Acquired brain injury

Acquired brain injury (ABI) is brain damage caused by events after birth, rather than as part of a
genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal
hypoxia.[1] ABI can result in cognitive, physical, emotional, or behavioural impairments that
lead to permanent or temporary changes in functioning.[1] These impairments result from either
traumatic brain injury (e.g. physical trauma due to accidents, assaults, neurosurgery, head injury
etc.) or nontraumatic injury derived from either an internal or external source (e.g. stroke, brain
tumours, infection, poisoning, hypoxia, ischemia, encephalopathy or substance abuse).[1] ABI
does not include damage to the brain resulting from neurodegenerative disorders.[1]

While research has demonstrated that thinking and behavior may be altered in virtually all forms
of ABI, brain injury is itself a very complex phenomenon having dramatically varied effects.[2]
No two persons can expect the same outcome or resulting difficulties.[2] The brain controls
every part of human life: physical, intellectual, behavioral, social and emotional. When the brain
is damaged, some part of a person's life will be adversely affected.[2]

Consequences of ABI often require a major life adjustment around the person's new
circumstances, and making that adjustment is a critical factor in recovery and rehabilitation.[2]
While the outcome of a given injury depends largely upon the nature and severity of the injury
itself, appropriate treatment plays a vital role in determining the level of recovery.

INTERVENTION
Cognitive rehabilitation represents a substantial portion of rehabilitative efforts put forth in
increasing independence following an acquired brain injury. Main outcomes and results: This
review examined four major areas of cognitive therapy including: attention/concentration,
learning and memory, executive functioning, and general cognitive rehabilitation approaches. In
total, 64 studies were evaluated throughout the four major areas, which provided the evidence-
base for 18 conclusions. The majority of the conclusions were based on moderate and limited
evidence, however three strong and one conflicting conclusions were made.
CASE
After Nigel was found unconscious, it was discovered had sustained an acquired brain
injury (ABI) and he spent many months in hospital with severe cognitive and behavioural
problems. After spending some time at our York House service, where staff worked with Nigel
to follow our neurorehabilitation model, he moved into Daniel Yorath House where he was able
to further develop independent living skills.

During Nigel's stay, a three-month placement in our Transitional Living Unit (TLU) was agreed
to ensure consistency and consolidation of his skills and abilities. Staff worked with Nigel on
helping him to control aggressive behaviour and develop his independence, which had been a
barrier to independent living in the community.

During Nigel's trial in the TLU, his mood was stable and he engaged in activities, continuing to
work on everyday tasks, increasing community access including going to the driving range with
a small group of other people currently in the service and swimming on a fortnightly basis.

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/acquired-brain-injury

EPILEPSY
Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes
abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of
awareness.

Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic
backgrounds and ages.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few
seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single
seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required
for an epilepsy diagnosis.

Treatment with medications or sometimes surgery can control seizures for the majority of people
with epilepsy. Some people require lifelong treatment to control seizures, but for others, the
seizures eventually go away. Some children with epilepsy may outgrow the condition with age.

https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093
INTERVENTION
Cognitive and behavioral interventions may be considered as low-risk adjuncts to standard
therapies. Efficacy data are limited, however, by small numbers of subjects, inadequate
randomization, controls, and blinding, brief trial durations, varying methodologies, and
variability in the presentation of results. Additional clinical trials are warranted.

ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094950/

Causes

Epilepsy has no identifiable cause in about half the people with the condition. In the other half,
the condition may be traced to various factors, including:

 Genetic influence. Some types of epilepsy, which are categorized by the type of seizure
you experience or the part of the brain that is affected, run in families. In these cases, it's
likely that there's a genetic influence.

Researchers have linked some types of epilepsy to specific genes, but for most people,
genes are only part of the cause of epilepsy. Certain genes may make a person more
sensitive to environmental conditions that trigger seizures.

 Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause
epilepsy.

 Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or
strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age
35.

 Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis,
can cause epilepsy.

 Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by
several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies.
This brain damage can result in epilepsy or cerebral palsy.

