Assessment of Traumatic Brain Injury

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Original Editor - Wendy Walker

Top Contributors - Wendy Walker, Kim Jackson, Naomi O'Reilly, Vidya Acharya, Eugenie Lamprecht, Rachael Lowe, Uchechukwu Chukwuemeka, Admin, Tarina van der Stockt, Simisola Ajeyalemi, Nicole Hills and Olajumoke Ogunleye  

Preparation for Physiotherapy Assessment

Physiotherapy assessment commences once the patient is medically stable.

In view of the complexity of many patients with TBI, the assessment is frequently unable to be completed within a single session so is ongoing for the first few physiotherapy sessions. Close liaison with other members of the multidisciplinary team is extremely beneficial, and on occasion joint assessments by 2 or even 3 therapists from different disciplines can be beneficial.

Handling during Ax

In the initial stages following TBI, careful handling is essential when assessing patients, especially if they are in a minimally conscious state.

Information required before starting the assessment

The following information should be provided by the medical team before beginning the physiotherapy assessment:

• State of consciousness of the patient - for further information see the Coma Recovery Scale page
• Areas of the brain injured, including diffuse and secondary injury
• Site of Decompression Craniotomy, if this has been performed on the patient
• Any other injuries sustained - patients who have TBI from road traffic accidents frequently also have a range of musculoskeletal, abdominal and chest injuries
• Any impact on cognition of the patient - neuropsychological assessment is indicated

Areas of Assessment

Abnormal Muscle Tone

The major abnormalities in muscle tone encountered in this popularion are hypertonicity and spasticity.

It is noticeable that, in contrast to Stroke when there is often a period of low tone before high tone develops, in cases of severe TBI hypertonicity and spasticity can develop very quickly, sometimes as early as one week post TBI. The symptoms may start to occur as sedation is reduced, or as the patient emerges from coma. A recent study concludes that "Signs of spasticity can often be noted within the first 4 weeks after brain injury and is more common in the upper than lower extremity. Impaired sensorimotor function is a predictor"

Approximately 18% to 30% of all TBI patients suffer from spasticity that requires treatment. Studies show that in the region of 85% of people with severe TBI demonstrate significant spasticity at a level which induces contracture.

Muscle Paresis

Muscle paresis very common following TBI

Movement Disorders

Ataxia, dyspraxia, dyskinesia, or reduced motor control

Balance and vestibular dysfunction

This is very common in TBI, and varies enormously in degree

Secondary Effects

• Reduced joint and muscle range of movement occur as a result of a combination of factors, including prolonged bed-rest, hypertonicity and spasticity, and in some cases as a result of musculoskeletal injuries sustained in the accident

• Pain may occur as a result of spasticity and hypertonicity

References