Post Tbi Neurologic Disorders

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Post TBI disorders

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-dementia
-movement disorders
-sleep disturbances
-fatigue
-visual dysfunction
-headaches
-seizures and epilepsy
-balance and dizziness
-cranial nerve disorders
-late intracranial complications
-speech, language and swallowing problems

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TBI consumer report findings

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-body temp. changes/hair and skin changes were found significantly more often in TBI.
-arthritic conditions
-women more likely than men to have a thyroid condition, headaches, sleep disturbances, loss of urinary control, frequent colds, arthritic symptoms, changes in weight, hair/skin, body temp.

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Mvmt Disorders: hypokinesia/hyperkinesia

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-hypokinesia: slowness or poverty of mvmt.
-hyperkinesia: excessive involuntary mvmts
-delayed onset: up to months or years post-injury (up to 20 yrs reported)

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Mvmt. Disorders: Tremor/Dystonia

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-Tremor- most common
-Dystonia: neurological mvmt disorder in which sustained muscle contractions cause twisting and repetitive mvmts or abnormal postures

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Mvmt Disorders: Segmental dystonia

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-hemidystonia: affects an arm and a leg on one side of the body
-multifocal dystonia: affects many different parts of the body
-generalized dystonia: affects most of the body

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Mvmt Disorders: Focal dystonias

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-Oromandibular dystonia: affects the muscles of the jaw and tongue, causes distortions of the mouth and tongue
-Spasmodic dysphonia/laryngeal dystonia: affects the muscles of the larynx, causing the voice to sound broken or reducing it to a whisper

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Mvmt Disorders: Tics and Parkinsonism

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-motor tics and vocalizations similar to Tourette's Syndrome
-Posttraumatic Parkinsonism: most common after chronic subdural hematoma/punch-drunk syndrome: boxers- chronic encephalopathy

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Sleep disturbances: dysomnias/parasomnias

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Occurrence rate: up to 82% hospitalized pts and 73% discharged pts
Dysomnias: obstructive sleep apnea, restless leg syndrome, periodic limb mvmt disorder
Parasomnias: sleep walking, sleep talking, sleep terrors, nightmares, bruxism

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Visual Problems

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-often visual problems resulting from aquired brain injury are overlooked during initial trtmt of the injury
-frequently these problems are hidden and neglected, lengthening and impairing rehab
-blurred vision
-sensitivity to light
-reading difficulties; words appear to move
-comprehension difficulty
-attn and concentration difficulty
-memory difficulty
-double vision
-aching eyes
-headaches w/ visual tasks
-loss of visual field

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TBI and neuropsychiatric disorders

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-several cortical regions including the frontal and temral cortex and hippocampus are particularly vulnerable to TBI
-b/c of this, specific neurotransmitter systems (e.g.,serotonergic, cholinergic) are likely to be affected
-structural and neurochemical injury play a major roles in the neurobehavioral profile assoc. w/ TBI

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What will families and caregivers notice

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-changes in personality, impulsivity, cognition, irritability,
-mood disorders: depression, mania, psychosis, anxiety, substance abuse, dementia

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Depression

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sadness, tearfulness, lethargy, withdrawl, loss of interest in activities once enjoyed, insomnia, or sleeping too much, weight gain or loss

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Anxiety

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excessive worry or fear that disrupts everyday activities or relationships, physical signs such as restlessness or extreme fatigue, muscle tension, sleeping problems

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mania

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state of extreme excitement, restlessness, hyperactivity, insomnia, rapid speech, impulsiveness, poor judgment

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psychosis

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inability to think realistically, symptoms such as halucinations, delusions, paranoia, problems thinking clearly
-if severe, behavior seriously disrupted
-if mild, behavior bizarre, strange, or suspicous

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obsessive-compulsive symptoms

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development of obsessions, and compulsions, preoccupation w/ details, rules, or orderliness to such a degree that the larger goal is lost, lack of flexibility or ability to change

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suicide risk

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states feelings of worthlessness or that life is not worth living or that world would be better off w/out him/her, talks about suicide, states intention to commit suicide, develops plan to commit suicide