Traumatic Brain Injury

Question 1

Definition of Traumatic Brain Injury and the Different Types?

Answer 1

an acquired transient/permanent neurological deficit resulting from external trauma:

• focal pathology (with contact) - falls/assault
• diffuse pathology (acceleration-deceleration) e.g. MVA

Question 2

Discuss Prognosis of TBI, and considerations on recovery?

Answer 2

Based on post-traumatic amnesia:
- period of time between incident and return of continuos
- Westmead PTA scale
memory/orientation.
mild with GCS 12-15 and PTA<24 hours = full recovery
moderate with GCS 9-11 and PTA 1-7 days = more prolonged
severe with GCS 3-8 initally and PTA 1-4 weeks = over months likely residual
very severe PTA>4 weeks = permanent deficits.

Seizure risk
RTD/RTW - return to driving and work - most need OT assessment

Question 3

What is the Assessment of someone who has come in with a TBI?

Answer 3

Neurological Impairment: • Common deficits
○ Visual Δ - esp diplopia (usually CN6 palsy), Δ accomodation, hemianopia
○ Anosmia (40%)
○ Balance / coordination difficulties, vertigo, dizziness
○ High-level word-finding difficulties
○ Focal neurological deficits

Observe for Medical Complications: 	• Common 
		○ SIADH / diabetes insipidus 
		○ Spasticity 
		○ Post-traumatic epilepsy (8%) 
			§ Open / penetrating injury 
			§ Large intracerebral bleeds 
			§ Early seizure (<7d)
			§ Risk ↓ to baseline after 2y 
		○ Heterotrophic ossification = abnormal bone around joints 
			§ Inflammatory signs 
			§ ↓movement 
			§ ↑spasticitiy 
			§ Confirmed w. triple phase bone scan 
			§ Rx = indocid 
		○ Psychiatric - depression 
	• Hydrocephalus 
		○ Suspected in fx ↓ / plateaus v. early in rehab
		○ NSx required 

Observe for cognitive/behavioural and QOL impairments too.

Question 4

What Westmead PTA scaling would indicate recovery from TBI?

Answer 4

can say they are out of it if they score 12/12 for 3 consecutive days. Test daily.