2.15 Brain Injury Flashcards
3 indexes for determining brain injury severity
Glasgow coma scale, length of LOC, length of post-traumatic amnesia
Mild TBI structural imaging
Usually normal
Mild TBI LOC
0-30 minutes
Mild TBI alteration of consciousness
A moment up to 24 hours
Mild TBI post-traumatic amnesia
0-1 day
Mild TBI GCS
13-15
Moderate TBI structural imaging
Normal or abnormal, usually abnormal
Moderate TBI LOC
> 30 min & <24 hours
Moderate TBI alteration of consciousness
> 24 hours
Moderate TBI post-traumatic amnesia
> 1 day & <7 days
Moderate TBI GCS
9-12
Severe TBI structural imaging
Normal or abnormal
Severe TBI LOC
> 24 hours
Severe TBI alteration of consciousness
> 24 hours
Severe TBI post-traumatic amnesia
> 7 days
Severe TBI GCS
<8 or 9
Glasgow Coma Scale scoring
Motor response (1-6) Verbal response (1-5) Eye opening (1-4)
Post-traumatic amnesia
Time from when patient regains consciousness to when they are able to form memories for ongoing events
Agitated Behavior Scale purpose
To assess nature & extent of agitation during the acute phase of recovery from acquired brain injury
Allows serial assessments for objective feedback about course of agitation
Coma/Near Coma Scale
Measure small clinical changes in patients with severe brain injuries
Expands levels of Disability Rating Scale (DRS)
5 levels based on 11 items
JFK Coma Recovery Scale purpose
Assist with differential diagnosis, prognostic assessment & treatment planning in patients with disorders of consciousness
JFK Coma Recovery Scale scoring
6 subscales: auditory, visual, motor, oromotor, communication, arousal
23 items
Higher score is better
Disability Rating Scale
Measure general functional changes during course of recovery from TBI
Can track from coma to community
Neurobehavioral Functioning Inventory
Collect information on wide spectrum of behaviors and symptoms commonly associated with brain injury
One completed by family members, one completed by patient
Rancho Los Amigos level I
No response
Prevent complications
Rancho Los Amigos level II
Generalized
Increase level of responsiveness, prevent complications
Rancho Los Amigos level III
Localized
Increase level of responsiveness, consistency of responses, and functional responses
Rancho Los Amigos level IV
Confused-agitated
Reduce agitation, increase consistency & functionality of responses
Rancho Los Amigos level V
Confused, inappropriate, non-agitated
Begin restorative treatment of cognitive function
Rancho Los Amigos level VI
Confused-appropriate
Decrease confusion, improve independence & cognition, improve information processing speed
Rancho Los Amigos level VII
Automatic-appropriate
Increase processing of complex information, increase awareness of deficits, develop compensatory strategies
Rancho Los Amigos level VIII
Purposeful-appropriate
Work on IADLs, exposure to community, options for employment
Focal cortical contusion causes (3)
GLF, assault, gunshot
Focal cortical contusion deficits (4)
Hemiparesis, aphasia, seizures, visuoperceptual
Diffuse axonal injury causes (3)
MVA, non-GLF, geriatric GLF
Diffuse axonal injury deficits (4)
Confused language, amnesia, apraxia, hypoarousal
Hypoxic/ischemic brain injury causes (3)
Anoxia, cardiac arrest, prolonged elevated ICP
Hypoxic/ischemic brain injury deficits (5)
Quadriparesis, spasticity, confusion, amnesia, hypoarousal
Left brain (5)
Positive Interpretation Planning, organizing, sequence Language, talking Knowledge of limits
Right brain (5)
Negative Intelligence Strategy, sports, hunting Imagination, creativity Intuition, impulse
Right temporal lobe damage
Visual memory
Left temporal lobe damage
Verbal memory/language functions
DAI damage
Slowing of cognitive processes, slow thinking, difficulty in getting things done
TBI recovery time
At least 18-36 months, with most rapid over first 6 months
Majority of mild TBI within 3 months
