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Traumatic brain injury

-is a frequent cause of mobility and mortality in the paediatric from 1 to 19 years
-The third leading cause of death in pediatrics Less than one year

‫ يقع من علي الرخامه او من عربية االطفال او لو طفل عنده‬،‫بتحصل بسبب ان الطفل يقع وهي بتهشكه مثال‬
‫وده اول طفل ليهم فمش عارفين يتعاملوه معاه فيقوم راميه علي حاجه‬colic

# if a child less than three years he will have CP

# if he is more than three years he will have double
hemiplegia or spastic quadriplegia ‫يعني علي حسب المكان اللي اتصاب‬

Definition: traumatic brain injury is any trauma sufficient to lose the level of
consciousness or to get coma, amnesia, and cause structural abnormality of the
brain (change in the anatomical structure)
‫ سواء عملت‬deep injury, compression, ICP, seizure ‫ او حصل‬infection
-maybe open or closed traumatic brain injury
-partial or total loss of function occur
-the injury may affect motor, sensory movement, perceptual, cognitive, thinking,
academic studies, problem solving, psychological, feeding, mode, speaking,... etc...
according to the affected area

* causes of traumatic brain injury

1-Falls

‫يقع وهو ماشي او اتزحلق من علي حاجه‬

2-motor vehicle accidents
3-gunshot wounds

‫عيل ابوه ظابط مثال فالحراميه خطفوه وضربوه‬

4-abuse, assault

‫لو الطفل صبي ميكانيكي مثال فتالقي اي غلطه بيعملها يقوم مضروب بالمفتاح في دماغه ويقولك ده انا بعلمه‬

5-shaking baby syndrome called countercoup forward and backward movement of

the brain tissue

‫لما نهشك الطفل جامد‬

Complication;
♡hypoxic ischaemic incephalopathy
6-sports as boxing, rugby, football

* mechanism of injury
1- impression injury

‫كان ماشي فاتحدف بالطوبه من حد مثال بال هدف‬

2-acceleration when a stationary head is hit by a solid object the

 ‫زي مثال طفل راكب معاك في العربيه وفجأه اتصدمت في عربية اللي قدامك‬

3-decceleration when moving head hit a fixed object

‫زي لما يقع من علي شجره‬

4-linear injury

‫اما تشيل حد تخبطه في الحيطه‬

5-rotational injury

‫ زي لما العربيه اتقلبت مثال‬angular movement ‫بتكون‬

*primary effect of head injury

1- concussion (temporarily or reversible) ‫االرتجاج‬
-transient impairment of consciousness occur immediately after injury and last for
few seconds to few minutes

‫ وقالك طفل وقع ونزف من مناخيره او اي مكان او رجع يبقا‬case ‫ناخد بالنا من الكالااام ده علشان لو جه‬
MRI ‫الاااااازم تعمل‬

-associated with mood changes hyperexcitability and hyperirritability

‫هتالقيه بقي عصبي وبيعيط كتير‬

2-skull fractures
3-cerebral contusion, invasive injury
4-intracranial hemorrhage
* Secondary effect of traumatic brain injury
1-cerebral edema: increase intracranial pressure and herination syndrome

‫ اللي هو‬decorticate posture ‫من مكانها فتعمل‬brain structures ‫ فزقت ال‬edema ‫حصلت‬
flexion in UL and extension in LL
extextension in UL and flexion in LL ‫ اللي هو‬decerbate posture ‫وده طبعا عكسسس ال‬

2-neurochemical effects

# other consequences
1-hydrocephalus, obstructive hydrocephalus if found you should take care and
avoid upside down exercise as stoop and recovery, turning head down,
facilitation of postural (reactions protective equilibrium rightinig), parachute

N. B
atlantoaxial dislocation‫حاالت الداون بردو مبنعملش فيها الحاجات دي الن ممكن يسببوله‬

Injury and the affected area

Cerebellum:will cause ataxia, incoordination, dysmetria, dysarthria
Basal ganglia: involuntary movement, dystonia, tremors, choreaathetosis
Frontal lobe: responsible for thinking and expressive language, social and motor
activity of UL and LL
injury of frontal lobe:personality changes, impaired intellectual function, impaired
motor skills
Parietal lobe: responsible for administration of sensation in the whole body
injury: inability to localize tactile stimulation, language dysfunction
apraxia(inability to do motor skills)

‫ الزم تقسم التاسك ل‬treatment ‫يعني تقوله امسك قلم واكتب ورجع القلم مكانه ميعرفش وده مهم في ال‬
‫ستيبس علشان مش هيعرف يعملهم مره واحده‬

