The Assessment and Treatment
of Mild to Moderate Head
Injuries within Orthopaedics
Megan Atkinson
Senior Physiotherapist
Southampton General Hospital
Nov 2015
Aims and Objectives
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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
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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:
• Common causes:
70 – 88% of head injuries are male
Assaults – 30-50%
10-19% - 65yrs or older
Falls – 22-43%
40-50% - are children
RTA- 25%
0.2% - mortality of all head injury
admissions
Alcohol is involved in up to 65% of head
injuries
NICE 2014 (PAGE 22)
Evidence Base
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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
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Evidence base – minimal (more towards mod-severe HI)
Discussion with seniors
Benchmarking
Core standards
Head Injury Core Standards
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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.