Head Injury or Traumatic Brain Injury (TBI) Care Plan
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Head injuries are one of the most common causes of disability and death in adults. Injuries to your brain, skull, or scalp are all types of head injury. It may be mild or severe depending on what caused it. Some injuries produce bleeding within your skull. Others cause damage on the outside of your head. These injuries may be in the form of lacerations, bumps or bruises.
Prevention of head injuries:
Follow these tips to reduce the risk of brain injury:
Seat belts and airbags. Always wear a seat belt in a motor vehicle.
Alcohol and drug use. Don't drive under the influence of alcohol or drugs, including prescription medications that can impair the ability to drive.
Helmets. Wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle.
The following tips can help older adults avoid falls around the house:
Install handrails in bathrooms
Put a nonslip mat in the bathtub or shower.
Install handrails on both sides of staircases.
Improve lighting in the home.
Keep stairs and floors clear of clutter.
Get regular vision checkups.
Get regular exercise
Preventing head injuries in children:
The following tips can help children avoid head injuries:
Install safety gates at the top of a stairway.
Keep stairs clear of clutter.
Install window guards to prevent falls.
Put a nonslip mat in the bathtub or shower.
Use playgrounds that have shock-absorbing materials on the ground.
Don't let children play on fire escapes or balconies.
Types of Head Injuries:
Closed Injury: A closed injury does not break open your skull or penetrate brain tissue. However, it can still cause bruising or swelling of the brain
Open Injury: An open injury is any damage that penetrates the skull. The damage may cause bleeding within the brain's tissues. It may also produce skull fractures or cause the skull bones to press into your brain tissue.
Concussion: A concussion occurs when your brain is shaken. It may lead to loss of consciousness and headache.
Scalp Wounds: Your scalp is the skin that covers and protects your skull. Injuries to the scalp may lead to bleeding or tissue damage.
Because traumatic brain injuries are usually emergencies and because consequences can worsen swiftly without treatment, doctors usually need to assess the situation rapidly. The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests with the prime focus on following points:
Information about the injury and symptoms:
How did the injury occur?
Did the person lose consciousness?
How long was the person unconscious?
Did you observe any other changes in alertness, speaking, coordination or other signs of injury?
Where was the head or other parts of the body struck?
Can you provide any information about the force of the injury? For example, what hit the person's head, how far did he or she fall, or was the person thrown from a vehicle?
Was the person's body whipped around or severely jarred?
Glasgow Coma Scale:
This 15-point test helps a doctor or other emergency medical personnel assess the initial severity of a brain injury by checking a person's ability to follow directions and move their eyes and limbs. The coherence of speech also provides important clues.
Abilities are scored numerically in the Glasgow Coma Scale. Higher scores mean less severe injuries.
Imaging tests may include:
Computed tomography scan (CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.
Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
Intracranial pressure monitor:
Tissue swelling from a traumatic brain injury can increase pressure inside the skull and cause additional damage to the brain. Doctors may insert a probe through the skull to monitor this pressure.
Treatment and rehabilitation of a head injury:
Specific treatment of a head injury will be determined by your physician based on:
Your age, overall health, and medical history
Extent of the head injury
Type of head injury
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the head injury
Your opinion or preference
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Depending on the severity of the injury, treatment may include:
Topical antibiotic ointment and adhesive bandage
Immediate medical attention
Hospitalization for observation
Moderate sedation or assistance with breathing that would require being placed on a breathing machine, or mechanical ventilator or respirator
Children are allowed to sleep, but should be woken every four hours to check their condition and gauge their reaction to familiar things.
Seek urgent medical care if you have:
Vomited more than twice
A Difficulty staying awake
Blood or clear fluid coming from your ears or nose
seizure (fit or spasm of arms, legs or face)
Numbness, tingling, pins and needles, or weakness in your arms or legs
Confusion, slurred speech or unusual behavior
Blurred or double vision
A high temperature, which may indicate the presence of infection
Any other concerns.
Most people who have had a significant brain injury will require rehabilitation. They may need to relearn basic skills, such as walking or talking. The goal is to improve their abilities to perform daily activities.
