Congenital and acquired brain injury
Congenital and Acquired Brain Injury. 3. Spectrum of the Acquired Brain Injury Population

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Abstract

Kwasnica C, Brown AW, Elovic EP, Kothari S, Flanagan SR. Congenital and acquired brain injury. 3. Spectrum of the acquired brain injury population.

This self-directed learning module highlights the subpopulations of traumatic brain injury (TBI) that are treated by the rehabilitation practitioner. It is part of the chapter on TBI in the self-directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Specifically, this article focuses on the management of patients with mild TBI, children, and individuals with acquired brain injury from other etiologies, such as anoxic events or neoplastic lesions. The clinical spectrum of TBI, from the most severe presentation to the mildest, requires similar clinical skills to evaluate and manage.

Overall Article Objective

To describe the spectrum of brain injury populations based on age, severity, and etiology.

Section snippets

3.1 Clinical Activity: To evaluate a nursing home patient who is reportedly still unresponsive 3 months after her traumatic brain injury

THE TERM DISORDERS OF CONSCIOUSNESS refers to a spectrum of conditions seen after cerebral injury, including coma, vegetative state, and the minimally conscious state.1 Most patients with severe traumatic brain injury (TBI) transiently pass through a vegetative or minimally conscious state; however, a subset of these patients remains in these states for an extended time. Most of the following discussion applies to disorders of consciousness regardless of etiology. When relevant, differences

An Overview of Out-of-Hospital Cardiac Arrest

The vast majority of people who sustain an out-of-hospital cardiac arrest succumb to their illness. Herlitz et al16 reported that between 1980 and 1992, of 3434 patients who suffered an out-of-hospital cardiac arrest, only 704 arrived alive to the hospital. For those who survive, anoxic/hypoxic injury is one of the most devastating injuries that can be sustained.

Cerebral Injury Sustained From Anoxia

Because the hippocampi and cortex are particularly sensitive to decreased oxygen delivery, anoxic injury results in significant

3.3 Clinical Activity: To evaluate a 50-year-old male executive who presents complaining of irritability, headaches, and fatigue after falling off a horse for the third time 2 months ago, reporting he briefly experienced feeling “dazed and confused.”

The vast majority of TBIs are classified as mild according to the Glasgow Coma Scale (GCS) (initial score of 13–15). The American Congress of Rehabilitation Medicine defined mild TBI as a traumatically induced alteration in brain function manifested by either loss of consciousness, amnesia for events immediately before or after the event, an alteration in mental state such as feeling dazed or confused, or focal neurologic impairment. It further stipulated that the GCS score measured 30 minutes

3.4 Clinical Activity: To manage a 12-year-old child who sustained a moderately severe TBI at age 4 with an apparently successful recovery and who is having recent academic difficulties

The estimated annual incidence of pediatric TBI is 180 per 100,000 in children under the age of 15. Guidelines for the early management of TBI in children now exist, as they do in adults. Although some overlap exists between pediatric and adult guidelines, such as in the use of intracranial pressure monitoring, some differences also exist, such as the use of hypothermia in children to reduce secondary injury.35 Outcome data in pediatrics have led to the generalization that younger children have

3.5 Educational Activity: To justify to an insurance company your plan to admit to your inpatient rehabilitation unit a 50-year-old male patient with a diagnosis of glioblastoma multiforme

Unlike the far more common acquired brain conditions of stroke and TBI, for which survival rates are high and recovery expected, survival for primary brain malignancies is limited. This consideration emphasizes the importance of providing timely and efficient rehabilitation services to this population. The total incidence rate for primary brain malignancies has slowly declined since 1987, and overall 5-year survival has steadily risen in recent decades to 31% in the year 2001.45 However, the

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