ASSIGNMENT No # 2

Neurological Physical therapy

Topic: Traumatic brain injury
Submitted to : Dr. Hira Majeed
Submitted by : Alisha Farasat
Roll no : 70106604
Semester : 8th
Section : A

The University of Lahore, Lahore

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Traumatic brain injury:
Definition:
Traumatic brain injury usually results from a violent blow or jolt to the head or
body. An object that goes through brain tissue, such as a bullet or shattered piece
of skull, also can cause traumatic brain injury.

Symptoms depend on severity of injury:

Mild traumatic brain injury may affect your brain cells temporarily. More-serious
traumatic brain injury can result in bruising, torn tissues, bleeding and other
physical damage to the brain. These injuries can result in long-term complications
or death.
Types of traumatic brain injury:
1.Concussions:

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Concussions are the most common type of traumatic brain injury. When a strong
force strikes your head, your brain moves in the direction of the force until it
collides with your skull, causing damage.
Symptoms of Concussions:
Symptoms can range from mild to severe, and in some cases can even cause life-
long difficulties.
If concussion symptoms persist for longer than a month, then you most likely have
developed post-concussion syndrome. Fortunately, there are ways to manage this
condition with certain post-concussion syndrome treatments.

2. Contusions:
These often accompany concussions. A contusion is essentially a bruise on the
brain, which means it is a mild form of bleeding. One type of contusion where
injury occurs in two parts of the brain is referred to as a coup-countercoups injury.

If a contusion does not heal on its own, it can turn into a hematoma, which doctors
can remove through surgery.
The damage a contusion causes depends on its size, location, and how long it lasts.

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3. Brain Hemorrhages:
A brain hemorrhage refers to uncontrolled bleeding on the surface of the brain or
within the brain tissue itself. Hemorrhages that occur in the space surrounding the
brain are known as subarachnoid hemorrhages, while those that originate in the
cerebral matter are called intracerebral hemorrhages.

Hematomas:
Hematomas are collections of blood outside of blood vessels. Large hematomas
that occur in the brain can lead to serious injury and even death if left untreated.
Types of hematomas:
There are several different types of brain hematomas, including:
Epidural hematomas: Blood collection between the skull and brain
Subdural hematomas: Blood collection under the thin layer of protection
surrounding the brain
Intracerebral hematoma: Collection of blood within the brain itself
In some cases, hematomas do not develop until several days or weeks after a head
injury.

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Symptoms of hematomas:
Symptoms of hematomas include vomiting, severe headache, unequal pupil sizes,
and slurred speech. If you experience any of these symptoms after your brain
injury, call your physician immediately.
5. Coup-Contrecoup Brain Injury:
Another serious type of traumatic brain injury is known as a coup-contrecoup
injury. The terms coup and contrecoup are French for “blow” and “counterblow.”
Therefore, a coup-contrecoup injury actually refers to two separate injuries.
Coup injury:
Coup injury which occurs directly under the point of impact.

Countercoup injury:

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Countercoup injury which occurs on the opposite side of the brain from where the
blow struck.

Causes of coup countercoup injury :

Most coup-contrecoup injuries occur when the person’s head slams against a
stationary object, such as a steering wheel. When the skull hits the object, the brain
moves forward until it collides with the front of the skull. Then, due to the strength
of the impact, it rebounds off the front of the skull and strikes the back, causing a
second impact.

6. Diffuse Axonal Injury (DAI)

Diffuse axonal injuries are one of the most severe types of traumatic brain injury.
They occur when the brain is shaken or twisted inside the skull. As the brain twists,
the cerebral tissue slides back and forth until the long connecting fibers in the brain

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(called axons) tear. Doctors refer to this as axonal shearing. The axonal shearing
disrupts messages that neurons send, resulting in loss of function.

7. Penetrating Brain Injury:

These injuries occur when an object penetrates the skull and brain, most
commonly a bullet.

People with penetrating head wounds often experience seizures and are more likely
to develop epilepsy after TBI than people with other types of brain injuries.
Never remove an object lodged in someone’s skull until they have been assessed
by a doctor, as that could worsen the bleeding and cause further damage.
8. Second Impact Syndrome:
Also called a recurrent traumatic brain injury, this type occurs when you suffer a
second brain injury shortly after your first one.
The second injury usually causes more severe damage than the first one and can
have devastating effects on a person’s health.

