PBL: Head Injuries

Case 1

Mr. A is an 18 year old trainee carpenter who had a frontal lobe haematoma evacuation following a RTA two months ago. He has tightness in his right pectoralis major which is restricting his upper limb function. You have asked a junior physio to perform some gentle stretches however they report that Mr. A however she reports that whenever she enters the room he begins to touch his genitals and displays inappropriate behaviour. How do you manage this situation?

Hints and tips Hints and tips
 Questions:

  • Describe the function of the pre-frontal lobe?
  • Discuss (tactfully) with family. Is this a normal behaviour ie patients personality or has this occurred since the traumatic brain injury (TBI)?
  • Can you change the environment? Does bringing the patient to the gym?
  • Does the patient change with different people? Perhaps treating as a pair with another male may change the behaviour?
  • Remove trigger if possible.
  • Make your line manager aware and discussed your proposed management, ask if they have any suggestions.
  • Documentation-This is very important and you must document your responses also.
  • Stretches.

Case 2

Mr. C is a 30 year old who had a TBI following a cycling accident. He finds it difficult  to communicate and is finding that he gets frustrated that he cannot express what he needs. He continues to point at his left calf suggesting that he has a problem here however when you try to assess the area he becomes agitated. He begins to swear and lash out. How would you manage this situation?

  Questions:

  • Hands off approach.
  • Utilise different communication strategies ie visual, writing.
  • You can try to get him to copy (ie to assess soleus length)
  • Start in known non painful area.
  • VAS scales.
Hints and tips Hints and tips
  • Awareness of potential threats – Building rapport.
  • Pain management- time with treatment.
  • Work in twos. Liaise with nursing staff.
  • Visual cues/ cards (time out periods if aggressive)

 

Paediatrics

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