Physiotherapy Lead Rehabilitation Of A Traumatic Head Injury e.g. Post Motor Vehicle Accident
Over the coming weeks I am going to discuss the management of people who have suffered a traumatic head injury. Initially and briefly, I will discuss the acute management of the person, which is somewhat similar irrespective of the severity of the injury. The rehabilitative stage is much more complex, nuanced and individualized to the persons cognitive, behavioral and sensorimotor needs and therefore will be discussed in more detail. Here, the path I will take is to deliberate the management guidelines for the many deficits that may be presented after a motor vehicle accident.
The initial concern and priority is quite obviously preservation of life. Concerned people and health care professionals must do this, then prevent further damage by determining the severity of the injury and the primary concerns, locations of damage etc. Due to the fact the person more than likely will be in shock and hypoxic (in an oxygen deficit) an accurate neurological function assessment is neither possibly nor vital acutely. The acute priorities are:
- Is there a functioning airway present?
- Are they oxygenated?
- Is there a sufficient arterial blood pressure and blood circulation?
These are vital for survival, the person will not survive for long without sufficient oxygen and if blood pressure and supply is not being maintained. Level of consciousness should be assessed using the Glasgow Coma Scale and following a now important, thorough but speedy neurological assessment the cervical spine and skull must be assessed. If transportation is now safe the person will be moved to undergo specialized tests and radiography to include ongoing monitoring of intracranial blood pressure.
Physiotherapy
Initially physiotherapy involves:
- Maintaining optimal lung function
- Prevention of contractures
- Implementing positional change protocols to prevent skin breakdown
- Postural drainage of lungs
- Percussion and vibration work can be utilized
- Passive range of movement work to reduce deformity
- Splinting and casting
The importance of the above cannot be overstated. Deformities lead to much more complex therapy down the line and must be reduced where possible acutely. Pressure sores and skin deformities can lead to infection and the associated serious issues. Lung function is quite obviously a primary concern as impaired use can lead to infection and worse. Physiotherapy is vital and imperative at this stage and will improve short and long-term function.