In this blog, NAPA paediatric physiotherapist Cait Parr shares information on traumatic brain injuries (TBI) and outlines TBI therapy options including intensive rehabilitation, physiotherapy, occupational therapy, and speech therapy.
Traumatic Brain Injury (TBI) is the result of trauma to any part of the brain. TBI is one of the leading causes of acquired disability and death in infants and children. It is the most frequent form of brain injury and may affect ambulation, cognition, communication, swallowing, and performance of daily skills. Roughly 1.7 million TBIs occur annually and approximately 80% of TBIs are classified as mild or moderate. According to the Centers for Disease Control and Prevention, the two age groups at greatest risk for brain injury are age 0-4 and 15-19.
The most common causes of TBIs include falls, motor vehicle accidents (MVAs), assault, and indirectly, alcohol use. Falls and MVAs are classified as unintentional causes, whereas abuse in infants and young children and assaults in adolescents are unfortunate inflicted causes of TBI. Surprisingly, in the case of MVAs, traveling at a speed of only 15mph is enough to cause a TBI.
Primary mechanisms of damage in TBIs are the acceleration and deceleration forces of trauma to the brain. Complications of TBI (also known as secondary mechanisms of damage) may occur during the first 12-24 hours after trauma or up to 5-10 days after injury. These may include an intracranial hemorrhage (pressure on brain tissue) or brain edema (swelling/inflammation as part of the body’s natural response to injury, causing increased pressure as well). Other complications include hypotension, electrolyte imbalance, anemia, hyperglycemia, hypoglycemia, hyperemia, hyponatremia, infection, epilepsy/seizures, and hydrocephalus.
Management of TBI focuses on limiting the progression of the primary brain injury and minimizing secondary brain injuries. The clinical course of a TBI begins with global brain function impairments, and then progresses through functional recovery phases. The most rapid recovery takes place in the first three months; at the end of that period of time, patients typically maintain this stable level of function without further deterioration.
A patient’s healthcare team typically develops a prognosis, or prediction, based on injury severity variables including the Glasgow Coma Scale (GCS), the length of coma, and the length of post-traumatic amnesia (PTA). A “good” prognosis is typically given for a patient who can follow commands within two weeks of initial injury and has less than two months of PTA. “Poor” prognosis is given for those who are unable to follow commands after more than a month, have PTA for more than three months, and are older than 65 years of age. Statistically, a patient with a TBI unconscious at 3 months after injury is given a 36% chance of recovery, unconscious at 6 months after injury is given a 21% chance of recovery. For those still unconscious at the one-year anniversary of their injury, there are fewer than 20 total verified cases of recovery.
TBI rehabilitation involves a multidisciplinary approach; at NAPA, we integrate physiotherapy, occupational, speech and feeding therapy into customized therapy sessions for children who have experienced traumatic brain injuries. In addition to intensive therapy, paediatric TBI patients may also benefit from ongoing, weekly paediatric TBI therapy to bring continued recovery and progress.
In TBI physiotherapy, we work toward maximizing physical recovery and independence in activities of daily living (ADLs). Hyperbaric oxygen therapy for brain injury allows a patient to breathe in highly concentrated oxygen to revitalize cells and enhance the body’s natural healing process.
Occupational therapy treatment for TBI strives to improve independence and address challenges in adapting to the home and school environment; TBI occupational therapy helps patients engage in daily activities.
Speech therapy after traumatic brain injury includes a variety of goals, ranging from feeding/swallowing to rehabilitation of word articulation and augmentative communication. Even after less serious injuries, family support and counseling, in addition to medical care and therapies, are also vital.
After initial intensive paediatric TBI rehabilitative treatment, when children reintegrate into community and schools, intensive outpatient rehabilitation helps facilitate continued recovery and progress. A stimulating TBI therapy environment is crucial in encouraging creative and integrated use of functions, reducing behavioral difficulties, and helping increase self-esteem. Come visit us at NAPA Centre and see what we can achieve together!
March is TBI awareness month. Every March, the Brain Injury Association of America leads a public awareness campaign. The theme this year is Change Your Mind. “The #ChangeYourMind public awareness campaign provides a platform for educating the general public about the incidence of brain injury and the needs of people with brain injuries and their families.”
Share the #ChangeYourMind stamp to participate in raising awareness!
Cait Parr is a paediatric physiotherapist at NAPA Centre. Her favorite animal is snails, because they remind her to slow down and enjoy the beautiful details about life. She loves desserts almost as much as she loves long walks with her husband on the beach at sunset.
At NAPA Centre, we take an individualised approach to therapy because we understand that each child is unique with very specific needs. We embrace differences with an understanding that individualised programs work better. For this reason, no two therapeutic programs are alike. If your child needs our services, we will work closely with you to select the best therapies for them, creating a customised program specific to your child’s needs and your family’s goals. Let your child’s journey begin today by contacting us to learn more.