Traumatic brain injury is an injury to the brain caused by an external force . 

TBI is  classified according to its sensitivity mildmoderate or severe . 

From a medical perspective there is Glasgow Coma Scale which assess motor , verberal eye opening response. 

The scale runs from 3-15.

3 is for dead or coma state .

15 is normal.

13-15 is the mild case.

Concussion is considered as mild TBI 

Loss of consciousness , (>30 min) ,amnesia , memory loss formore than 24 hours is the  case of mild to severe TBI MAJOR CAUSE

TBI is the commonest cause of death and disability in humans.·        

  • Suicide ·        
  • Assault·        
  • Struck by objects ·       
  •  Motor vehicle accidents ·        
  • Fall ·        
  • Others 

RISK FACTORS Everyone is at equal risk in case of TBI  but young age men , old age group peoples and small children are at greater risk. 

TYPES OF TBI 

  • CLOSED BRAIN INJURY No break in skull , caused by a rapid forward or backwardmovement and shaking of brain inside the bony skull that results in bruising andtearing of brain tissue and blood vessels. Shaking baby Syndrome is shaking ababy can result in closed brain injury.
  • PENETRATING BRAIN INJURY Break in skull for example , bucket pierces the brain .

SEQUELAE DEVELOPED FROM TBI 

  • Hematoma
  • Contusion
  • Intracellular hemorrhage 
  • Subarchnoid hemorrhage
  • Diffuse injuries
  • Diffuse axonal injuries
  • Ischaemia
  • Skull fracture

SYMPTOMS 

Mild TBI Symptoms  :-·        

  • Loss of consciousness ·        
  • Headache ·        
  • Confusion ·        
  • Light headedness·        
  • Dizziness·        
  • Blurred vision ·        
  • Ringing in the ears ·        
  • Bad taste in mouth ·        
  • Fatigue or lethargy ·        
  • A change in sleep pattern ·        
  • Behavioural or mood changes trouble with memory ,concentration , attention , or thinking 

Moderate to severe cases :- ·        

  • A Headache gets worse or doesnot go away.·       
  • Repeated vomiting or nausea ·        
  • Convulsions or nausea ·        
  • Not being able to wakeup from sleep·        
  • Larger than one pupil of one or both eye .·        
  • Slurred speech ·        
  • Weakness or numbness in arms or legs ·         
  • Loss ofcoordination ·        
  • Increased confusion , restlessness or agitation. 

TBI may results in :- ·        

Physically - Changes in movement control                             

  • Muscle weakness with reduce muscle tone                             
  • Overactivity/increase muscle tone                             
  • Incoordination ·        

Balance Difficulties :- 

  • problem in the abilityto remain upright                                        
  • Problem in the adjustment in the body and limbs.·        

Reduce endurance and general weakness ·        

Could be due to trauma or prolonged period ofhospitalization 

DIAGNOSIS ·        

  • Neurologic test ·        
  • Imaging test such as CT Scan  , MRI .·        
  • Glasgow coma scale to determine severity of TBI.·        
  • Neuropsychological test to check how brain isfunctioning.

TREATMENT

 For mild TBI the main treatment is the rest . 

For moderate to severe TBI , first important thing is toprevent any further injury . this manage your blood pressure , check thepressure inside your skull , and make sure that there is enough blood and oxygen getting to your brain . 

Treatment may include :- 

SURGERY·        

  • To relieve pressure in skull ·        
  • Remove hematomas ·        
  • Get rid of damaged or dead brain tissue ·        
  • Repair skull fracture 

MEDICINE ·        

  • Anticoagulants to prevent blood clots ·        
  • Anticonvulsants to prevent seizures ·        
  • Anti depressant to treat symptoms of depressionand mood instability ·        
  • Muscle relaxants to reduce muscle spasm ·        
  • Stimulants to increase alertness and attention 

PHYSIOTHERAPY IN TBI ·        

  • Therapeutic exercise ·        
  • Manual therapies like mobilisations ormanipulations ·        
  • Prescription and application of equipment like orthotic or prosthetic devices , mobility aid , wheel chair 
  • Airway clearance techniques ·        
  • Functional training in daily life activities,home care , workplace , play and leisure activities including community reintegration·        
  • Use of modalities like hydrotherapy ,electrotherapy , cryotherapy. 

PHYSIOTHERAPY MANAGEMENT CAN HELP WITH :-  ·        

  • Restoring muscle strength and joint stability .   
  • Reducing muscle spasms, contractures, stiff joints and associated pain . 
  • Improving balance (in sitting and standing) co-ordinationand normal patterns of movements·        
  • Re-education of walking ·        
  • Re-training of functional tasks , forexample  sit to standing turning to bed ,activities of daily living ·        
  • Reducing the risk of fall ·        
  • Restoring independence and quality of life ·        
  • Training and teaching of family members / carersinvolved with the rehabilitation process, for example manual handling , bed/bath / chair / toilet transfers , positioning techniques and exerciseprogrammes to maintain muscle strength , co-ordination and flexibility of softtissues.