The Neurosurgery Patient: From Surgery Thro

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The Neurosurgery Patient From Surgery Thro Rehab

• Nadia Bhayat
• Senior Specialist Speech Language Pathologist

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TBI

• leading cause of death - lt 45yrs
• leading cause of disability
• Causes
• Adult MVAs, falls, sports injuries
• Children MVAs, bicycle accidents, falls
  child abuse
• Children more susceptible than adults to
  permanent brain damage

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Parietal lobe
Frontal lobe
Occipital lobe
Temporal lobe
Cerebellum
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Motor cortex
Somatosensory cortex
Sensory associative cortex
Pars opercularis
Visual associative cortex
Brocas area
Visual cortex
Primary Auditory cortex
Wernickes area
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Effects of Brain injury on Brain Function

• Central Part awake alert damage gt coma
• Parietal lobe damage weakness in limbs on
  opposite side of the body
• Left hemisphere or Brainstem damage sp
  lang imp
• Hidden disabilities frontal lobe damage gt
  behav. prob

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Outcome/Recovery

• 1. Post Traumatic Amnesia (PTA) confused
  disorientated, unable to remember conv. or do/say
  bizarre things
• stage thro which person will pass
• length is NB indication of severity of injury
• 2. Coma length
• 1 2 best measure of eventual outcome

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Types of HI

• Minor HI brief unconsc. or feel dizzy/sick
• Causes banging head (car/doorway/slipping)
• 75 of all HI
• Effects nausea, headaches, dizziness, lt conc.,
  memory prob., gt tiredness, intol. to light
  noise gtanxiety depression
• Persists Post Concussion Syndrome
• Recovery 3 to 4 mths

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2. Moderate HI

• unconsc. 15min to 6 hrs PTA - 24 hrs
• kept in hospital overnight for obs
• Effects Physical tired, headache, dizziness
• Cognitive thinking, memory planning,
  attention,
• organization wd finding prob
• Emotional Behavioral irritability gt anxiety
• Difficulty returning to work
• Recovery 6 to 9 mths

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Severe HI

• Coma 6 hrs PTA 24 hrs
• Serious physical deficits

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Physical Effects

• Damage to Motor Cortex, Brainstem
• Cerebellum
• affects m/m, balance coordination
• R side damage gt L side of body affected
• (weakness/paralysis)
• Cerebellum fine motor coordination
• Balance damage to vestibular system gt
• dizziness
• limb dyspraxia voluntary actions affected
• cant bend arm, but can tell time

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Sensory Problems

• Sensory Cortex damage gt loss of sight, hearing,
  
• taste smell
• Occipital lobe damage gt blindness
  (full/partial)
• or visual neglect (visual processing)
• Brainstem damage gt Temperature control

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Emotional Behavioral Effects

• agitation restlessness, pacing, pulling out
  tubes
• coping mechanism
• explosive anger irritability labile
  extreme swings
• lack of awareness insight lack of
  sensitivity/empathy
• impulsivity disinhibition speak your mind,
  breech
• social etiquette
• self centered own needs
• apathy poor motivation
• depression
• Anxiety
• Inflexibility obsessiveness

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Cognitive Effects

• affects the way you think, learn remember
• memory Amnesia retrograde amnesia ST memory
• loss
• attention conc. - gt tired, stressed/worried
• information processing slow
• executive functions of Planning, Organizing
  problem
• solving

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Visuo Spatial Perceptual Difficulties

• make sense of incoming info from ears
• eyes
• unable to judge distances, spatial
• relationships orientation bump into
• furniture
• unilateral neglect prob. With 1 side eat ½
• food on a plate, read ½ way across a page,
• draw ½ a person

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Language Problems

• Receptive make sense of what is heard or read
• Expressive unable to find the right words to
  say or
• write
• Referred to as APHASIA
• Both receptive expressive areas affected
  Global
• Aphasia
• ability to make sounds controlled by muscles
  
• innervated by cranial nerves

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Dysphagia

• affects ability to chew swallow food /
  fluid
• causes choking aspiration, dehydration,
• malnutrition
• if severe ptt fed via NGT, OGT or PEG

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Speech therapy is not only a Science but an Art
form as well

• Effective management Individual family MD
  Team
• no cook book or rack of remedies to overcome
  communication difficulties
• setting specific individual goals, a high level
  of motivation and active participation by the
  individual and his/her family.

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Intervention

• ?---------------------------------?
• Birth Old
  Age
• Role dynamic, diverse and varied fascinating
  and a challenging
• involves a bit of magic added in for good measure
  and a whole lot of scientific skill!

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Thank You
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