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LEARNING OBJECTIVES

LEARNING OBJECTIVES

  1. Describe the pathophysiology of traumatic brain injury.

  2. Analyze the impact of cognitive, neurobehavioral, and neuromuscular impairments, activity limitations, and participation restrictions on outcomes of people with traumatic brain injury.

  3. Identify the different team members and settings in the management of the patient with traumatic brain injury.

  4. Compare and contrast persistent vegetative state and minimally conscious state.

  5. Identify key components of the physical therapy examination during the acute stage of recovery in patients with severe to moderate traumatic brain injury.

  6. Create a plan of care for a patient with a severe to moderate traumatic brain injury that presents with disorder of consciousness in the acute stage of recovery.

  7. Select evidence-based outcome measures to use during the physical therapy examination of a patient with moderate to severe traumatic brain injury during the active rehabilitation stage of recovery.

  8. Explain the impact of cognitive and neurobehavioral impairments on the physical therapy plan of care in the active rehabilitation stage of recovery.

  9. Create a plan of care for a patient with a severe to moderate traumatic brain injury in the active rehabilitation stage of recovery.

  10. Select evidence-based outcome measures to use during the physical therapy examination of a patient with a mild traumatic brain injury.

  11. Outline a return to play/activity timeline for a patient with a mild traumatic brain injury.

  12. Create a plan of care for a patient with a mild traumatic brain injury.

INTRODUCTION

A traumatic brain injury (TBI) is defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force.”1 The TBI population is one of the most challenging and rewarding that a physical therapist (PT) is likely to encounter. Because of the multiple body systems affected by a brain injury and the strong likelihood of secondary impairments, a PT must be proficient in a wide variety of examination procedures and intervention techniques. Owing to behavioral difficulties encountered during recovery, a PT working with this population must also possess strong communication and interpersonal skills, be able to react quickly and effectively to suddenly changing situations, and have keen observation skills. These factors and others can make working with this population challenging and exhausting—cognitively, emotionally, and physically. However, the rewards of assisting a patient with a severe brain injury to return to home, work, or school vastly outweigh the challenges of rehabilitation.

The patient with a brain injury is treated across a wide continuum of care, which includes the intensive care unit (ICU), acute hospital, inpatient rehabilitation center, skilled nursing facility (subacute rehabilitation), and long-term care facility. Additional services may include outpatient services, community reintegration programs, comprehensive day treatment, and residential programs for assisted living and neurobehavioral services. Because of the wide variety of presenting impairments, activity limitations, and participation restrictions, rehabilitation for the patient with TBI requires a strong interdisciplinary team. A PT is an important member of this team. It is crucial that ...

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