 Developmental disorders. Epilepsy can sometimes be associated with developmental

disorders, such as autism and neurofibromatosis.
https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093
Cerebral palsy (CP) is a group of permanent movement disorders that appear in early
childhood.[1] Signs and symptoms vary among people and over time.[1][3] Often, symptoms
include poor coordination, stiff muscles, weak muscles, and tremors.[1]There may be problems
with sensation, vision, hearing, swallowing, and speaking.[1] Often, babies with cerebral palsy do
not roll over, sit, crawl or walk as early as other children of their age.[1] Other symptoms
include seizures and problems with thinking or reasoning, which each occur in about one third of
people with CP.[1] While symptoms may get more noticeable over the first few years of life,
underlying problems do not worsen over time.[1]
Cerebral palsy is caused by abnormal development or damage to the parts of the brain that
control movement, balance, and posture.[1][4] Most often, the problems occur during pregnancy;
however, they may also occur during childbirth or shortly after birth.[1] Often, the cause is
unknown.[1] Risk factors include preterm birth, being a twin, certain infections during pregnancy
such as toxoplasmosis or rubella, exposure to methylmercury during pregnancy, a difficult
delivery, and head trauma during the first few years of life, among others.[1] About 2% of cases
are believed to be due to an inherited genetic cause.[5] A number of sub-types are classified based
on the specific problems present.[1] For example, those with stiff muscles have spastic cerebral
palsy, those with poor coordination have ataxic cerebral palsy and those with writhing
movements have athetoid cerebral palsy.[1] Diagnosis is based on the child's development over
time.[1] Blood tests and medical imaging may be used to rule out other possible causes.[1]

INTERVENTION
Two interventions are now being used to reduce the risk or severity of cerebral palsy:

 Magnesium Sulfate – is given to pregnant mothers when they are at risk of very preterm
birth. This can help protect babies from the brain injury that leads to cerebral palsy.
 Cooling – Newborn babies who have suffered a brain injury due to lack of oxygen before
birth (hypoxic ischemic encephalopathy) may be treated with a special cooling which
aims to reduce the impact of the brain injury.

Interventions for movement issues

MedicationInterventions for movement issues

Medication
Medical specialists may prescribe medications that assist movement issues. Some medications
are taken orally (e.g. diazepam) and others are injected or delivered through surgically implanted
pumps (e.g. Baclofen). Many children with cerebral palsy benefit from Botulinum toxin type A
injections into muscles affected by spasticity. This intervention is used from about two years of
age and is most effective when used in conjunction with therapy.
Surgical procedures
Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a small
percentage of children with cerebral palsy to permanently reduce spasticity in their legs.
Physical therapy and occupational therapy
Physiotherapists and occupational therapists focus on encouraging a person’s day-to-day
movement skills such as sitting, walking, playing, dressing and toileting. They will use a range
of specialist interventions such as movement training and equipment, e.g. walking frames,
wheelchairs, supportive seating, footwear and orthotics.

Medical specialists may prescribe medications that assist movement issues. Some medications
are taken orally (e.g. diazepam) and others are injected or delivered through surgically implanted
pumps (e.g. Baclofen). Many children with cerebral palsy benefit from Botulinum toxin type A
injections into muscles affected by spasticity. This intervention is used from about two years of
age and is most effective when used in conjunction with therapy.
Surgical procedures

Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a small

percentage of children with cerebral palsy to permanently reduce spasticity in their legs.
Physical therapy and occupational therapy

Physiotherapists and occupational therapists focus on encouraging a person’s day-to-day

movement skills such as sitting, walking, playing, dressing and toileting. They will use a range
of specialist interventions such as movement training and equipment, e.g. walking frames,
wheelchairs, supportive seating, footwear and orthotics.

CASES
There are two common terms used to describe how cerebral palsy affects muscle tone —
hypotonia and hypertonia. These are useful to better understand the types of CP.

 Hypotonia – Low muscle tone, causing a loss of strength and firmness

 Hypertonia – High muscle tone, causing rigidity and spasmodic movement

https://www.cerebralpalsyguide.com/cerebral-palsy/types/
 Cystic fibrosis is a hereditary disease that affects the lungs and digestive system. The body
produces thick and sticky mucus that can clog the lungs and obstruct the pancreas.

Fast facts on cystic fibrosis

Here are some key points about cystic fibrosis. More detail is in the main article.

 Cystic fibrosis (CF) involves the production of mucus that is much thicker and more sticky
than usual.

 It mainly affects the lungs and digestive system.

 CF is a hereditary condition that occurs in a child when both parents have the defective gene.

 All newborns in the U.S. are screened for CF.

 There is no cure, but good nutrition and taking steps to thin mucus and improve mucus
expectoration can help.

https://www.medicalnewstoday.com/articles/147960.php

INTERVENTION: There is currently no cure for CF. Treatment can manage the symptoms of
the disease, however, and improve quality of life. Symptoms can vary and treatment plans will
be individualized.

CASE
Cystic fibrosis (CF) is considered one of the most commonly occurring fatal genetic disorders.
This disorder is associated with pancreatic insufficiency and pulmonary complications. However,
at birth the initial complications are associated with bowel obstruction. Cystic fibrosis
management warrants an interdisciplinary team because this disorder affects various organ
systems. Effective management of the newborn with CF assists in improving the child's overall
prognosis. Family support is critical throughout the prenatal and postnatal periods. The case
presented reviews a child born with suspected CF and the clinical course within the NICU.

https://www.ncbi.nlm.nih.gov/pubmed/29789057
Multiple sclerosis, or MS, is a long-lasting disease that can affect your brain, spinal cord, and the
optic nerves in your eyes. It can cause problems with vision, balance, muscle control, and other
basic body functions.