Occipital lobe: responsible for vision

injury: impaired vision or blindness
Temporal lobe, responsible for hearing and smell
injury:inability to recognize sensory stimulus and hearing dysfunction
Thalamus and hypothalamus, center of blood pressure, hunger and feeding and
respiration
injury:anorexia, loss of weight
Brain stem, responsible for cranial nerves, except 1st CN, and resposible for
respiration
injury: flaccid muscle tone
*Severity assessment of traumatic brain injury
1-glasgow coma scale
measure motor responsiveness, verbal responsivness and eye opening
scale from 3 to 15
2- Rancho scale
assess the cogintive ability
∆ factors affecting prognosis of traumatic brain
injury
1-site of lesion
2-type of lesion
3-age of lesion
4-time of intervention

* problems
» abnormal abnormal muscle tone
» abnormal posture
» loss of balance and coordination
» loss of strength and indurance
» shortening and contracure
» heterotopic ossification: formation of laminar bone inside the soft tissue, and
common in shoulder,elbow,hip and knee
# treatment physiotherapy

surgery and excision ‫لو مفيش اي تحسن منه هنعمل‬،‫ شهر‬18 ‫لمدة‬

» fractures
» functional loss
»gait abormalities

*Prevention
» care of the baby
» walkers: avoid

shortening in muscles ‫مشاية االطفال دي غلط بتسبب وقعات كتيره وبتعمل‬

‫»غطي السيراميك‬
‫«بالش ركوب عجل ومتوسيكالت ولو حصل نلبسه خوذه‬

» follow traffic instructions

* management
-assessment and treatment
-assessment and evaluation
-treatment

♕ICU and hospitals

-life saving the procedure: respiration and cardiopulmonary
-fracture: reduction and fixation
-change position every 2 hours
-respiratory exercise
-postural drainage
-positioning and avoid deformeties

♕Prevention
‫بعد ما يطلع من العنايه بقا‬

-Prevent musceloskeletal problems

-ROM active free, active assisted
-Posturaldrainage
-positioning
-prevent effect of gravity on the primitive reflexes

sidelying ‫احسن وضع احطه فيه هو ال‬

then sitting back supported, wedge under knees to put hip and knee in flexion,
head support, heel rest on the wheelchair put ankle in dorsi flexion
꧁꧂ change positions from wheel chair to stand, stand forward and

backwards,
standing with wide base and narrow base, stand on one limb, use stand
frame,takecare of orthostatic hypotension,
3-Coma stimulation technique
visual
tactile
auditory
vestibular
1- visual, level of cognition

‫خياره وهكذا‬،‫ زي مثال شوكه‬familiar objects ‫هتجيب صور وتقوله ده بابا ودي ماما واستعمل‬
‫اللي حواليه‬familiar persons ‫واعرفه ال‬
‫بقا‬auditory ‫طب لو الطفل اتعمي بعد الحادثه هستعمل ال‬،

2-Auditory

‫صوت االم والجرس والدكتور وهكذا‬

3-Tactile, touch and clubing,raging, piece of cotton, heat and cold

4-Vestibular, changing position, turning head
# coma stimulation techniques should be brief, Take 15 minutes, repeat 8 to 10
times/day with rest in between, avoid over stimulation to prevent agitation
4-Structural

building ‫وتعمل‬cognition ‫دي مرحلة ازاي ارجع التكوين الحركي بتاع العيان ده زي انك تظبطله ال‬
 ‫‪up movement‬واقلل ال ‪pathological movement‬‬
‫‪#‬حاجتين تاخد بالك منهم في المرحله دي‬

‫‪1-Agitated stage‬‬

‫مرحلة عصبيه ممكن يضربك يضرب امه ويزعق‬

‫‪2-Confused stage‬‬

‫مرتبك ومش عارف هو بيعمل ايه فالزم تراعي ده والتاسك يتعمل علي ستيبس بالراحه مش مره واحده‬
‫‪#‬كل حاجه تعملها عادي في المرحله دي زي‬

‫‪-Balance exercise‬‬
‫‪-Facilitation of milestone‬‬
‫‪-Facilitation of righting and equlibrium‬‬
‫‪-Weight bearing exercise‬‬
‫)‪-gait training (open, closed, obstacles‬‬
‫‪-thought therapy‬‬

‫نبدأ نعمله بقا ونجيبله مدرس ويبدا حياته‬

‫تمت بحمد للا‬