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Symptoms:
Traumatic brain injury can have wide-ranging physical and psychological effects.
Some signs or symptoms may appear immediately after the traumatic event, while
others may appear days or weeks later.
Mild traumatic brain injury:
signs and symptoms of mild traumatic brain injury may include:
Physical symptoms:
 Headache
 Nausea or vomiting
 Fatigue or drowsiness
 Problems with speech
 Dizziness or loss of balance
Sensory symptoms:
 Sensory problems, such as blurred vision, ringing in the ears, a bad taste in
the mouth or changes in the ability to smell
 Sensitivity to light or sound

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Cognitive, behavioral or mental symptoms:
 Loss of consciousness for a few seconds to a few minutes
 No loss of consciousness, but a state of being dazed, confused or disoriented
 Memory or concentration problems
 Mood changes or mood swings
 Feeling depressed or anxious
 Difficulty sleeping
 Sleeping more than usual
Moderate to severe traumatic brain injuries:
Moderate to severe traumatic brain injuries can include any of the signs and
symptoms of mild injury, as well as these symptoms that may appear within the
first hours to days after a head injury:
Physical symptoms:
 Loss of consciousness from several minutes to hours
 Persistent headache or headache that worsens
 Repeated vomiting or nausea
 Convulsions or seizures
 Dilation of one or both pupils of the eyes
 Clear fluids draining from the nose or ears
 Inability to awaken from sleep
 Weakness or numbness in fingers and toes
 Loss of coordination
Cognitive or mental symptoms:
 Profound confusion
 Agitation, combativeness or other unusual behavior
 Slurred speech
 Coma and other disorders of consciousness

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Children’s symptoms:
Infants and young children with brain injuries might not be able to communicate
headaches, sensory problems, confusion and similar symptoms. In a child with
traumatic brain injury, you may observe:
 Change in eating or nursing habits
 Unusual or easy irritability
 Persistent crying and inability to be consoled
 Change in ability to pay attention
 Change in sleep habits
 Seizures
 Sad or depressed mood
 Drowsiness
 Loss of interest in favorite toys or activities
Causes:
Common events causing traumatic brain injury include the following:
Falls:
Falls from bed or a ladder, down stairs, in the bath, and other falls are the most
common cause of traumatic brain injury overall, particularly in older adults and
young children.
Vehicle-related collisions:
Collisions involving cars, motorcycles or bicycles — and pedestrians involved in
such accidents — are a common cause of traumatic brain injury.
Violence:
Gunshot wounds, domestic violence, child abuse and other assaults are common
causes. Shaken baby syndrome is a traumatic brain injury in infants caused by
violent shaking.
Sports injuries:

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Traumatic brain injuries may be caused by injuries from a number of sports,
including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and
other high-impact or extreme sports. These are particularly common in youth.
Explosive blasts and other combat injuries:
Explosive blasts are a common cause of traumatic brain injury in active-duty
military personnel. Although how the damage occurs isn’t yet well understood,
many researchers believe that the pressure wave passing through the brain
significantly disrupts brain function.

Risk factors:
The people most at risk of traumatic brain injury include:
 Children, especially newborns to 4-year-olds
 Young adults, especially those between ages 15 and 24
 Adults age 60 and older
 Males in any age group

Rehabilitation of Traumatic brain injury:

Treatment for traumatic brain injury will depend on the type and severity of your
injury. If the injury only caused mild bruising, you will be sent home to rest. After
a few days, you can gradually return to your normal activities.
Severe Injury treatment:
If the injuries were more severe, treatment may take much more time and effort,
but recovery is still a real possibility. Therapy will mainly focus on activating your
brain’s neuroplasticity, which will allow you to regain function.
Neuroplasticity:
Neuroplasticity refers to the brain’s ability to reorganize neural pathways to allow
undamaged areas of the brain to take over function from damaged ones.
You can activate neuroplasticity through task-oriented, repetitious exercise.

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The following are a few of the best therapies that utilize these techniques:
Speech therapy:
If your injury caused aphasia, begin speech therapy right away. A speech therapist
can teach you how to retrain your brain and regain language skills. You will also
require speech therapy if you have any cognitive deficits following your TBI
(which most people do).
Physical and occupational therapy:
These therapies can help you recover muscle strength and coordination after a
traumatic brain injury, and get you back to engaging in your typical daily tasks
with more independence.
Cognitive training:
Training can help improve memory, attention, problem-solving, and learning skills.
Cognitive training will likely be incorporated into all of your therapies in some
way, but speech therapy and occupational therapy will address cognition the most.

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