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OBJECTIVES

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  • 1) Differentiate the focal and diffuse injury and sequela associated with traumatic brain injury

  • 2) Examine the medical management of the patient with traumatic brain injury

  • 3) Differentiate the evaluation and treatment methods of those with traumatic brain injury from those for other neurologic conditions

  • 4) Structure evaluations and treatment sessions appropriate to the cognitive recovery level described by the Ranchos Scale to promote both physical and cognitive gains

  • 5) Manage various behaviors as they arise during a treatment session with particular emphasis paid to agitation

  • 6) Screen for mild traumatic brain injury

  • 7) Recognize family adjustment issues and provide appropriate education

  • 8) Write goals with cognitive and behavioral qualifiers to the physical activities

  • 9) Review the presentation, pathology, and medical management of brain tumor in adults and children

  • 10) Discuss the role of physical therapy in the management of patients with brain tumor

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CASE A, PART I

Aaron is a 22-year-old Caucasian male brought by ambulance to the Emergency Department, following a motor vehicle accident (MVA), in which he was driving without a seatbelt, struck an electric pole, and flew through the windshield. His blood alcohol level is .20, and he is unconscious with multiple fractures, including his right femur, right clavicle, right radius and ulna, multiple ribs and jaw. He has multiple contusions and a deep gash on the right side of his head, although the skull remains intact. He is not opening his eyes even to deep pressure on his palm or foot, is not verbalizing, and his intact left extremities are held in flexion.

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INTRODUCTION

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Traumatic brain injury (TBI) is thought to affect up to 10 million people worldwide1 and is a leading cause of long-term disability with 500,000 new cases2 and an annual estimated cost of $17 billion dollars in the United States alone, yet that cost does not reflect the growing numbers of concussions (mild TBIs), for which medical attention is not typically sought.1 It is more common in men, especially in the adolescent and young adult years (17–24), becoming more gender neutral in older adults. This commonly relates to the level of activity and degree of risk-taking displayed by boys/young men. The incidence of TBI has two peak time periods; the first is the 17–24 year range, and the second is at the 60–70 year range.

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TBI can result from a blow to the head and/or sudden acceleration–deceleration of the head. As described in the case, many TBIs (often the most severe) occur as a result of a car accident, where the driver or passenger experiences a rapid forward movement of his body as the car hits an object or another car, stopped quickly by either the seatbelt, dashboard, or ground (acceleration–deceleration); in the worst situations, the car flips and there can be multiple head blows against the side window, roof of the car, and/or the dashboard along with ...

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