The Assessment and Treatment

of Mild to Moderate Head

Injuries within Orthopaedics

Megan Atkinson

Senior Physiotherapist

Southampton General Hospital

Nov 2015

Aims and Objectives

• Background of project

• Brief overview of mild-mod HI

• Why this is relevant to Orthopaedic therapy

• Service evaluation

• Core standards

• Therapy notes proforma

• Outcome

Background

• I started within UHS T+O therapy dept 2012

• Many pts on the unit for neuro monitoring and observation

• Varied treatment of pt group

• Time spent with HI nurse specialist

Head Injury Definitions

• NICE describes Head Injury as ‘any trauma to the head, other then superficial injuries to the face’ NICE 2003,2007,2014

• “Traumatic brain injury is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairments of cognitive, physical and psychosocial functions with an associated diminished or altered state of consciousness” By Segun T Dawodu

• Penetrating or closed injury

Classification of Head Injury Severity

Epidemiology

• Each year, 1.4 million people attend A&E in England & Wales with HI.

Of these, 200,000 are admitted and 1 in 5 will have serious HI.

• 95% of all head injury admissions have a GCS greater than 12 (mild head injury category).

The majority of fatalities are in the moderate – severe category.

Epidemiology (2)

• In the UK:

70 – 88% of head injuries are male

10-19% - 65yrs or older

40-50% - are children

0.2% - mortality of all head injury admissions

• Common causes:

Assaults – 30-50%

Falls – 22-43%

RTA- 25%

Alcohol is involved in up to 65% of head injuries

NICE 2014 (PAGE 22)

Evidence Base

• Very limited evidence

• Much more towards mod/severe HI

• NICE 2014 suggest pt info sheets. Did not mention therapy Ax

• Bayley et al 2012 discuss the importance of rehab for cognitive impairments

by implementing strategies

• More evidence for cognitive ax and treatment than for physical impairments

Service Evaluation

• Evidence base – minimal (more towards mod-severe HI)

• Discussion with seniors

• Benchmarking

• Core standards

Head Injury Core Standards

• Acute phase (0-48hrs)

• Receive contact from therapist

• Ax PCS (ie dizziness, nausea, mild head aches)

• Basic neuro ax (sensation/balance/transfers/mob) and ax of other injuries

• Stair ax

• Ref appropriate pts to OT

• Written info

Therapy Notes Proforma

Clinical Audit

• Retrospective audit – notes pre proforma and post proforma

• Audit against core standards (2016)

Thank You

References

• Bayley, M., Berrigan, L., Marshall, S., McCullagh, S. & Velikonja, D. (2012) ‘Clinical

practice guidelines for mild traumatic brain injury and persistent symptoms’,

Canadian Family Physician Vol. 58.

• Medscape.com., 2015. Traumatic Brain Injurt (TBI)- Definition and Pathophysiology:Segun

Toyin Dawodu [online][viewed 29 October 2015].

Available:http://emedicine.medscape.com/article/326510-overview

• NICE GUIDELINES [CG176] (2014) Head Injury: Triage, assessment,

investigation and early management of head injury in infants, children and adults.