Head injury means damage to any of the structures of the
head as a result of trauma.
As defined by National Head Injury Foundation of America,
Head Injury is “a traumatic insult to brain capable of
producing physical, intellectual, emotional, social and
The term “Head Injury” is most often used to refer to an
injury to the brain, that may also involve the bones, muscles,
blood vessels, skin or other organs of the face or head.
9. MECHANISM OF INJURY…
Head impacts to a stationary object
Moving skull stops motion almost
However, brain, floating in cerebral
spinal fluid (CSF), briefly continues
moving in skull towards direction of
impact, resulting in significant forces that
10. MECHANISM OF INJURY…
Injury resulting from rapid, violent
movement of brain is called coup and
Coup: an injury occurring directly
beneath the skull at the area of impact.
Contra coup: injury occurs on the
opposite side of the area that was
A. Depending on the severity of the injury:
1. Mild Head Injury
2. Moderate Head injury
3. Severe Head injury.
We use Glasgow Coma Scale to interpret the severity of the
head injury. Glasgow Coma Scale (GCS) is a neurological
scale which aims to give a reliable and objective way of
recording the conscious state of a person for initial as well as
13. Glasgow coma scale…
Modified GCS for vocal responses from children under 5 years:
2-5 years Points <2 years
Words of any sort 5 Coos, smiles, cries
Monosyllables 4 Cries only
Cries or screams 3 Unstimulated screaming
Grunts 2 Grunts
None 1 None
B. Depending on the structures involoved in the injury, there
are 5 types. They are:
1. Brain contusion
2. Brain concussion
3. Skull fractures
4. Diffuse axonal injury
5. Intracranial hematoma.
The most common and least serious type of
traumatic brain injury is called a concussion.
The word comes from the
Latin concutere, which means "to shake
Here, the brain is pushed towards and against
Diffuse axonal injury:
Diffuse axonal injury occurs when
shearing, stretching and/or
angular forces pull on axons and
Impaired axonal transport leads to
focal axonal swelling and after
several hours may result in axonal
Decrease in venous return resulting in reduced ventricular filling
Increased sympathetic tone and hypercontractility of ventricles with under
Ventricular mechanoreceptor activation and feedback to Medulla(CNS) via
afferent vagus nerve
Sympathetic withdrawal, parasympathetic overdrive leading to bradycardia
26. CLINICAL FEATURES
Clinical manifestations come according to the area of damage of
the brain. Such as.
Damaged Frontal lobe:
Problem in intellectual activities.
Loss of ability to organize.
Problem in personality, behavior and emotional control.
Damaged Temporal lobe:
Problem in memory, speech and comprehension.
27. CLINICAL FEATURES…
Damaged Parietal lobe:
Inability to read and write
Difficulty to understand spatial relationship.
Damaged Occipital lobe:
Problem in vision.
Posture and trunk instability
Loss of body equilibrium and co-ordination of movements.
Change in rapid limb movements.
28. CLINICAL FEATURES…
Some features commonly found in head injuries:
Symptoms typically progress through three successive stages-
1. Coma : Severe head injury results in coma, a loss of
2. Post – traumatic amnesia : It is a stage of acute confusion
and the hallmark of this stage is cognitive impairment.
3. Recovery : recovery is characterized by progressive
improvement in cognitive and behavioral functions.
A complete neurological evaluation is performed to rule out
conditions requiring neurosurgical attention, such as
hematomas, depressed skull fractures, and elevated intracranial
pressure. Some diagnostic tools are used as:
Angiogram: A test to examine blood vessels in the brain.
ICP monitor: A device used to monitor intracranial pressure.
EEG: A test to measure electrical activity in the brain.
X-rays, MRIs, and CT Scans: to detect fractures, hemorrhages,
swelling and certain kinds of tissue injury.
There are three stages of treatment for head injury.
Acute – to stabilize the patient immediately after the injury.
Sub-acute – to rehabilitate and return the patient to
Chronic – to continue rehabilitation and treat the long – term
Unblocking the airway
Keeping the blood circulating
Cardiopulmonary resuscitation may be necessary.
Surgery is indicated if any blood clot causes increased
intracranial pressure in case of subdural hematomas and
Sub – acute treatment is provided after stabilization. Which ranges from
medical stability to patient’s return to the community or admission to a chronic
facility. The main goals of sub-acute treatment are:
Early detection of complications, such as:
1. Cranial nerve damage
4. Heterotopic ossification
5. Diabetes insipidus.
Facilitation of neurological and functional recovery
Prevention of additional injury.
