Moderate to Severe TBI

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Consequences of Moderate to Severe TBI
Physical Impairments

  • Mobility: This refers to how the child is able to move in their environment. This includes bed mobility, transfers, ambulation, stair skills, and negotiating unlevel surfaces. A child with moderate-severe acquired brain injury may demonstrate deficits in these areas due to partial or full loss of motor function and control. An individual may require adaptive equipment or assistive devices to improve mobility skills.
  • Strength: Strength refers to the ability of a muscle or muscle group to move against resistance. Muscle strength is graded on a scale of 0-5. It may be absent altogether, demonstrate a trace sign of contraction, allow movement against gravity, or tolerate movement against some resistance or tolerate movement against full resistance. Muscular strength provides the framework to maintain correct posture for daily activities. A child with this type of injury may display variable degrees of strength deficits for which strength training may be required or beneficial.
  • Range of Motion: This refers to the ability to move a joint through its available arc of motion with or without resistance. Often ROM is lost in the child due to decreased activity level. ROM needs to be within normal limits for the child to function independently within their environment. Muscle groups more susceptible or at higher risk of deficits in ROM include hamstrings, heelcords, hip flexors, biceps, wrist and hand flexors.
  • Coordination: A child who has sustained a brain inury may experience difficulty performing smooth and accurate movements. This may include fine motor or gross motor activities for example feeding, buttoning, drawing, writing, running, jumping, etc… (Trombley, 1995).
  • Vision: Vision may be impaired due to damage sustained in the retina, cranial nerves or occipital lobe. The child may have difficulty with oculomotor skills, visual field deficits and visual attention. Impairments may include double vision, neglect of a portion of the visual field, controlled movement of the eyes, blindness or difficulties with perception (Kovich & Bermann, 1988).
  • Perception: After a brain injury, a child may have difficulty organizing internal and external sensory input into meaningful information which allows him/her to interact with the environment ( Kovich & Bermann, 1988).
  • Hearing: Frequently, as a result of traumatic injury to the head, temporal bone fractures and middle and inner ear injuries occur. This may result in loss or displacement of the middle ear ossicles and conductive hearing loss. Inner ear problems resulting in sensorineural hearing loss occur frequently but do not necessarily impede function. A complete audiologic and otologic evaluation is recommended for children with significant head injuries.
  • Sensation: Depending on the location of a brain injury, a child may experience a change in sensation. Areas of sensation that may be affected include: hearing, vision, smell or tactile systems. Temperature, pain, touch and position of the body in space are examples of possible impairment with the tactile systems (Kovich & Bermann, 1988).
  • Balance: Refers to the ability to maintain midline orientation without falling in a variety of positions i.e. standing, sitting, hands and knees, sidelying, walking. Balance is assessed in both static and dynamic activities. Depending on the location of injury to the brain, balance may be severely or mildly affected.
  • Safety Awareness: Following an injury to the brain, some children may experience deficits in cognition such as initiation, attention, sequencing, memory and sensory processing. These deficits may affect the childs safety and judgement in the performance of functional tasks (i.e. crossing the street, wearing protective gear or recognizing emergency situations) (Kovich & Bermann, 1988).
  • Muscle Tone: A child who has sustained a brain injury may develop abnormal muscle tone. Muscle tone is the resistance of a muscle to passive stretch or elongation. The presence of abnormal muscle tone in the form of hypertonia (increased muscle tone; "stiff") or hypotonia (decreased muscle tone; "floppy") may be evident (Trombley, 1995).

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