5- ABI Rehabilitation Flashcards
Key criteria for diagnosing individuals with a mild TBI (Concussion). 🔑🔑
💡 Findings with these criteria should be made in the absence of illicit drugs, alcohol, medications with sedating effects, or other injuries or problems.
ERABI
ICD 10 Criteria for post concussion syndrome
DSM-5 Criteria for post concussion syndrome 🔑🔑 EXAM 2021
ICD 10 Criteria (TBI + 3/8 Symptoms)
- History of traumatic brain injury (TBI)
- Presence of 3 or more of the following 8 symptoms:
- Headache
- Dizziness
- Fatigue
- Irritability
- Insomnia
- Concentration
- Memory difficulty
- Intolerance of stress, emotion, or alcohol.
Cuccurollo 4th Edition Chapter 4 TBI pg94
https://emedicine.medscape.com/article/828904-overview
ICD 5 Criteria (TBI + 3 Major Severity Indicators + Neuro Deficit)
Evidence of a traumatic brain injury—that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull
With one or more of the following
- Loss of consciousness = Coma
- Posttraumatic amnesia
- Disorientation and confusion = Low GCS
- Neurological signs (e.g. - neuroimaging demonstrating injury; a new onset of seizures; a marked worsening of a preexisting seizure disorder; visual field cuts; anosmia (loss of smell); hemiparesis).
List the 4 domains of concussion seen in mTBI 🔑
List 4 categories of symptoms seen in mTBI 🔑
- Somatic (headache, dizziness, visual disturbances, nausea)
- Cognitive (confusion, LOC, inability to concentrate, and memory problems)
- Affective (emotional lability, anxiety, sadness, and irritability)
- Sleep changes (insomnia, or sleeping more or less than usual)
Cuccurollo 4th Edition Chapter 2 TBI pg95
Name two tests used for assessment of concussion.
- Standardized Assessment of Concussion (SAC)
- Sport Concussion Assessment Tool 5 (SCAT5)
- IMPACT (computerized evaluation)
- Maddock’s questions.
Braddom 6th Edition Chapter 39 Sports Medicine pg806
23 year old male involved in MVC 3 months ago, presenting with “mild TBI” symptoms.
List three DDx. 🔑🔑
- Depression
- Post-traumatic stress disorder (PTSD)
- Fatigue (Central or periphral)
- Medication side effect
- Alcohol and drug abuse
- Insomnia
- Early dementia
- Malingering
Review notes 2012
What is Second Impact Syndrome? Why it’s important? 🔑
💡 Morbidity and mortality rates close to 100% and 50% respectively.
Results from a person (usually an athlete) sustaining a second brain injury (that may be minor in severity) before symptoms of a prior concussion have cleared.
Immediately following the second head injury, patients become dazed, and within 15 seconds to several minutes can rapidly decompensate—collapse, pupil dilation, loss of eye tracking, respiratory failure, semicomatose state.
Cuccurollo 4th Edition Chapter 2 TBI pg94
Sport concussion. How to examine other than neurological examination?🔑🔑 EXAM
- MSK: Neck pain and tenderness “whiplash injury”
- Ortho: Facial injury, Rhinorrhea or otorrhea (clear) ?skull fracture
- Neuropsychiatric evaluation: PTSD, Depression
General thoughts
TBI in boxers. 2 clinical features. Remember M. Ali.
- Tremor
- Parkisonism
DeLisa 5th Edition Chapter 24 pg593
Return-to-play (RTP) criteria
- No RTP on the day of a concussive injury regardless of the severity.
- Physical and cognitive rest until the acute symptoms resolve (usually 24–48 hours).
- Athlete can only proceed to the next level if asymptomatic at the current level.
- At least 1 week to proceed through the full rehabilitation protocol.
- Each step should take at least 24 hours.
- If any post concussion symptoms occur, the athlete is to drop back to the previous asymptomatic level and try to progress again after another 24-hour period of rest has passed!
Cuccurollo 4th Edition Chapter 2 TBI pg96
Athlete post-concussion with normal physical exam.
What are the two most notable features in determining readiness to return to play?
- Asymptomatic with exercise and at rest.
- Asymptomatic with cognitive stress.
Ref: McRory (2008)
Driving post TBI. Mention the skills required and what are the warning sign?
How to manage school in pediatric TBI patient?
Goal
- Minimizing absences
- Avoid social isolation, depression, and anxiety
More
- frequent breaks
- additional time to complete assignments
- preferential seating for better attention & focus
- preprinted notes in large font, audiobooks, and oral teaching.
Less
- reduced workload
- modified assignments
- reduced auditory stimulation
- reduced visual stimulation.
- avoidance of electronic screens
Interventions for the rehabilitation of functional fine motor skills? 🔑🔑
- Meal preparation
- Finger sequence tasks
- Block assembly
ERABI Module 6 pg16
What areas of upper motor function has virtual reality (VR) been shown to improve specifically in ABI populations?
- Dexterity
- Reaching accuracy
- Dominant hand speed
- Range of motion
ERABI Module 6 pg17
List 4 Lower Extremity Interventions used in TBI rehabilitation. 🔑🔑 List 2 ways to rehab lower extremity motor skills in TBI patient.
- Range of motion exercises
- Muscle strengthening
- Sit-to-Stand Exercises
- Balance exercises
- Gait Training +/- Treadmill training
ERABI Module 6 pg16
What is the most common cause of dizziness following TBI? 🔑🔑 OSCE
Location of injury associated with higher incidence?
List 4 causes of dizziness following TBI.
Benign paroxysmal positional vertigo (BPPV)
Location: damage to the inner ear.
Other Causes
- Labyrinthine Concussion (hearing loss and vertigo)
- Temporal bone fracture (bloody otorrhea and severe pain)
- Trauma to brainstem and cerebellum (nystagmus, diplopia, abnormalities of pupillary response) → think about EOM movements and brainstem reflexes
ERABI Module 6 pg10
Braddom 6th Edition Chapter 43 pg943
Define Benign paroxysmal positional vertigo (BPPV), PEx and 2 Tx. 🔑🔑 (OSCE Q)
Definition
Brief episodes of vertigo provoked by movement of the head.
Examination
Dix-Hellpike maneuver
Treatment
- Otolith reposition by Epley maneuver
- Vestibular rehabilitation therapy (VRT) to promote static and dynamic postural stability
