Diagnostic Grouping: Traumatic Brain Disorders

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Ruth Allison
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1 Diagnostic Grouping: Traumatic Brain Disorders Brittany Livengood and Emily Lineberger Specific Type Names of disorders in this category Traumatic Brain Disorders Closed : This happens when the head thrusts forward and then suddenly decelerates causing the brain to hit the frontal and occipital lobe. (For example: A mountain biking accident and the contact with a tree or rock.) Opened : Occurs when an object fractures the skull and then enters the brain and damages the brain tissue on impact. (For example: getting hit in the head with a bullet.) Penetration : Occurs when the impact of a knife or other sharp object forces fragments from the object into the brain Acquired : An acquired TBI can result from moderate damage to the brain such as stroke, tumors, toxins, near drowning, or degenerative diseases. Anoxia : Brain injury where the brain does not receive oxygen Hypoxic : Brain injury where the brain receives some oxygen, but not enough. Concussion : Occurs when the brain receives a sudden momentum or impact causing the blood vessels to stretch and can lead to cranial nerves being damaged.( For example: playing football.) Contusion : Is a direct impact on the brain which causes a bruise or bleeding on the brain. Coup-Contrecoup : Are contusions that are at the site of impact and on the opposite side of the brain. Caused when the force impacting the head is great enough to cause a contusion at the site of impact, but moves the brain and causes it to slam into the other side of the skull therefore causing another contusion. Diffuse Axonal : Brain injury caused by strong rotations or shaking of the head which causes the brain structures to tear. (For example: shaken baby syndrome or a car accident.) Levels of Brain Injury Mild TBI : A mild traumatic brain injury happens when the loss of consciousness occurs during a very short time or not at all, or

2 when scans of the brain may appear normal. A mild TBI must have some type of change in mental status or stability. Although a mild TBI is the least intense form of TBI, multiple mild TBI s in a small amount of time can still be fatal. (EX: Whiplash, Concussion) Moderate TBI : A moderate TBI is typically non-penetrating and can result in loss of consciousness from a few minutes to maybe even a few hours, confusion that can last up to a few weeks and physical or mental impairments and disabilities that can either last for a few months or permanently. (EX: Shaken Baby Syndrome) Severe TBI : A severe TBI typically occurs when there is an extreme blow or penetrating injury to the brain tissue. A severe TBI causes the most intense and life threatening injuries out of all types of TBI. Although closed head injuries can also result in severe TBI s, the most common type of severe TBI is when the skull has been fractured or crushed in some way. Once a severe TBI has occurred there is a very small chance that the patient will be able to return to their previous lifestyle. Typical Symptoms Mild TBI Symptoms : Loss of consciousness for less than 30 minutes Headache Difficulty Thinking Memory loss Attention Deficits/ Concentration Mood swings Frustration Fatigue Visual Disturbances Sleep disturbances Dizziness/ Balance issues Feelings of Depression Seizures Nausea Loss of smell Sensitivity to light or sound Moderate-Severe TBI Symptoms :

3 Persistent headache vomiting/ nausea Slurred speech Convulsions Seizures Inability to wake from sleep Enlargement of pupils Numbness in extremities Loss of coordination Confusion Restlessness/ Agitation Loss of consciousness that can last from a few minutes up to a few hours Memory loss Frustration Anticipated Assessment findings Medications and Side effects Sustaining attention Concentrating on a task Speech and learning Memory loss Limited motor skills Emotional mood swings/ personality change Aggression Lack of motivation Depression Vision problems Fatigue Balance Currently there are no medications to treat TBIs although there are several medications to treat TBI symptoms, such as: Anti-Convulsant Ex: Sodium valproate, neurontin, and topiramate Symptoms include: alopecia, amnesia, anorexia, ataxia, confusion diploplia, drowsiness, dysarthria, insomnia, nausea, nystagmus, tremor, vomiting, and weight gain. Anti-Depressant Ex: citalopram, amitriptyline, and paroxetine

