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  • 1) Differentiate anoxic from traumatic brain injury

  • 2) Differentiate primary from secondary sequelae of brain injury

  • 3) Examine the medical management of the patient with brain injury

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

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

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

  • 7) Screen for mild traumatic brain injury/concussion

  • 8) Recognize family adjustment issues and provide appropriate education

  • 9) Recognize causes and unique features of anoxic brain injury and structure evaluation and treatment of these patients.

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

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


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.


Acquired brain injury has many causes. In this chapter we will focus on traumatic and anoxic brain injuries (BI) and neoplastic brain disorders. Traumatic brain injury (TBI) is thought to affect up to 10 million people worldwide1 and is a leading cause of long-term disability with 1% of the population living with some long-term complication of TBI.2 There are an estimated 2.53 million emergency room visits annually, of which nearly 300,000 result in hospitalization and nearly 60,000 result in death from TBI. Estimates of the cost of care, both acutely and long term, range from $56 to $221 billion annually,2 yet that cost does not reflect the growing numbers of concussions (mild TBIs), for which medical attention is not typically sought.1 In the United States, the incidence of occurrence averages 68.3 per 100,0003; in Europe, it averages 258/100,000.4 The incidence of TBI is greatest for those over 75, followed by children under 4, and then by adolescents and young adults (15-24).2 It is universally more common in men (55-80%), especially in those 15-24, becoming more gender neutral in older adults.3,4 This commonly relates to the level of activity and degree of risk-taking displayed by boys/young men. The most common causes of TBI are falls, MVAs, ...

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