Physiotherapy intervention in traumatic brain injury

A head injury is any sort of injury to the brain, skull, or scalp. It can result 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. This can range from a mild bump or bruise to a traumatic brain injury. Common head injuries include concussions, skull fractures, and scalp wounds. The consequences and treatments vary greatly, depending on what caused your head injury and how severe it is.

Head injuries may be either closed or open. A closed head injury is any injury that does not break your skull. An open (penetrating) head injury is one in which something breaks your scalp and skull and enters your brain.

Symptoms of traumatic injury

• A headache a persistent or worsening headache, Lightheadedness, and nausea.
• A spinning sensation, mild confusion
• temporary ringing in the ears, balance, or coordination problems.
• A loss of consciousness, seizures
• serious disorientation
• an inability to focus the eyes, or abnormal eye movements.
• a loss of muscle control
• memory loss
• changes in mood
• leaking of clear fluid from the ear or the nose

Causes of head injury

Head injuries can be divided into two categories based on what causes them. They can either be head injuries due to blows to the head or head injuries due to shaking. Head injuries caused by shaking are most common in infants and small children, but they can occur any time you experience violent shaking.

Head injuries caused by a blow to the head are usually associated with:

• motor vehicle accidents
• falls
• physical assaults or sports-related accidents

In most cases, the skull protects the brain from serious harm. However, injuries severe enough to cause head injury can also be associated with injuries to the spine.

Types of head injury

Hematoma: A hematoma is a collection, or clotting, of blood outside the blood vessels. It can be very serious if a hematoma occurs in the brain. The clotting can lead to pressure building up inside your skull. This can cause you to lose consciousness or result in permanent brain damage.

Concussion: A concussion occurs when the impact on the head is severe enough to cause brain injury. It is thought to be the result of the brain hitting against the hard walls of your skull or the forces of sudden acceleration and deceleration. The loss of function associated with a concussion is temporary. However, repeated concussions can eventually lead to permanent damage.

Edema: Any brain injury can lead to edema or swelling. Many injuries cause swelling of the surrounding tissues, but it is more serious when it occurs in your brain. Your skull cannot stretch to accommodate the swelling. This leads to pressure buildup in your brain, causing your brain to press against your skull.

Skull fracture: Unlike most bones in the body, the skull does not have bone marrow. This makes the skull very strong and difficult to break. A broken skull is unable to absorb the impact of a blow, making it more likely that there will also be damage to the brain. 

Diffuse axonal injury: A diffuse axonal injury (sheer injury) is an injury to the brain that does not cause bleeding but does damage the brain cells. The damage to the brain cells results in them not being able to function. It can also result in swelling, causing more damage. Though it is not as outwardly visible as other forms of brain injury, a diffuse axonal injury is one of the most dangerous types of head injuries. It can lead to permanent brain damage and even death.

Physiotherapy interventions

There are several approaches to neurological rehabilitation and physiotherapy post-traumatic brain injury. All rehabilitation process should observe neuroplasticity, motor learning, and motor control principles as well as the patient-centred approach with an individual’s goals setting and choice of treatment procedures.

Physiotherapeutic interventions can be grouped into three main categories:

• Restorative interventions focusing on reactivation of penumbra and diaschisis and restoring premorbid movements.
• Compensatory interventions focusing on optimal function enhancement using remaining skills to compensate the loss, i.e.: using non hemiplegic side for personal care.
• Preventative interventions focusing on reducing impairment and promoting general health, i.e.: respiratory physiotherapy enhancing chest health.

The categories include treatment techniques and activities like:

• Therapeutic exercises
• Manual therapy techniques like mobilizations or manipulations
• Application of equipment like orthotic or prosthetic devices, mobility aid, wheelchair
• Airway clearance techniques
• Functional training in self-care (ADLs) and home care
• Functional training at work, school, play and leisure activities including community reintegration.
• Use of physical agents and other modalities use like hydrotherapy, electrotherapy, cryotherapy.
• Integumentary protective techniques enhancing tissue viability.
• And finally discharge Planning.

It can be hard to assess how serious a head injury is just by looking. Some minor head injuries bleed a lot, while some major injuries do not bleed at all. It is important to treat all head injuries seriously and get them assessed by a doctor.