Physiotherapy management of head injury

Head trauma Treatment
Once the severity and nature of the head injury has been diagnosed, you'll be given appropriate treatment. A serious head injury must always be treated in hospital. This really is to minimise the chance of complications.
Initial treatment
When you turn up at the emergency department of the hospital or if you call an ambulance, the doctors or paramedics (people in the emergency medical services) treating you'll prioritise any injury which may be life threatening. This could mean:
• checking that the airway is clear
• checking that you're breathing, and starting cardio-pulmonary resuscitation (CPR or mouth-to-mouth) if you're not
• stabilising your neck and spine, for instance using a neck brace
• stopping any severe bleeding
• providing pain alleviation if you are in a lot of pain
• splinting any fractured or brittle bones (strapping them in to the correct position)
When you are stable, further treatment is going to be arranged, as necessary, including any tests you need to help determine the seriousness of your injury. See Diagnosing severe head trauma for more information about the tests you might have.
Observation
If you need to remain in hospital for observation, the doctors and nurses who're treating you will check:
• your Glasgow Coma Scale (GCS) score (a scale of three to 15 that assesses the extent of harm to your brain)
• the size your pupils (the black circles in the center of each eye) and whether or not they react to light
• how you can move your legs and arms
• your breathing
• your heart rate
• your blood pressure level
• your temperature
• the level of oxygen inside your blood
These checks is going to be made every 30 minutes until your GCS score is 15 (optimum score). A GCS score of 15 suggests that you know where and what you are, you can speak and move as instructed as well as your eyes are open. Following this, checks will be made less often.
Any changes in your problem or behaviour may also be closely monitored. If your condition worsens, you may want to have further tests, like a computerised tomography (CT) scan (a scan that creates images of the inside your body).
Cuts and grazes
For those who have any external cuts or grazes for your head, these is going to be cleaned and treated to avoid further bleeding or infection. Deep or large cuts may need stitches (sutures) to ensure that they're closed until they heal. Local anaesthetic (a painkilling medication) enables you to numb the area round the cut so that you don't feel any pain.
Neurosurgery
Neurosurgery is any type of surgery that is used to deal with a problem with the central nervous system (the brain, spinal cord and nerves). In the event of severe head trauma, neurosurgery is usually carried out around the brain.
Neurosurgery is required in 1-3% of individuals with a severe head trauma. Every year in the UK, approximately just under 4,000 individuals have neurosurgery following a head injury.
Possible causes of neurosurgery include:
• a haemorrhage (severe bleeding) within your head, which puts pressure around the brain and may lead to brain injury (brain damage) and, in severe cases, death
• a haematoma (blood clot) within your head, which can also put pressure around the brain
• cerebral contusions (bruises on the brain), which could develop into blood clots
• skull fracture (see below)
These conditions is going to be identified during tests, like a CT scan, and a neurosurgeon (a specialist in surgery from the brain and central nervous system) may come and talk to you or your family about whether surgical treatment is necessary.
As the above conditions could be serious and may require urgent treatment, in some instances there may not be time for you to discuss the surgery prior to it being carried out. After the operation, your surgeon will require the time to discuss the facts of the surgery with you and your family.
One possible kind of surgery that may be required is really a craniotomy.
Craniotomy
A craniotomy is a type of surgery which involves making a hole inside your skull (the bone in your mind that surrounds your mind) so that the surgeon can access your mind. This will be carried out under general anaesthetic so you are unconscious and can't feel anything.
When your surgeon has access to your mind, they will remove any thrombus that may have formed and repair any damaged arteries. Once any bleeding within your brain has stopped, the bit of skull bone is going to be replaced and reattached.
Other surgical treatments
Depending on the type of harm to your brain, there are a number of other possible surgical treatments. Ask your surgeon to learn more or see below for those who have one of these conditions:
• A subdural haematoma is really a blood clot that forms within the space between the brain and also the skull.
• A subarachnoid haemorrhage is where blood leaks from blood vessels over the top of the brain.
Skull fractures
Your skull can fracture (crack) throughout an injury to your head. Should this happen, you will usually have an X-ray to look for the extent of the injury.
You will find different types of skull fractures, including:
• simple (or closed) fracture, in which the skin has not broken and also the surrounding tissue isn't damaged
• compound (or open) fracture, in which the skin has broken and also the surrounding tissue might be damaged
• linear fracture, in which the break in the bone appears like a straight line
• depressed fracture, where area of the skull is crushed inwards
Open fractures might be more serious because there is high risk of infection when the skin is broken. The reason being bacteria could go into the wound through the open skin. Depressed fractures can also be more serious because small bits of bone can press inwards from the brain.
Treating skull fractures
Most skull fractures will heal on their own, particularly if they are simple, linear fractures. The recovery process can take many months, although any pain will often disappear in around 5-10 days.
When the fracture is open, you might be prescribed antibiotics (medicines to deal with infections that are brought on by bacteria) to prevent contamination.
If the fracture is extremely severe or depressed, you may want to have surgery to assist prevent any harm to the brain. This will usually be completed under general anaesthetic.
On your operation, any bits of bone that have been pressed inwards can be taken off and returned for their correct position. If required, metal wire or mesh enables you to reconnect the bits of your skull.
When the bone is back in position, it should heal naturally. If you want, your surgeon will show you the procedure that you are having in greater detail.
After surgery
For the way serious your operation was, you may want to recover in an intensive care unit (ICU). This can be a small, specialised ward where your problem will be constantly monitored.
Within an intensive care unit, you might be placed on a ventilator. It is really an artificial breathing machine that moves oxygen-enriched air interior and exterior your lungs. The ventilator gets control some of your body’s usual responsibilities, for example breathing, giving the body time to recover.

