22 Flashcards
Classification of TBI
Mild, moderate, severe
Based on Glasgow Coma Scale
(table 22-3 pg 900) responses = eye opening, best motor response, best verbal response 3-15 score Lower is the worst higher the better
score of 8 or less coma/severe brain damage
9 to 12 moderate injury
13-15 max mild
Open or closed injury (skull fractured w/ open wound)
High velocity impact or low velocity
Diffuse or focal
pahtology how do they usally come about
Focal injury- (coup-contrecoup injury) localized brain injury common areas of injury are the anterior inferior and frontal lobes
Diffuse axonal injury
Hypoxic- ischemic injury
Increased intracranial pressure – may result from hematomas
Factors influencing outcome
Premorbid status- pretty much a vegetable
Primary injury- the injury right after the inceident happens
Secondary injury- Something that happens later after the injury has already occurred usually not form a direct blow or a coup or counter coup
Primary injury is like from what explain the type it is
Local brain damage
Clot, contusion, laceration or combination of 3
Mild, moderate, server
Directly under the site of impact or directly opposite from the site of impact “coupcontrecoup injuries”- bouncing of brain
focal brain damage – head on collision
Diffuse axonal injury- scattered shearing of subcortical axons- deeply comatose/ abnormal posturing
Secondary injury give some examples
Hypoxic-ischemic injury (HII) Arterial hypoxemina Intracranial hematomas (talk and die) Epidural, subdural, intercerebral Intracranial pressure- 5-10 mmHG (herniation) Intracranial infection Cerebral artery vasospasms, tumors, obstructive hydrocephalus Post traumatic epilepsy Auto destructive cellular phenomena SCI Fractures Peripheral nerve injury damage Soft tissue and internal organ injury
Direct impairments associated with traumatic brain injury
Box 22.2 pg 898
Cognitive deficits- memory.attention, altered level of consciouness things of that nature, problem sloving
minimally conscious state (MCS)
Stupor
Obtunded
Declarative/ explicit, procedural/ implicit
Neuromuscular deficit-
abnormal tone, sensory loss, paresis, paralysis
Visual deficits
Perceptual deficits
Swallowing deficits
Behavioral disinhibition
impulsiveness, sexual inapporiatness, disinhibition, egocentrically, apathy, physical and verbal aggressivenes
Communication- receptive aphasia, expressive aphasia, dysarthia, auditory deficits
dysphagia
Indirect impairments 22.1 pg900
Contractures Mobility deficits Skin breakdown Heterotrophic ossification Decreased endurance Infection Pneumonia Impaired speech, tracheotomy Deep venous thrombosis
Ranchos Los Amigos Level of Cognitive Functioning
LOCF
Descriptive scale that outlines the predictive sequence of cognitive and behavioral recovery
Box 22-2 pg 901
Glasgow Outcome Scale
Prognostic study at DC and 6 months to year after injury
Table 22.4 pg 901
8 categories
research Dead vegatative, severly disabled, moderately disabled, good recovery, dependent, indepent and grade on a scale of 0-5 very basic system better now then.
Rappaport’s disability rating scale
DRS Table 22-5 pg 902
Serially used to document patient progress over time. Can track a patients progress from coma all the way to community intergration to see if they are able to work or not anymore
Improving arousal through sensory stimulation
give some examples
Latency, consistency, intensity, duration Auditory stimulation Olfactory stimulation Gustatory stimulation Tactile stimulation Vestibular stimulation
Techniques to decrease abnormal posturing & primitive reflexes
Every 2 hours proper bed positioning Wheelchair positioning Postural drainage Passive range of motion- heterotopic ossification (bone in muscle) Early mobilization Therapeutic guiding Developmental sequence table Prone elbows, quadreped, brdging, sitting, kneeling 1/2 kneeling, modifed platigrade, standing
Considerations for the treatment of abnormal tone
SPLINTS
SERIAL CASTING
NERUOMUSCUALR ELCETIRAL STIMUALTION
NERVE BLOCKS
Home modifications think like canes
ADAPTIVE EQUIPMENTS
ENVIURONEMTNAL CONTROL UNIT (ECU)
