Table Of ContentACUTE HEAD INJURY
FORTHCOMING TITLES
Occupational Therapy for the Brain-Injured Adult
Jo Clark-Wilson and Gordon Muir Giles
Multiple Sclerosis
Approaches to management
Lo"aine De Souza
Modem Electrotherapy
Mary Dyson and Christopher Hayne
Autism
A multidisciplinary approach
Edited by Kathryn Ellis
Physiotherapy in Respiratory and Intensive Care
Alexandra Hough
Community Occupational Therapy with Mentally Handicapped People
Debbie Isaac
Understanding Dysphasia
Lesley Jordan and Rita Twiston Davies
Management in Occupational Therapy
Zielfa B. Maslin
Keyboard, Graphic and Handwriting Skills
Helping people with motor disabilities
Dorothy E. Penso
Dysarthria
Theory and therapy
Sandra J. Robertson
Speech and Language Problems in Children
Dilys A. Treharne
THERAPY IN PRACTICE SERIES
Edited by Jo Campling
This series of books is aimed at 'therapists' concerned with rehabilitation
in a very broad sense. The intended audience particularly includes occupa
tional therapists, physiotherapists and speech therapists, but many titles will
also be of interest to nurses, psychologists, medical staff, social workers,
teachers or volunteer workers. Some volumes will be interdisciplinary,
others aimed at one particular profession. All titles will be comprehensive
but concise, and practical but with due reference to relevant theory and
evidence. They are not research monographs but focus on professional
practice, and will be of value to both students and qualified personnel.
1. Occupational Therapy for Children with Disabilities
Dorothy E. Penso
2. Living Skills for Mentally Handicapped People
Christine Peck and Chia Swee Hong
3. Rehabilitation of the Older Patient
Edited by Amanda J. Squires
4. Physiotherapy and the Elderly Patient
Paul Wagstaff and Davis Coakley
5. Rehabilitation of the Severely Brain-Injured Adult
Edited by Ian Fussey and Gordon Muir Giles
6. Communication Problems in Elderly People
Rosemary Gravell
7. Occupational Therapy Practice in Psychiatry
Linda Finlay
8. Working with Bilingual Language Disability
Edited by Deirdre M. Duncan
9. Counselling Skills for Health Professionals
Philip Burnard
10. Teaching Interpersonal Skills
A handbook of experiential learning for health professionals
Philip Burnard
11. Occupational Therapy for Stroke Rehabilitation
Simon Thompson and Maryanne Morgan
12. Assessing Physically Disabled People at Home
Kathy Maczka
13. Acute Head Injury
Practical management in rehabilitation
Ruth Gamer
14. Practical Physiotherapy with Older People
Lucinda Smyth et al.
Acute Head Injury
Practical management in
rehabilitation
RUTH GARNER
Therapy in Practice 13
SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
© 1990 Ruth Gamer
Originally published by Chapman and Hall Ltd in 1990
Typeset in 10/12 Times by
Mayhew Typesetting, Bristol
ISBN 978-0-412-32420-8
This paperback edition is sold subject to the condition
that it shall not, by way of trade or otherwise, be
lent, resold, hired out, or otherwise circulated without
the publisher's prior consent in any form of binding
or cover other than that in which it is published and
without a similar condition including this condition
being imposed on the subsequent purchaser.
All rights reserved. No part of this book may be
reprinted or reproduced, or utilized in any form or by
any electronic, mechanical or other means, now known
or hereafter invented, including photocopying and
recording, or in any information storage and retrieval
system, without permission in writing from the
publisher.
British Library Cataloguing in Publication Data
Gamer, Ruth
Acute head injury: Practical management in
rehabilitation. - (Therapy in practice; 13).
1. Head injured patients. Rehabilitation
I. Title II. Series
362.1'9751
ISBN 978-0-412-32420-8 ISBN 978-1-4899-3456-7 (eBook)
DOI 10.1007/978-1-4899-3456-7
Library of Congress Cataloging in Publication Data
available.
To my mother and father,
Ruth and Bill Thomas,
and to my husband Frank
Contents
Acknowledgements xi
Foreword xiii
1. Introduction 1
The extent of the problem 2
Classification of head injury 2
Course of recovery 3
Prognostic considerations 5
Clinical features 5
The treatment team 6
Rehabilitation defined 8
2. Early intervention 9
Aims of treatment 9
Knowing the patient 10
Evaluation 12
Family involvement 16
Environment 17
Stimulation programme 21
Summary 26
3. Activities of daily living 28
Reality orientation 29
Therapeutic application of everyday activities 30
Washing 32
Dressing 35
Continence 39
Feeding 42
Summary 45
4. Perception 46
Assessment 47
Visuo-perceptual disorders 51
Visuo-spatial disorders 53
Tactile perception 55
Olfactory and gustatory perception 56
Body scheme 57
Apraxia 61
Treatment notes 63
Summary 67
ix
CONTENTS
5. Aspects of physical dysfunction 69
Positioning 70
Spasticity 76
Ataxia 81
Sensory impairment 82
Muscular weakness or paralysis 84
Range of movement 85
Visual disorders 85
Hearing 86
Speech 87
Epilepsy 87
Protective helmets 88
Summary 92
6. Return to the community 94
The social worker 94
Home visiting 95
Following the home visit 101
A relative's experience 102
Discharge 105
Support groups 110
Summary 110
7. Psychosocial aspects 113
Personality change 113
Behaviour 114
Effects on the family 121
Cognitive impairment 123
Summary 128
Where to go from here 129
References 131
Index 135
X
Acknowledgements
My many thanks go to those who have provided help and guidance
by reading and commenting on parts of this book; these include
Karen Jones, Liz Wakely, Wyn Jones-Owen, Jackie Berisford and
Rosemary Jenkins. Thanks also go to other colleagues at the Birm
ingham Accident Hospital, who have been supportive over the years,
and with whom it has been a pleasure to work. Without the support
of staff within the Occupational Therapy Department and the help
and encouragement of Marianne Col bear, District Occupational
Therapist, the task of writing a book would have been a far more
arduous one.
I am indebted to the members of Headway West Midlands for
allowing me to be part of this organization. I am particularly grateful
to Karen Oakly for giving me permission to include a part of her
private diary to illustrate the text and to Marion Hemmings for shar
ing her experiences with me. There are too many dedicated members
to mention by name, but I have always considered the work of this
group to be invaluable in the support they provide both for families
and members of the caring profession.
My special thanks go to Mr P.S. London, currently Honorary
Consulting Surgeon at the Birmingham Accident Hospital, who has
given me considerable encouragement and guidance during the
preparation of this manuscript, as well as during my career. Mr
London, over many years, has made a significant contribution to the
treatment of head-injured victims and was one of the first to
acknowledge the burden that such patients place on the family and
community at the time of discharge from hospital. I am proud and
privileged to have worked with him.
Finally, thanks go to my husband, Frank, for being so patient
during long periods of my preoccupation with the word-processor,
for providing a proof-reading service and for having faith.
XI