The effects are often different for everyone who has the disease. Some people have mild
symptoms and don’t need treatment. Others will have trouble getting around and doing daily
tasks.

MS happens when your immune system attacks a fatty material called myelin, which wraps
around your nerve fibers to protect them. Without this outer shell, your nerves become damaged.
Scar tissue may form.

INTERVENTION:
There is no cure for MS right now, but a number of treatments can improve how you feel and keep
your body working well.
Your doctor can also prescribe drugs that may slow the course of the disease, prevent or treat attacks,
ease your symptoms, or help you manage the stress that can come with the condition.
https://www.webmd.com/multiple-sclerosis/what-is-multiple-sclerosis#3

CASES
Ms. M is a 30‐year old woman who comes to an outpatient physical therapy clinic because she
recently began experiencing some pain in her posterior left knee and thigh toward the end of her
normal, daily 2‐ mile run. Upon taking the history, the PT found that Ms. M was diagnosed with
the relapsing‐remitting type of multiple sclerosis (MS) 3 months ago. She had been in perfect
health when she experienced a 2‐ week period of numbness and tingling in her feet that worsened
after prolonged exertional physical activity, on hot and humid days, or even after a hot shower.
Her primary care physician referred her to a neurologist for further examination. This workup
included an MRI that was positive for gadolinium‐ enhancing lesions) in her cervical spine, and a
lumbar puncture that was positive for oligoclonal bands Ms. M’s physician also noted gaze‐
evoked linear nystagmus). She related a history that included previous, transient incidences of
lower extremity numbness and tingling after longer runs. Based on these findings the neurologist
gave her a diagnosis “probable MS” Overview – Medical Diagnosis section), and prescribed
Copaxone (Glatiramer acetate) as a disease‐modifying agent (please see the PTNow MS Clinical
Summary Medical Management – Disease Modifying Therapy table). Because her motor exam
was normal other than the hyperactive deep tendon reflexes, the neurologist did not suggest that
she see a Physical Therapist (PT). Ms. M only pursued PT because of the pain in her leg.

http://www.neuropt.org/docs/default-source/csm-2016-handouts/ptnow-and-ms-edge-
supplement-ptnow-early-and-mild-ms-case.pdf?sfvrsn=2
Spina bifida is a birth defect where there is incomplete closing of the backbone and
membranes around the spinal cord.[1]There are three main types: spina bifida
occulta, meningocele, and myelomeningocele.[1] The most common location is the lower back,
but in rare cases it may be the middle back or neck.[9] Occulta has no or only mild signs.[5] Signs
of occulta may include a hairy patch, dimple, dark spot, or swelling on the back at the site of the
gap in the spine.[1] Meningocele typically causes mild problems with a sac of fluid present at the
gap in the spine.[1] Myelomeningocele, also known as open spina bifida, is the most severe
form.[2] Associated problems include poor ability to walk, problems with bladder or bowel
control, accumulation of fluid in the brain (hydrocephalus), a tethered spinal cord, and latex
allergy.[2] Learning problems are relatively uncommon.[2]
INTERVENTION

Spina Bifida

Currently, there is no cure for spina bifida, but there are a number of treatments available to help
manage the disease and prevent complications.

In some cases, if diagnosed before birth, the baby can undergo surgery while still in the womb in
an effort to repair or minimize the spinal defect. The procedure is performed by fetal surgeons
after an extensive risk assessment of mother and fetus.

Treatment after birth may include ongoing surgery, medications and physical and behavioral
therapy, depending on the type and severity of the defect, your child's age and overall health as
well as personal preferences.

Children with the mildest form of the disease, spina bifida occulta, usually don't need treatment.

Children with spina bifida meningocele typically can be treated without surgery. However, they
may develop complications, such as bladder problems and hydrocephalus, or excessive fluid in
the brain. If untreated, it may cause movement disorders or mental retardation.

Fluid can be drained from the brain through a surgical procedure that uses a special tube called a
shunt. The shunt runs under the skin into the abdomen and the fluid passes into the child's body
without harm.
Case
A 27-year-old woman was referred for assessment of a 23-week gestation fetus with
thoracolumbosacral SB. The lesion was first detected on a 20-week ultrasound performed
because of an elevated maternal serum alpha-fetoprotein level. Serial ultrasound demonstrated
good leg movements, and karyotype by amniocentesis was normal. Ultrafast fetal MRI revealed
a SB lesion extending from thoracic level 11 to sacral level 1, Arnold-Chiari type II
malformation, and borderline hydrocephalus (the fetal lateral ventricles measured 10 mm). The
mother declined pregnancy termination and consented to surgery.

