Sudden impact : a case study on traumatic brain injury secondary to vehicular accident

Date of Completion

1997

Document Type

Thesis

Degree Name

Bachelor of Science in Physical Therapy

Keywords

Brain Injuries, Traumatic, Accidents, Traffic

Abstract

Numerous studies have been documented regarding Traumatic Brain Injury (TBI). The age distribution being bimodal, shows the highest incidence in the young adults and the elderly. However, less information is available about the middle adulthood groups where in our patient belongs. The above reasons led the researchers of this case study to contribute information on effectivity of Physical Therapy (PT)treatment and home program on TBI patients; extent of factors affecting neurologic and functional recovery; various deficits affecting patient's current status; other associated problems such as learning, behavior and memory dysfunction affecting rehabilitation; and premorbid status of patient with relation to functional outcome. Our patient who have been in a comatose state for 2 weeks with glasglow Coma Scale of 4, experienced a Post-Traumatic Amnesia for a week and delayed return of motor function 3 weeks post-injury was still able to regain complete independence in all activities of daily living (ADL) with difficulty despite of these factors suggesting a poor prognosis. With these in mind, we have observed the following from our patient who is 46 year old male. Present re-evaluation revealed left upper extremity (UE) joint contractures, weakness of the left UE muscles, with grade ranging from 3+ to 4, was also noted but with underlying Grade 1 spasticity on his left UE and LE. difficulty in self-care activities, bed mobility, transfers, and ambulation was observed. In spite of the presence of deviation in his posture, the patient still has a good standing balance. It is very much obvious that the patient manifest with a gait deviation that is wide-based with decreased swing and stance phase on both LE which could be due to existing spasticity on the left LE and perceptual deficits. Lastly, behavioral problem, impaired judgement, and short-term memory was impaired. Based from the above observations, the researchers have made an assumption that with poor prognosis initially, there is no final endpoint to the recovery process of middle-aged post- TBI patients, but rather there is slowing both of the pace and scope of recovery. In wanting to help the patient more, the researchers have come up with recommendations and modifications regarding ADL's home environment, and long term home program consisting mainly of self exercises. The patient was advised to continuously practice performing ADL's independently to improve his confidence. Family education was provided regarding the PT management, patient's conditions and the possible complications that may develop including behavioral problems, physical and cognitive deficits. The patient was again strongly encouraged to have a monthly check-up at the PT clinic. Finally, the researcher suggest that follow-up studies should be made regarding the case to monitor the patient's progress and compliance with the treatment.

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