2.15 Brain Injury

Question 1

3 indexes for determining brain injury severity

Answer 1

Glasgow coma scale, length of LOC, length of post-traumatic amnesia

Question 2

Mild TBI structural imaging

Answer 2

Usually normal

Question 3

Mild TBI LOC

Answer 3

0-30 minutes

Question 4

Mild TBI alteration of consciousness

Answer 4

A moment up to 24 hours

Question 5

Mild TBI post-traumatic amnesia

Answer 5

0-1 day

Question 6

Mild TBI GCS

Answer 6

13-15

Question 7

Moderate TBI structural imaging

Answer 7

Normal or abnormal, usually abnormal

Question 8

Moderate TBI LOC

Answer 8

> 30 min & <24 hours

Question 9

Moderate TBI alteration of consciousness

Answer 9

> 24 hours

Question 10

Moderate TBI post-traumatic amnesia

Answer 10

> 1 day & <7 days

Question 11

Moderate TBI GCS

Answer 11

9-12

Question 12

Severe TBI structural imaging

Answer 12

Normal or abnormal

Question 13

Severe TBI LOC

Answer 13

> 24 hours

Question 14

Severe TBI alteration of consciousness

Answer 14

> 24 hours

Question 15

Severe TBI post-traumatic amnesia

Answer 15

> 7 days

Question 16

Severe TBI GCS

Answer 16

<8 or 9

Question 17

Glasgow Coma Scale scoring

Answer 17

Motor response (1-6)
Verbal response (1-5)
Eye opening (1-4)

Question 18

Post-traumatic amnesia

Answer 18

Time from when patient regains consciousness to when they are able to form memories for ongoing events

Question 19

Agitated Behavior Scale purpose

Answer 19

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

Question 20

Coma/Near Coma Scale

Answer 20

Measure small clinical changes in patients with severe brain injuries
Expands levels of Disability Rating Scale (DRS)
5 levels based on 11 items

Question 21

JFK Coma Recovery Scale purpose

Answer 21

Assist with differential diagnosis, prognostic assessment & treatment planning in patients with disorders of consciousness

Question 22

JFK Coma Recovery Scale scoring

Answer 22

6 subscales: auditory, visual, motor, oromotor, communication, arousal
23 items
Higher score is better

Question 23

Disability Rating Scale

Answer 23

Measure general functional changes during course of recovery from TBI
Can track from coma to community

Question 24

Neurobehavioral Functioning Inventory

Answer 24

Collect information on wide spectrum of behaviors and symptoms commonly associated with brain injury
One completed by family members, one completed by patient

Question 25

Rancho Los Amigos level I

Answer 25

No response | Prevent complications

Question 26

Rancho Los Amigos level II

Answer 26

Generalized | Increase level of responsiveness, prevent complications

Question 27

Rancho Los Amigos level III

Answer 27

Localized | Increase level of responsiveness, consistency of responses, and functional responses

Question 28

Rancho Los Amigos level IV

Answer 28

Confused-agitated | Reduce agitation, increase consistency & functionality of responses

Question 29

Rancho Los Amigos level V

Answer 29

Confused, inappropriate, non-agitated | Begin restorative treatment of cognitive function

Question 30

Rancho Los Amigos level VI

Answer 30

Confused-appropriate | Decrease confusion, improve independence & cognition, improve information processing speed

Question 31

Rancho Los Amigos level VII

Answer 31

Automatic-appropriate | Increase processing of complex information, increase awareness of deficits, develop compensatory strategies

Question 32

Rancho Los Amigos level VIII

Answer 32

Purposeful-appropriate | Work on IADLs, exposure to community, options for employment

Question 33

Focal cortical contusion causes (3)

Answer 33

GLF, assault, gunshot

Question 34

Focal cortical contusion deficits (4)

Answer 34

Hemiparesis, aphasia, seizures, visuoperceptual

Question 35

Diffuse axonal injury causes (3)

Answer 35

MVA, non-GLF, geriatric GLF

Question 36

Diffuse axonal injury deficits (4)

Answer 36

Confused language, amnesia, apraxia, hypoarousal

Question 37

Hypoxic/ischemic brain injury causes (3)

Answer 37

Anoxia, cardiac arrest, prolonged elevated ICP

Question 38

Hypoxic/ischemic brain injury deficits (5)

Answer 38

Quadriparesis, spasticity, confusion, amnesia, hypoarousal

Question 39

Left brain (5)

Answer 39

``` Positive Interpretation Planning, organizing, sequence Language, talking Knowledge of limits ```

Question 40

Right brain (5)

Answer 40

``` Negative Intelligence Strategy, sports, hunting Imagination, creativity Intuition, impulse ```

Question 41

Right temporal lobe damage

Answer 41

Visual memory

Question 42

Left temporal lobe damage

Answer 42

Verbal memory/language functions

Question 43

DAI damage

Answer 43

Slowing of cognitive processes, slow thinking, difficulty in getting things done

Question 44

TBI recovery time

Answer 44

At least 18-36 months, with most rapid over first 6 months | Majority of mild TBI within 3 months