Behav. Sci. TBI

Question 1

TBI definition

Answer 1

injury to the head arising from a blunt or penetrating trauma or from acceleration/deceleration forces resulting on one or more of the following:
decreased level of consciousness, amnesia, objective neurologic or neurophsychological abnormalities, skull fracture, diagnosed intracranial lesion, head injury listed as a cause of death

Question 2

mild TBI definition

Answer 2

traumatically induced physiological disruption of brain function (loss of consciousness, loss of memory for events immediately before/after the accident, alteration of mental state AND/OR focal neurological deficits that may or may not be transient BUT loss of consciousness does not exceed 30 min, glasgow coma scale score is between 13-15 30 min after impact and post-traumatic amnesia does not exceed 24 hours

Question 3

MCCs of TBI

Answer 3

falls (65+), blunt trauma, motor vehicle collision (15-24), assault, unknown

Question 4

risk factors for TBI

Answer 4

male aged 0-4, 15-24, and 65+
lower income metropolitan area
alcohol use
recurrent TBI
prescription drug use

Question 5

who is most likely to die from TBI?

Answer 5

men 3x more likely than women (highest rates in 65+ due to falls)

Question 6

what are primary causes of TBI?

Answer 6

diffuse axonal injury, vascular tear, focal cortical contusions, intracranial or extracerebral hemorrhage

Question 7

what are the secondary causes of TBI?

Answer 7

ischemia, hypoxia, vasospasm, edema, necrosis, apoptosis, inflammation, seizure

Question 8

how does diffuse axonal injury happen?

Answer 8

deceleration of the brain within the skull causing shearing or torsional forces of brain tissue (can be stretched or sheared - message is slowed in stretching)

Question 9

what happens metabolically following a TBI?

Answer 9

neurometabolic cascade:

• hypermetabolic glycolytic state
• decreased cerebral glucose metabolism
• reduced cerebral blood flow and glucose delivery
• energy crisis with mismatch of energy demand to vascular energy supply

Question 10

glasgow coma scale scores

Answer 10

severe, score of 3-8; moderate 9-12; mild 13-15

Question 11

glasgow coma scale classifications

Answer 11

eye opening: spontaneous (4), to loud voice (3), to pain (2), none (1)
verbal response: oriented (5), confused, disoriented (4), inappropriate words (3), incomprehensible sounds (2), none (1)
best motor response: obeys (6), localizes (5), withdraws (flexion) (4), abnormal flex on posturing (3), extension posturing (2), none (1)

Question 12

systemic complications following TBI

Answer 12

autonomic dysregulation of heart, pulmonary embolus, dysphagia, gastritis, delayed gastric emptying, neurogenic bladder, heterotopic ossification, electrolyte imbalances, hypopituitarism, spastic pain, dysesthesia, heache, CRPS, hydrocephalus, vasospasms, seizures, infection, depression, anxiety, agitation, delirium, sleep dysfunction

Question 13

recovery based on…

Answer 13

ranchos los amigos levels of cognitive function stages I-X

Question 14

stage I recovery

Answer 14

coma, unresponsive eyes closed, no sign of wakefulness

Question 15

stage II recovery

Answer 15

vegetative state, no cognitive awareness

Question 16

stage III recovery

Answer 16

minimally conscious state - inconsistent, simple purposeful behavior

Question 17

stage IV recovery

Answer 17

confusional state - interactive and communication, appropriate object use begins

Question 18

stage V recovery

Answer 18

post-confusional - resolution of posttraumatic amnesia, achieving functional independence

Question 19

stage VI recovery

Answer 19

social competence - resumption of basic houshold independence

Question 20

emotional and behavioral changes after TBI

Answer 20

post-traumatic agitation, personality changes, psychiatric disorders, substance misuse disorders

Question 21

post-traumatic agitation behaviors

Answer 21

impulsive, impatient, low tolerance for pain or frustration
explosive or unpredictable anger
restless, pacing, excessive movement
loud, rapid, excessive talking

Question 22

treatment of post-traumatic agitation behaviors

Answer 22

identify agitation -> address precipitating factors (pain, overstimulation, lack of sleep, etc) -> treat with either environmental modification/education and/or medications

Question 23

which classes of medication are used to treat post-traumatic agitation?

Answer 23

beta blockers, antiepileptics, antidepressants, antipsychotics
although there is no FDA approved medication

Question 24

personality changes with TBI

Answer 24

frontal-subcortical circuits: modulate complex human emotional expression and behavior 
social comportment (lateral orbitofrontal)
executive function (dorsolateral prefrontal)
motivated behavior (anterior cingulate)

Question 25

what is more common following a TBI?

Answer 25

psychiatric disorders esp depression, anxiety, obsessive compulsive, and PTSD (with mild)
also substance misuse