup-contrecoup is a mechanism that describes bruising of the brain that occurs after a direct blow to the head. It involves both a coup injury at the site of impact and a contrecoup injury on the opposite side of the brain. “
contracoup injury
“A bruise that occurs on the opposite side of the brain from the impact site. This is caused by the brain rebounding and hitting the opposite side of the skull. “
coup injury
“A bruise that occurs directly beneath the site of impact. This is caused by mechanical trauma, often from a small, hard object. “
coup-contracoup =
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.
concussion vs loss of consciousness
You do not need to lose consciousness to have a concussion
which directional force is most likely to lead to loss of consciousness & PPCS
ROTATIONAL force
Rotational force is the most likely to lead to loss of consciousness and is the most likely to lead to persistent post concussion symptoms
note concussion vs whiplash
Concussion and whiplash often occur together
People who suffer a concussion, in the majority of cases, also suffer a whiplash injury. Some researchers are recommending that guidelines for the care of both are amalgamated.
concussion tx
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
concussion & activity
not intense
but light/regular cardiovascular exercise for bloodflow is valuable for recovery
severe cases/concussion tx options
In severe cases: physical therapy, speech therapy, recreation therapy and occupational therapy may be needed
symptom exacerbation during physical activity post exercise
light exercise that does not more than mildly exacerbate symptoms is OK
how long after concussion is light cardio OK?
initial 24-48 hours following a concussion
concussion vs screens
reduced screen time 48 hours post injury is great
may be OK to gradually increase screen time after 48 hours
PPCS SSx
Autonomic dysfunction
Headaches
Dizziness
Loss of concentration and memory
Ringing of the ears
Emotional and psychological changes
Sleep changes
Vision changes
massage vs PPCS
Remove noxious stimuli
no bright lights
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)
two types of seizures
focal (partial) seizures
generalized seizures
focal (partial) seizures
Seizure is limited to a single area of the brain (60% of cases)
2 categories of focal seizures:
—> Without loss of consciousness
—> With impaired awareness
focal seizure 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
focal seizure with impaired awareness
Change or loss of consciousness
Appear to have a blank stare or have a repetitive movements like hand rubbing or (lip) smacking, or start walking in circles
Generalized Seizures
Involves more of a diffuse area and is seen approximately 30% of cases
2 types:
—> Absence (petit mal)
—> Tonic-clonic (grand mal)
generalized seizure –> petit mal (absence)
brief loss of awareness and often facial movements lasting up to 10 seconds
—> Often people have no memory of what happens during the seizure
generalized seizure –> grand mal (Tonic-clonic)
intermittent contract-relax pattern in muscles and are associated with loss of consciousness
—> Can last for several minutes
tonic-clonic etymology
“The term “tonic-clonic” comes from the words “tonic” and “clonic” and describes the two phases of a seizure. “Tonic” means stiffening, and “clonic” means rhythmical jerking. “
which seizure type more common
focal (partial) seizure
—> 60% of cases
seizure tx
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 vs massage
Understand and remove triggers
Follow first aid (left) if seizure occurs
It is sensible to work from a template of gentle, relaxing massage techniques
seizure – other massage considerations
Adjust face rest to ensure comfort
Limit position changes if client is experiencing dizziness
If client has difficulty communicating establish a form of communicating
(e.g. raising hand)
Avoid techniques that cause the client to rock or shake
CI/precautions TBI/seizure
AVOID ROCKING/SHAKING
avoid intense techniques
avoid stimulatory tx if goal is to sedate
