Clinical Assessment and Management of Spasticity and Contractures in Traumatic Brain Injury
Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway in Neurological Rehabilitation, 2018
Traumatic brain injury results in a wide spectrum of medical complications. In a retrospective study that reviewed medical complications of 116 patients in 2000–2006, the authors reported urinary incontinence in 32.7%, heterotopic ossification (HO) in 18.1%, and post-traumatic seizure in 13.8% on admission to rehabilitation (Safaz et al. 2008). These medical complications and their treatment may interact with spasticity. For example, HO is reported to be significantly associated with spasticity after a TBI. In a total of 107 TBI patients with spasticity, HO was present in 40 patients (Dizdar et al. 2013). In the experience of many clinicians, a sudden change in spasticity may result from progression intracranial complications, such as hydrocephalus, or co-morbidities, among which urinary tract infections are commonly observed. Medications used to treat TBI-related complications, such as psychostimulants used to treat inattention, benzodiazepines to manage agitation, and anti-epileptics, have also been observed to affect spasticity. Zafonte et al. (2004) suggest assessment of spasticity several times per day, since muscle tone may be affected by medications, procedures, and other medical conditions, such as pain.
Toughness
Rudi Coetzer in The Notebook of a New Clinical Neuropsychologist, 2017
The trajectory of recovery after traumatic brain injury varies, is complex, and is determined by many factors. As Dr Burger pointed out to me a couple of months ago, some of these factors include injury severity, pre-morbid abilities and problems including psychiatric, family support, post-injury social problems or support, access to rehabilitation, age, education and problems with substance misuse, among many others. Most of the spontaneous, and also the most dramatic, recovery occurs during the first 6–12 months. During the second year things slow down, and from year three onwards there is thought to be a plateau. But individuals vary in their psychological makeup, and motivation to do well and engage with rehabilitation ranges from none to stubbornness. For these reasons, and because we are scientists not politicians, we don’t predict the future when we don’t have at least some data to back up what we are saying. My intellectual reasoning is suddenly interrupted.
The Neurologic Disorders in Film
Eelco F. M. Wijdicks in Neurocinema—The Sequel, 2022
At the heart of these questions about the consequences of traumatic brain injury lies the further issue of chronic form of traumatic brain injury and its association with contact sports. We already have a key film to watch. Concussion (2015) , directed by Peter Landesman and starring Will Smith as the neuropathologist Dr. Bennet Omalu, is an important film about sports-related concussions and the recent interest in chronic traumatic encephalopathy (CTE). Omalu’s slides show amyloid plaques and tau-positive threads in NFL football players. Omalu explains that gannets, woodpeckers, and rams have internal shock absorbers, adding, “God did not intend for us to play football.” Neurologists may know, for example, that punch-drunk syndrome was first described by the British neurologist McDonald Critchley in a 1949 book as the “chronic traumatic encephalopathy of boxers.”51 James W. Geddes found tau neuropil threads in the depth of sulci in 1999. CTE is now being studied by several academic institutions in the United States, most notably by Boston University’s Center for the Study of Traumatic Encephalopathy. This comprehensive work can be attributed to neuropathologist Ann McKee at the New England Veterans Administration Medical Centers in Boston.52 Omalu’s report of CTE in National Football League (NFL) player, coauthored by neurologist Steven DeKoskey and neurosurgeon Julian Bailes, was first published in the journal Neurosurgery in 2005.53
Design, methods, and baseline characteristics of the Brain Injury Education, Training, and Therapy to Enhance Recovery (BETTER) feasibility study: a transitional care intervention for younger adult patients with traumatic brain injury and caregivers
Published in Current Medical Research and Opinion, 2022
Tolu O. Oyesanya, Callan Loflin, HyunBin You, Melissa Kandel, Karen Johnson, Timothy Strauman, Qing Yang, Jodi Hawes, Lindsey Byom, Rosa Gonzalez-Guarda, Courtney Van Houtven, Suresh Agarwal, Janet Prvu Bettger
Traumatic brain injury (TBI) is defined as “a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain”1. Each year, more than 2.7 million U.S. people sustain a TBI1. Despite high risks of readmission and complex medical needs, there are no U.S. standards of care for patients with mild-to-severe TBI discharged home from acute hospital care without inpatient rehabilitation2. Research suggests up to 60% of patients with mild-to-severe TBI nationwide are discharged home from acute hospital care into a fragmented environment that does not integrate healthcare, community, and social services3. These patients have cognitive, physical, behavioral, and emotional impairments that affect their abilities to independently self-manage their health, wellness, and activities of daily living and are often dependent on family who have difficulty managing the patient’s care and needs4–9. The consequences of TBI have tremendous implications for nuclear and extended family members of younger adult patients with TBI (age 18–64) 10,11, especially for patients who were in school or working, may not yet be financially secure, and/or have small children12.
Stability and Falls Evaluations in AMPutees (SAFE-AMP 1): Microprocessor knee technology reduces odds of incurring an injurious fall for individuals with diabetic/dysvascular amputation
Published in Assistive Technology, 2023
Shane R. Wurdeman, Taavy A. Miller, Phillip M. Stevens, James H. Campbell
The consequences of a fall can be detrimental to a person’s health. In terms of immediate physical health, 1 out of 5 falls results in serious injury such as broken bones or head injury (Alexander et al., 1992; Centers for Disease Control and Prevention [CDC], 2020; Sterling et al., 2001). Falls are also the most common cause of traumatic brain injury (CDC, 2020; Jager et al., 2000), as well as the leading cause of death for Americans aged 65 and older (Burns & Kakara, 2018; Roubik et al., 2017). Additionally, fall sequelae are not limited to immediate injury. For example, only 25% of elderly individuals report a return to prior levels of independence after a fall (Ayoung-Chee et al., 2014; Roubik et al., 2017). In 2015, the total healthcare cost burden in the United States for falls was approximately $50 billion, with Medicare and Medicaid covering about 70% of the costs (Florence et al., 2018).
The King-Devick test in mixed martial arts: the immediate consequences of knock-outs, technical knock-outs, and chokes on brain functions
Published in Brain Injury, 2019
Ryan Hubbard, Gene Stringer, Ken Peterson, Mario Roberto Filho Vaz Carneiro, Jonathan T. Finnoff, Rodolfo Savica
There has been considerable attention brought to the issue of concussion (mild traumatic brain injury) in athletics and how repetitive insults such as these may affect long-term brain function (1–5). Studies suggest that it may take up to 14 days for cognitive function to return to baseline after sustaining a concussion; and although a very high percentage of athletes experience normal recovery, having a second brain insult prior to full recovery can be associated with metabolic brain abnormalities and negative neuropsychological sequelae (1,2,4). Mild traumatic brain injury (TBI), often considered to be a “concussion,” can present with a variety of emotional, physical, and cognitive symptoms including, but not limited to, blurred vision, confusion (mental status changes), feeling dazed, dizziness, focal neurologic symptoms, headache, nausea, and oculomotor impairment (6,7). More recently, attention has focused on improved detection of concussion in sport, particularly injuries that do not cause immediate, obvious clinical evidence of a TBI. This has led to considerable resources allotted to the detection and evaluation of these subclinical injuries and the development and validation of quick screening tools to aid the practitioner in clinical diagnosis of brain injury in an attempt to improve the safety of youth and professional athletes engaged in contact sports (2,7–12).
Related Knowledge Centers
- Concussion
- Disability
- Skull
- Brain
- Scalp
- Injury
- Closed-Head Injury
- Penetrating Head Injury
- Head Injury
- Falling