Rehabilitation specialists may include:
Physiatrist, a doctor trained in physical medicine and rehabilitation, who oversees the entire rehabilitation process, manages medical rehabilitation problems and prescribes medication as needed
Occupational therapist, who helps the person learn, relearn or improve skills to perform everyday activities
Physical therapist, who helps with mobility and relearning movement patterns, balance and walking
Speech and language pathologist, who helps the person improve communication skills and use assistive communication devices if necessary
Neuropsychologist, who assesses cognitive impairment and performance, helps the person manage behaviors or learn coping strategies, and provides psychotherapy as needed for emotional and psychological well-being.
Social worker or case manager, who facilitates access to service agencies, assists with care decisions and planning, and facilitates communication among various professionals, care providers and family members
Rehabilitation nurse, who provides ongoing rehabilitation care and services and who helps with discharge planning from the hospital or rehabilitation facility
Traumatic brain injury nurse specialist, who helps coordinate care and educates the family about the injury and recovery process
Recreational therapist, who assists with time management and leisure activities
Vocational counselor, who assesses the ability to return to work and appropriate vocational opportunities and who provides resources for addressing common challenges in the workplace.
Life-long considerations for a person with a head injury:
The key is to promote a safe environment for children and adults and to prevent head injuries from occurring. The use of seat belts when riding in the car and helmets (when worn properly) for activities such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.
Persons who suffer a severe brain injury may lose part(s) of muscle, speech, vision, hearing, or taste function, depending on the area of brain damage. Long- or short-term changes in personality or behavior may also occur. These persons require long-term medical and rehabilitative (physical, occupational, or speech therapy) management.
The extent of the person's recovery depends upon the type of brain injury and other medical problems that may be present. It is important to focus on maximizing the person's capabilities at home and in the community. Positive reinforcement will encourage the patient to strengthen his/her self-esteem and promote independence.
Following a brain injury, individuals who exercise are typically less depressed and report better quality of life than those who do not exercise. The key is to determine what type of exercise is best for you and to follow a program that accommodates your individual needs and concerns.
You can get help from Physical Therapist in:
If limitations prevent the return to pre-injury activities, a physical therapist can help the patient improve mobility and master the use of equipment such as an ankle brace, a walker, or a wheelchair.
The physical therapist uses exercise and task-specific training to help the patient improve:
The ability to maintain alertness and follow commands
Muscle and joint flexibility that may be reduced after inactivity
The ability to move around in bed, to sit without support, and to stand up
The ability to balance safely when sitting, standing, or walking
The ability to move by strengthening and the practicing of functional activities
Balance and coordination
Strength and energy, reducing any feelings of fatigue that occur from inactivity or the injury to the brain itself
A return to sports and fitness activities.
The goals of your program should be to improve cardiovascular fitness, increase muscle strength and endurance, improve range of motion, and increase independence, mobility and ability to do daily activities.
You may need to do some exercises such as biking or walking with a workout buddy if you have difficulty with balance or with finding your way throughout a community.
Choose low-impact activities such as walking, cycling or water exercises, which involve large muscles groups and may be done continuously.
Start slowly and gradually progress the intensity and duration of your workouts. If your fitness level is low, start with shorter sessions (10 to 15 minutes) and gradually build up to 20 to 60 minutes, three to five days per week.
Perform resistance training and range-of-motion exercises two days per week.
Take frequent breaks during activity if needed.
Avoid exercises that overload your joints or increase your risk of falling. Begin each exercise in a stable position and monitor your response before proceeding.
Reduced motor control in your limbs may restrict your ability to do certain exercises.
Exercise equipment may need to be modified to accommodate your specific needs.
Always wear protective headgear when cycling or doing any other activity in which a fall is possible, as the rate of a second head injury is three times greater after you have had one head injury
Do not hesitate to ask for demonstrations or further explanations about how to perform exercises properly.
Consider contacting a certified health and fitness professional who can work with you and your health care provider to establish realistic goals and design a safe and effective program that addresses your specific needs.
Things to remember in head injury:
Always seek medical attention for a head injury.
There is no specific treatment for mild head injury other than plenty of rest and not overdoing things.
It can take some time for the brain to recover from a head injury and during this time, headaches, dizziness and mild cognitive (thought) problems are common.
Don't go to work or school, or resume sporting activity until you have fully recovered.
A person recovering from traumatic brain injury (TBI) will require close monitoring of their nutritional status in the acute and rehabilitation phase of their injury.
