POSSIBLE MEDICAL MANAGEMENT

• PHYSICAL THERAPY

®Physical therapy is a health care profession which provides services to

individuals and populations to develop maintain and restore maximum
movement and functional ability throughout life. This includes providing
services in circumstances where movement and function are threatened by
aging, injury, disease or environmental factors. Physical therapy is concerned
with identifying and maximizing quality of life and movement potential within
the spheres of promotion, prevention, treatment/intervention, habilitation
and rehabilitation. This encompasses physical, psychological, emotional, and
social well being. It involves the interaction between physical therapist (PT),
patients/clients, other health professionals, families, care givers, and
communities in a process where movement potential is assessed and goals
are agreed upon, using knowledge and skills unique to physical therapists.

● OCCUPATIONAL THERAPY
® Therapists work with the client to relearn activities of daily living and to
use assistive devices that promote independence.
● SPEECH THERAPY
® Speech pathologists work with the client to foster the maximum amount of
speech recovery possible through relearning, accentuation of speech sounds,
or use of alternative communication devices. The swallowing mechanism is
also assessed and recommendations are made for initiation and progression
of foods and fluids to decrease the risk for aspiration.
● CASE MANAGEMENT
® To facilitate all care provides and to advocate for the client and family

ACTUAL SURGICAL MANAGEMENT

CRANIECTOMY

Craniectomy is a neurosurgical procedure in which part of the skull is

removed to allow a swelling brain room to expand without being squeezed. It
is performed on victims of traumatic brain injury and stroke. Though the
procedure is considered a last resort, some evidence suggests that it does
improve outcomes by lowering intracranial pressure (ICP), the pressure
within the skull. Raised intracranial pressure is very often debilitating or fatal
because it causes compression of the brain and restricts cerebral blood flow.
The aim of decompressive craniectomy is to reduce this pressure. The part of
the skull that is removed is called a bone-flap. A study has shown that the
larger the removed bone-flap is, the more ICP is reduced.

POSSIBLE SURGICAL MANAGEMENT

CRANIOTOMY

Surgical removal of part of the skull to expose the brain.

There are two basic ways to open the skull:

• a curving incision from behind the hairline, in front of the ear, arching
above the eye
• at the nape of the neck around the occipital lobe

The surgeon marks with a felt tip pen a large square flap on the scalp that
covers the surgical area. Following this mark, the surgeon makes an incision
into the skin as far as the thin membrane covering the skull bone. Because
the scalp is well supplied with blood, the surgeon will have to seal many
small arteries. The surgeon then folds back a skin flap to expose the bone.
 Using a high speed hand drill or an automatic craniotome, the surgeon
makes a circle of holes in the skull, and pushes a soft metal guide under the
bone from one hole to the next. A fine wire saw is then moved along the
guide channel under the bone between adjacent holes. The surgeon saws
through the bone until the bone flap can be removed to expose the brain.

After the surgery for the underlying cause is completed, the piece of skull
is replaced and secured with pieces of fine, soft wire. Finally, the surgeon
sutures the membrane, muscle, and skin of the scalp.

SURGERY TO REPAIR ANEURYSMS AND ARTERIOVENOUS

MALFORMATIONS (AVMS)

An aneurysm is a weakened, ballooned area on an artery wall that has

a risk for rupturing and bleeding into the brain. An AVM is a congenital
(present at birth) or acquired disorder that consists of a disorderly, tangled
web of arteries and veins. An AVM also has a risk for rupturing and bleeding
into the brain. Surgery may be helpful, in this case, to help prevent a stroke
from occurring.