4 Symptoms include: blurred vision, cardiac palpitations, confusions, constipation, dizziness, drowsiness,dry mouth, gastrointestinal disturbance, hypotension, insomnia, numbness, seizures, skin rash, tremor, and urinary retention. Anti-Psychotic Ex: quetiapine Symptoms include: blurred vision, dizziness, dry mouth, dystonia, headache, hypotension, parkinsonism, tremor, urinary retention,and weight gain. Pain management Ex: ibuprofen and naproxen sodium Symptoms include: burning sensation, constipation, dizziness, gastrointestinal irritation and bleeding, heartburn, nausea, Reye s syndrome, sedation, tingling sensation, and vomiting There are also several medications that may be used to prevent further damage to the brain directly after injury, such as: Diuretics help reduce pressure inside brain Ex: Thiazide Symptoms: low/ high potassium levels in the blood, low sodium levels, headaches, dizziness, muscle cramps, skin rash, gout, diarrhea Anti-Seizure medications Given to avoid any additional brain damage that could be caused by a seizure. Coma Inducing Drugs Puts patient into temporary coma so that their comatosed brain will need less oxygen - used in situations where the brain may not be getting all of the nutrients it needs anyways Impacts on each domain Cognitive Domain Thinking and processing- problem solving, reasoning, speed at which information is processed Attention- focus, concentration, multitasking, distractibility

5 Memory- Learning of new information and transferring the information into short term memory. Long term memory typically is not affected. Function- Difficulties in Goal setting, planning, organization, judgement and self monitoring can be present in someone with a TBI. Physical Domain Paralysis either moderate or severe Headaches Fatigue Functioning - balance, walking, muscle spasticity, writing, drawing, hearing, vision, impaired sensation and touch Social Domain Speech- that is slurred, to soft, word finding, or disjointed. In some severe cases they don t talk at all. Lack of social communication skills can cause difficulties in understanding nonverbal cues, sarcasm, facial expressions, and humor. Emotional/ Behavioral Domain Reactivity- overreacting or having a lack of emotion Emotional control- outburst, aggressive behavior, and agitation may occur Mood swings Anxiety depression Personality changes 3 General interventions and why Aquatic Therapy : Aquatic therapy can help those with traumatic brain injuries by utilizing the buoyancy in the water as well as hydrostatic pressure in order to make the client feel like they are exerting less energy or muscle strength. Aquatic therapy can help improve muscle strength, pain, range of motion, blood circulation, and attitude. Art Therapy : Art therapy can help those with TBI s by increasing activity psychologically, socially, physically, and cognitively. Art therapy can reduce anxiety, decrease isolation, increase fine motor

6 skills, increase hand-eye coordination, and ultimately improve memory and attention span (Malchiodi, C., 2013). Yoga : Yoga is a type of exercise that doesn t require any specific skill set. Some yoga can be done from a hospital bed, although the best part of yoga is that it can be adapted to your mental and physical abilities. Overtime yoga can help improve flexibility, balance, range of motion, mind-body connectivity, concentration, and overall quality of life. Three (3)measurable objectives Aquatic Therapy : After two weeks of 2 hour sessions, 4 days a week, client will be able to demonstrate improved muscle strength and range of motion to best of ability with minimal assistance from the CTRS. Art Therapy : After two weeks of art therapy in one hour sessions, 3 days a week client will demonstrate how to create a new color pallet from primary colors, while holding a brush, in order to improve memory and fine motor skills. Yoga : After four weeks of yoga therapy and thirty minute sessions five days a week, client will demonstrate Warrior One pose without use of chair or CTRS for balance. Test Questions 1. Brittany- A typical symptom of a mild Traumatic Brain Injury could include? a. Seizures b. Mood swings c. Loss of Smell d. All of The Above 2. Emily- Someone can get an Acquired Traumatic Brain Injury from? a. Shaken baby syndrome b. Car accident or mountain bike accident c. Stroke or tumors d. Bullet or rock

7 Balsiger, L. (n.d.). Traumatic Brain Injury - Effects and Impacts. Bend Language and Learning. Retrieved February 21, 2017 from Ellis, M., (16, November 7). Diuretics: What to Know. Retrieved March 02, 2017, from Malchiodi, C. (2013, August 31). Art Therapy and Mild Traumatic Brain Injury. Retrieved March 02, 2017, from Mild TBI Symptoms. (n.d.). Retrieved March 02, 2017, from Oeverman, S. (2012). Why Aquatic Therapy? Retrieved March 02, 2017, from Traumatic Brain Injury A to Z - TBI Medication Chart. (n.d.). Retrieved March 02, 2017, from te-to-severe-tbi/tbi-medication-chart Types and Levels of Brain Injury. (n.d.). Brain Injury Alliance of Utah. Retrieved February 21, 2017 from What are common TBI symptoms? (n.d.). Retrieved March 02, 2017, from

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