Head injuries can lead to trauma to the skin, bone, or brain tissue in the head area. Conditions that develop damage to the brain due to an external force are called traumatic brain injury. It is most commonly caused by traffic accidents, falls, sports accidents and acts of violence. Signs of traumatic brain injury must be noticed in people who have suffered such injuries; because it requires immediate treatment. Recovery after traumatic brain injury is one of the special interests of physical therapy and rehabilitation.
Trauma can cause direct or indirect damage to the brain. Damage to the brain tissue due to the direct effect of the impact is direct damage. Direct damage occurs at the time of injury or within a very short time. Indirect injury occurs due to circulatory and metabolic disorders. It can take effect within hours, days or weeks. Indirect injuries can be prevented or lessened with good medical care.
Minor injuries lead to concussion, known as a concussion. In concussions, no physical damage can be detected, but disturbances in brain functions are seen, sometimes lasting for just a few seconds, sometimes for a few months.
Symptoms such as headache, loss of consciousness for a few seconds or minutes, not remembering what happened during the injury process, changes in the senses of hearing, sight, taste and smell, lack of attention, confusion, emotional fluctuations, and fatigue can be seen in concussion. Concussions usually get better. However, being traumatized for the second time before recovering from a concussion can lead to a deadly condition called “second blow syndrome”. Therefore, the rest period is very important.
Traumatic Brain Injury Symptoms
Signs of moderate or severe traumatic brain injury in a person with a head injury include:
- Headache that does not go away and gets worse
- Nausea and multiple vomiting
- speech disorder,
- Loss of consciousness for more than a few minutes and inability to wake up
- Dilation of one or both pupils
- numbness in arms or legs,
- Confusion and worsening of irritability.
Emergency Treatment of Traumatic Brain Injury
In the patient with traumatic brain injury and related loss of consciousness, first of all, it is ensured that the airway is open, as in all emergency situations; respiratory and circulatory functions are checked and if there are deficiencies, appropriate intervention is made. The depth of coma is evaluated with an examination-based method called the “Glasgow coma score” in patients with blurred or closed consciousness. Brain damage is initially visualized by computed tomography (CT). CT is examined for signs of potentially fatal problems such as intracranial bleeding, edema, and herniation. In order to prevent the increase in intracranial pressure, patients can be temporarily put to sleep with drugs and respiratory support can be provided during this period. The patient is usually followed closely in the intensive care unit and the neurosurgeon decides whether or not he needs surgery.
Additional Problems That May Occur in the Early and Late Period in a Person with Traumatic Brain Injury
Consciousness disorders, seizures (epilepsy), impaired blood pressure, heart rate and body temperature control (autonomic dysfunctions), accompanying cranial nerve injuries, ossification that may cause pain and joint limitation in muscles or other soft tissues called heterotopic ossification, clot formation in leg veins ( deep vein thrombosis) and this clot breaking off and blocking the pulmonary vessels (pulmonary embolism), problems with urination, swallowing and feeding problems, involuntary stiffness and contractions in the muscles (spasticity), muscle weakness, hormonal system disorders, deterioration of salt balance in the blood, psychiatric problems, memory and attention loss.
Physical Therapy in Traumatic Brain Injury
Traumatic brain injury is a problem in which the brain is affected, such as a stroke. Although the symptoms of traumatic brain injury are similar to stroke, they have their own characteristics. Therefore, patients with traumatic brain injury need treatment by a multidisciplinary rehabilitation team headed by a physical therapy and rehabilitation physician who is specialized and experienced in the field. In addition to the specialist physician, the rehabilitation team includes health professionals such as rehabilitation nurse, physiotherapist, occupational therapist, speech therapist, orthotic prosthesis technician, social worker. When necessary, the patient can be consulted to departments such as neurology, neurosurgery, psychiatry and internal medicine. The rehabilitation program is specially planned for each patient in accordance with his or her clinical condition. In other words, planning is made according to the course of the treatment.