Foods to Avoid: Try to avoid the following foods:
Excessive sweets and candy
If a person's oral intake is poor, then they will need to be supplemented with liquid formulas or to explore food habits and preferences to encourage a person to eat through consistency of food and planning a balanced diet. The speech therapist will be able to determine the appropriate modified consistency of food (i.e. blended, soft and moist or easy chew) and fluids (i.e. pudding, honey, nectar or thin) of a person Planning a balanced diet is important to allow adequate nutrition for the recovery in a person with TBI. The table below will be a guide to choosing and planning meals from the four major food groups.
For more details about DIET IN HEAD INJURY you can watch:
Post-surgery, many patients experience poor appetite.To boost your appetite, consume small portions of food about 7-9 snacks/meals throughout the day.Nausea is another common complaint that could be caused due to medications. Take the prescribed medicines on full stomach. Consult your doctor if nausea persists.
A day's meal comprises of several food items. Generally,all food items can be classified into six major groups (5) as shown in the Healthy Heart pyramid.(6)
Immediate Diet Plan
Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables in your daily diet.
Add plenty of Whole Grains (whole wheat flour, brown rice, whole beans).
Choose foods high in Good Fat such as olive oil, peanut oil, fatty fish, walnuts, flaxseeds. If you do not eat fish, talk to your doctor about taking fish supplements.
Instead of whole milk, choose low fat or skim milk.
Include food sources rich in Magnesium and Potassium to increase heart health.
Say NO to all Sugary and Refined foods (cakes, pastries) and do not add any sugar to beverages.
Avoid Unhealthy Fats such as Cholesterol, Saturated and Trans Fat. Stay away from egg yolks, cream, butter, ghee, coconut, deep fried items, whole milk, dalda, vanspati.
No Carbonated, Caffeinated and Alcoholic beverages.
Curb Salt intake, as it can increase blood pressure. Don't add salt while cooking and reduce packaged food consumption.
Sample Diet Plan:
Below is a sample Diet Plan for a patient who has undergone angioplasty. Make sure to check the correct portion sizes for each food item by going to these links.(8), (9), (10)
Talk to you doctor or dietician about any restrictions on fluid or water intake. Do not add SALT or SUGAR while cooking or as seasoning. For cooking, use only Olive Oil.
- 1 Cup lukewarm water with 1 Tbsp. freshly squeezed lemon juice and 1/2 tsp. honey
- 1 Cup Dahlia, porridge made with Skim Milk OR 1 Moong Dal Dosa(Recipe)OR 1 Ragi Dosa(Recipe)
- 1 medium Apple OR medium Orange OR 1/2 Cup pomegranate seeds
Early Morning Snack
- 1 Cup boiled Sweet potatoes, sprinkled with lemon juice OR 1 Cup Brown rice Poha with low fat yoghurt
- 1 Cup Coconut water (discard the "malai")
- 2 dried apricots and 1 whole walnut OR 2 dried figs and 2 almonds (unsalted)
- 1 large bowl of Salad (carrots, cucumbers, beets, tomatoes and onions)
(Dressing is important , use - Olive oil, lemon juice and pepper)
- 2 Ragi Biscuits OR 2 Unsweetened Oatmeal Biscuits
- 1/2 Cup Brown rice with 1 Cup Mixed vegetable sambar OR 1 Cup Brown rice Khichadi with 1 small bowl Raita
- 1 Cup cabbage curry OR steamed Cauliflower curry OR Karela curry
- 1 Cup Buttermilk
Late Night Snack
- 1/2 Cup cubed Papaya OR Musk melon
Life Long Instructions:
It is never too late to adapt a healthy lifestyle.
Maintain a balanced diet and perform regular physical activity. Eat foods that are low in saturated fats and cholesterol. If overweight or obese, loose the extra kilos and maintain a healthy weight. Quit smoking and cut down on alcohol. Check your blood pressure and blood glucose regularly.
Legal issues faced by people with brain injury:
As soon as it happens, a brain injury brings up several legal questions, like:
Who is legally entitled to make medical decisions for the injured person?
Did the injury occur due to some wrongful situation?
What are the circumstances of the injury?
Did the injury occur while on the job?
Will this injury require long-term care or planning?
What types of insurance provisions are available to the injured person?
Does the person have an advanced medical directive or will?