1. CHAPTER 9
REHABILITATION OF INJURIES
• Rehabilitation is any process that seeks to restore a
patient to a previous level of health.
Rehabilitation of injury to the head, neck and face
Head injury
• Head injury refers to trauma of the head.
• This may or may not include injury to the brain.
• However, the terms traumatic brain injury and head
injury are often used interchangeably in medical
literature.

2. Classification
• Head injuries include both injuries to the brain and those
to other parts of the head, such as the scalp and skull.
• Head injuries may be closed or open.
• A closed head injury is where the dura mater remains
intact.
• The skull can be fractured, but not necessarily.
• A penetrating head injury occurs when an object pierces
the skull and breaches the dura mater.
• Brain injuries may be diffuse, occurring over a wide area,
or local, located in a small, specific area.
• A head injury may cause skull fracture, which may or may
not be associated with injury to the brain.

3. Continued…
Specific problems after head injury can include:
• Skull fracture
• Lacerations to the scalp and resulting hemorrhage of
the skin.
• Traumatic subdural hematoma, a bleeding below the
dura mater which may develop slowly.
• Traumatic extradural, or epidural hematoma,
bleeding between the dura mater and the skull.
• Traumatic subarachnoid hemorrhage.
• Cerebral contusion, a bruise of the brain.
• Concussion, a loss of function due to trauma.
• A severe injury may lead to a coma or death.

4. Concussion
• Traumatic brain injury (TBI) is an exchangeable
word used for the word concussion.
• This term refers to a mild brain injury.
• This injury is a result due to a blow to the head
that could make the person’s physical, cognitive,
and emotional behaviors irregular.
• Symptoms may include: Clumsiness, Fatigue,
Confusion, Nausea, Blurry Vision, Headaches,
and etc.

5. Continued…
• Common symptoms of head injury include coma,
confusion, drowsiness, personality change, seizures,
nausea & vomiting, and headache.
• Symptoms of skull fracture can include:
• leaking cerebrospinal fluid (a clear fluid drainage
from nose, mouth or ear).
• visible deformity or depression in the head or face;
for example a sunken eye can indicate a maxillar
fracture.
• an eye that cannot move or is deviated to one side
can indicate that a broken facial bone is pinching a
nerve that innervates eye muscles
• Wounds or bruises on the scalp or face.

6. Causes
• Common causes of head injury are motor vehicle
traffic collisions, home and occupational accidents,
falls, and assaults.
• Bicycle accidents are also a cause of head injury-
related death and disability, especially among
children.
Diagnosis
• The need for imaging in patients who have suffered
a minor head injury is debated.
• CT scan of the head should be performed
immediately in all those who have suffered a
moderate or severe head injury, an MRI is also an
option.

7. Management
• Most head injuries require no treatment beyond
analgesics and close monitoring for potential
complications such as intracranial bleeding.
• If the brain has been severely damaged by
trauma, neurosurgical evaluation may be useful.
• Head injury may be associated with a neck injury.
• Bruises on the back or neck, neck pain, or pain
radiating to the arms are signs of cervical spine
injury and merit spinal immobilization via
application of a cervical collar.

8. Rehabilitating Neck Injuries
• Most non-traumatic conditions that produce neck
pain can be managed with physiotherapy to
augment rehabilitation.
• One key role the physiotherapist can often play is to
reassure the patient that the injury is not serious.
• After that, the goal of immediate treatment is to
minimize pain and inflammation with
recommendations of anti-inflammatory drugs,
application of TENS, icing, and in some cases
immediate manipulation.
• The physiotherapist will perform an examination to
determine if manipulation is clinically warranted at
the onset of treatment.

9. Immediate Treatment
• A specific diagnosis of non-traumatic neck pain is
sometimes difficult to make, especially if the pain is
localized.
• Therefore, the physiotherapist’s key role can be in
assuring the athlete that the problem is not serious.
• If the patient has normal strength and reflexes and
a history consistent with mechanical pain, he or she
can be told with confidence that no significant
herniated disk or nerve injury exists, and that
resolution or control of symptoms is expected
without surgery.

10. Continued…
• In the acute phase, the goal is to minimize pain and
inflammation.
• Initial treatment of acute injuries consists of
manipulation, electrotherapy, and anti-inflammatory
drugs.
• Further, frequent self-administered ice packs to the
painful area for 10 to 15 minutes, and home stretching.
• The patient should discontinue activities that aggravate
symptoms.
• As pain and inflammation are being controlled, the
athlete is advanced to the recovery phase of
rehabilitation, where the goal is to recover lost function.