Physiotherapy management of head injury

Physiotherapists work, included in a multidisciplinary team, with younger inpatients and outpatients who've acquired brain injury. The aims will be to maximise patients' physical recovery and functional outcome. Physically including retraining activities for example bed mobility, sitting and standing balance, transfers, walking and running. We facilitate the opportunity of patients to return to usual activities of everyday living, sport and work.

Inpatients and Daily Therapy
Because of the nature of brain injury and also the complexities of the presenting neuro-motor problems the great majority of patient treatment sessions are carried out on an individual basis.
Physiotherapists use their patients to improve the caliber of movement, posture and balance carrying out a brain injury. The physiotherapist can advise and help with:
• Positioning and movement of limbs to keep full range of movement and stop contractures
• Ensuring that paralysed limbs are situated to prevent damage to joints and soft tissue
• Assess the seriousness of impairment (due to neurological injury or disease)
• The control over abnormal movement patterns
• Retraining quality movement in standing and sitting
• Training in safe transfer techniques
• Facilitating walking
• Challenging and retraining balance and dynamic skills eg running
• Patient and relative/carer education concerning the impact of the injury/disease
• Management of vestibular problems / dizziness
• Determine the requirement for ongoing rehabilitation or suitability for safe discharge in to the community.
Our clinic is fully accessible and contained inside the ward itself. This permits us to provide neurological assessments / treatment to clients of levels of disability. The clinic has excellent facilities for neurological rehabilitation including:
• Large first floor level access treatment area
• Specialist standing hoist- good for patients who have not represented a while
• Mobility Hoist - Ideal for patients of all amounts of mobility.
• Rehabilitation Treadmill - created for use in rehabilitation centres to be used in people relearning just to walk.
• Parallel walking bars
• Bobath Plinths - the therapy couch for neurological physiotherapists
• Tilt table - strengthens bones and muscles in patients who're unable to stand.
• Walking sling - enables those vulnerable to falls or not able to take their full weight just to walk safely.
• Functional electronic stimulation - electrotherapy machines popular in the treatment of drop foot.
• Access to personal assessment and treatment rooms.
• Large ½ model car for transfer training.
Complications of head trauma

Severe head injuries may cause serious complications. This really is mainly because a serious problems for the head can potentially damage the mind, sometimes permanently.
In particularly severe cases, a significant head injury can result in death. For this reason your condition will be observed at close range when you are admitted to hospital. This can allow any complications that arise to become dealt with promptly and effectively.
Infection
In case your skull is fractured throughout a head injury, your chance of developing an infection might be increased. Skull fractures will often tear the membrane (the thin layer of cells) that surrounds the mind. If this happens, bacteria can go into the wound and cause contamination.
It is important to keep any external wounds in your head clean so they do not become infected. You might be prescribed antibiotics (medicines to deal with infections that are brought on by bacteria).
Coma
A coma is to are unconscious and unresponsive for a long period. Some people who have a serious head injury may enter a coma. Most comas only serve you for a few days or weeks, but sometimes they are able to last for years.
Many people get over comas. However, in some severe cases, the individual never regains consciousness or adopts a vegetative state.
Vegetative state
An individual in a vegetative state might seem to be awake and could show some limited physical response, however they have no awareness of their surroundings. They might be able to breathe or eat by themselves, but they cannot speak or know very well what is said to them.
Headway, the mind injury charity, estimates that at any particular amount of time in the UK, there are around 100 folks a vegetative state.
Brain injury
A serious head injury can damage the brain in a number of ways. For example, a blood clot may form and set pressure on the brain. This may lead to a variety of complications. Some kinds of brain injury are just temporary, whereas others lead to permanent damage. The result of any brain injury is determined by:
• where on the head damages occurs
• the type of injury, for instance if the skull is fractured
• the harshness of the injury, for example whether it requires surgery
The various effects of a brain injury are described below.
Physical effects
Physical results of a brain injury may include difficulty moving or keeping balance and loss of co-ordination. You may even experience headaches or increased tiredness.
Hormonal effects
Some head injuries can harm the pituitary gland. The anterior pituitary gland is a pea-sized gland in the middle of the head. It hangs underneath the brain and produces hormones (powerful chemicals which have a wide range of effects on our bodies). If the pituitary gland is damaged, it might lead to the low manufacture of hormones.
Sensory effects
Your senses might be affected by a head trauma. For example, you may lose your feeling of taste or smell. You may even notice blind spots inside your vision or you might not be able to control your body's temperature as well as before, so you feel too hot or freezing.
Cognitive effects
Carrying out a head injury, your ability to consider, process information and solve problems might be affected. You may also experience memory problems, particularly together with your short-term memory, and have difficulty together with your speech and communication skills.
Emotional or behavioural effects
Following a severe head injury, you might experience changes for your feelings and behaviour. For instance, you may have feelings of irritation, anger or selfishness.
You might be less sensitive to other people’s feelings or lose your inhibitions and behave in a manner that other people may not consider appropriate. You may even laugh or cry a lot more than before the injury.
Getting support
As everyone’s brain injury will change, it is a good idea to find further information about the potential side effects and rehabilitation techniques. Numerous charities and organisations might be able to help. You can find information on these in the useful links (above right).