Disabilities from head injury may last a lifetime, and different
interventions may be appropriate even many years later.
There are two categories of chronic treatment .
Community-based rehabilitation and return to work or school,
Treatment of long term consequences of the injury.
36. PHYSIOTHERAPY INTERVENTION FOR
Plan of care:
The purpose of the plan of care is to maintain an optimal
physical condition, thus providing a basis from which learning
and relearning may be enhanced. The components of a plan of
Control of posture – in lying, sitting and standing.
Maintenance of range of motion in joints.
Encouragement of remaining ability.
37. PHYSIOTHERAPY INTERVENTION FOR
The patient will have limited lung excursion due to loss of
function of respiratory muscle and poor postural control, and
this will predispose to chest infection. To prevent respiratory
complications, a physiotherapist can prescribe:
Breathing exercises : Deep breathing exercise, Breathing
control exercise, Active cycle of breathing technique.
Encouraging active coughing.
38. PHYSIOTHERAPY INTERVENTION FOR
Control of posture:
Posture while lying
Patients with asymmetrical, decerebrate posture and inability to
accept the support of the surface of the bed are vulnerable to
joint contractures, pressure sores and respiratory complications.
The presenting posture may be modified by providing
additional support such as pillows, wedges and foam rolls and
thus stability to the body segments.
41. PHYSIOTHERAPY INTERVENTION FOR
Posture while sitting
There are three typical postural
patterns in sitting:
1. C – shaped posture: This is a
slumped kyphotic pattern.
42. PHYSIOTHERAPY INTERVENTION FOR
2. Arched posture: The body is
arched backwards from the coccyx,
with an exaggerated lumbar
lordosis. Legs tend to flex, and
arms to extend. Inevitably the
buttocks will tend to lift and slide
43. PHYSIOTHERAPY INTERVENTION FOR
3. Asymmetrical posture: In this
posture the legs may be
windswept, the pelvis tilted and
rotate, and the trunk and the
side of the head flexed and
44. PHYSIOTHERAPY INTERVENTION FOR
The patient may display a combination of these
postures and most will adopt a preferred position in
sitting. If a patient is unable to provide own postural
support, it must be provided externally to provide
stable, balanced, symmetrical and functional position,
whilst relieving pressure and shearing forces.
45. PHYSIOTHERAPY INTERVENTION FOR
Posture while standing:
Standing is achieved by the mechanical
support of a tilt-able or standing frame,
when the joint range of the lower
extremities allow this to be a safe and
46. PHYSIOTHERAPY INTERVENTION FOR
Maintenance of Joint ROM:
Reduced ROM can lead to contractures and contribute to
asymmetrical posture and an unstable position. To maintain
ROM a physiotherapist can do to a patient:
Active facilitated and active movements.
If contracture is developed then splinting and serial casting
can help to stretch the contracted tissues.
47. PHYSIOTHERAPY INTERVENTION FOR
Encourage remaining ability:
Stimulating interest in task, providing an element of
competition and frequent repetition, may enhance
performance of even the most simple task. Leisure
activities are encouraged like swimming, archery and
table tennis. These activities will depend on the
patients ability to enjoy and/or take part in them.
48. PHYSIOTHERAPY INTERVENTION FOR
Other Physical therapeutic interventions required for head injury:
Inhibit abnormal patterns of reflex activity by :
2. Reflex inhibiting
Increase sensory stimulus by:
1. Encouraging awareness of surroundings
2. Afferent cutaneous reactions
3. Encouraging motivation
49. PHYSIOTHERAPY INTERVENTION FOR
Develop normal tone
Develop normal reactions
Facilitate voluntary movements
Reeducate functional activities by:
1. Choice and adaptation of activities which do not conflict
with other principles of movements.
2. Choice and use of aids.
50. HEAD INJURY PATIENTS IN
NUROLOGY UNIT of PT DEPARTMENT
exercise with the
help of Theraband.
Prognosis depends on several indicators to predict the level of
patient’s recovery during first few weeks and months after injury.
Duration of coma
Severity of coma in the first few hours after the injury.
Duration of post-traumatic amnesia
Location and size of contusions and hemorrhages in the brain
Severity of injuries to other body systems sustained at the
time of the injury.
Age of the patient.
The overall objective of a management programme
for the brain-injured patient with severe long-term
physical disability is to ensure that the patient enjoys
the best possible quality of life, in terms of general
wellbeing and control of adverse secondary
complications, whilst exploring to the full of any