Prader–Willi syndrome (PWS) is a genetic disorder due to loss of function of

specific genes.[3] In newborns, symptoms include weak muscles, poor feeding, and slow
development.[3] Beginning in childhood, the person becomes constantly hungry, which often
leads to obesity and type 2 diabetes.[3] Also, mild to moderate intellectual impairment and
behavioral problems are typical.[3] Often, the forehead is narrow, hands and feet are small, height
is short, skin is light in color, and most of the affected are unable to have children.[3]
About 74% of cases occur when part of the father's chromosome 15 is deleted.[3] In another 25%
of cases, the person has two copies of chromosome 15 from their mother and none from their
father.[3] As parts of the chromosome from the mother are turned off, they end up with no
working copies of certain genes.[3] PWS is not generally inherited, but instead the genetic
changes happen during the formation of the egg, sperm, or in early development.[3] No risk
factors are known.[7] Those who have one child with PWS have less than a 1% chance of the next
child being affected.[7] A similar mechanism occurs in Angelman syndrome, except the defective
chromosome 15 is from the mother or two copies are from the father.[

Treatment
PWS has no cure; however, several treatments are available to lessen the condition's symptoms.
During infancy, subjects should undergo therapies to improve muscle strength. Speech and
occupational therapy are also indicated. During the school years, children benefit from a highly
structured learning environment and extra help. The largest problem associated with the
syndrome is severe obesity. Access to food must be strictly supervised and limited, usually by
installing locks on all food-storage places including refrigerators.[20] Physical activity in
individuals with PWS for all ages is needed to optimize strength and promote a healthy
lifestyle.[13]
Prescription of daily recombinant GH injections are indicated for children with PWS. GH
supports linear growth and increased muscle mass, and may lessen food preoccupation and
weight gain.

Because of severe obesity, obstructive sleep apnea is a common sequela, and a positive airway
pressure machine is often needed. A person who has been diagnosed with PWS may have to
undergo surgical procedures. One surgery that has proven to be unsuccessful for treating the
obesity is gastric bypass.[42] People with PWS have a very high tolerance to pain;, so may be
experiencing abdominal symptoms such as acute gastritis, appendicitis, or cholecystitis and not
be aware of it.
Behavior and psychiatric problems should be detected early for the best results. These issues are
best when treated with parental education and training. Sometimes medication is introduced, as
well. Serotonin agonists have been most effective in lessening temper tantrums and improving
compulsivity.
CASE
The Characteristics of the Object. The male neonatal was clinically suspected to be a PWS
patient. This patient is the first child of his parents. There was weak quickening, fewer fetal
movements at 39 weeks and intrauterine distress during the pregnancy. Therefore he was born
bycesarean delivery and his birth weight was only 2.8 kg. Furthermore, his Apgar score was 3.

Genome-wide copy number variation analysis. Informed consent was obtained from the parents
of the patient. The peripheral blood of the patient and his parents were taken for normal
chromosome and high resolution chromosome G banding (4). Meanwhile, the blood genomic
DNA was isolated by the standard phenol/chloroform method and then tested by genome-wide
copy number variation analysis using the Illumina HumanCyto SNP-12 Beadchip.

This patient has low muscle tone, little limb activity, low crying and crying like a cat call
syndrome, poor sucking force, feeding difficulties and a characteristic face, which are basically
according to the clinical diagnosis standards. The characteristics including white skin color,
narrow face, small jaw, almond eyes, small mouth, thin upper lip and convex, angle downward,
low ear, slightly larger head, small hands and feet compared to the standard, short torso, lack of
wrist radian in both ulnar sides of upper limbs, limited outreach, reproductive organs dysplasia,
bilateral cryptorchidism, slightly thin limbs and flat belly. However, the intelligence and
appearance of his parents are normal and there are no relatives with similar manifestations
compared to the patient.

In this study, we found that there was a deletion of a 5 Mb region in chromosome 15q11.3–q13.3
in this patient by genome-wide copy number variation analysis (Figure 1). Furthermore, it was a
regional deletion in paternal chromosome 15q11–q13 in this PWS patient, but there were no
abnormalities in conventional karyotype and high resolution chromosome analysis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204554/
Action Plan for Acquired brain injury

objectives Assessment Activity Duration

1. Conduct a Make motivation for Making an interesting At least 1hr.
research about person with acquired video that can get the
acquired brain brain injury. attention of this
injury. person.

2. Define the evaluate deficits in Make a presentation At least 1hr

stages of advanced motor skills that can help him\her
acquired brain in children with to define his\her stage.
injury. acquired brain injury

3. To increase Present more idea or Make a video At least 1hr.

awareness and example to the person presentation that can
understanding with acquired brain get more information
of brain injury injury. with disability.
and its
consequences