Brain Injury Flashcards
List 2 characteristics of a traumatic brain injury.
- Damage is caused by an external force
2. Can be open or closed
List 2 characteristics of a non-traumatic brain injury.
- Not caused by an external force
2. Sometimes called Acquired Brain Injury
List 4 primary mechanisms of traumatic brain injury.
- Coup and contrecoup
- Diffuse Axonal Injury
- Open head injury: skull facture
- Bleeding
List 4 characteristics of coup and contrecoup injuries.
- Coup: occurs at the site of impact
- Contre coup: occurs opposite of the impact site
- Causes cerebral contusion (bruising)
- Considered a focal injury
Diffuse axonal injury occurs with _____ and _____ to the brain leading to _______ injury.
Shearing
Tensile stress
Widespread injury
List 4 types of bleeding that can affect the brain.
- Epidural
- Subdural
- Subarachnoid
- Intraparenchymal
List 8 secondary mechanisms of TBI.
- Ischemia
- Hypoxia
- Hypotension
- Cerebral edema
- Increased intracranial pressure
- Hypercapnia
- Acidosis
- Excitotoxicity
Describe 2 types of encephalopathy.
- Toxic – due to exposure to toxic substances
2. Metabolic – due to abnormalities in fluid levels, electrolytes, and overall brain chemistry
List the 2 most alarming signs and symptoms of increasing intracranial pressure (ICP).
- Decreased level of consciousness
2. Cushing’s Triad (Increased SBP, bradycardia, and abnormal respiration (Cheyne stokes/Biot)
What are 3 symptoms to look for in patients that may have a DVT.
- Warmth
- Redness
- Swelling
Following a TBI, especially with a GSW/Skull fracture, the risk of _____ greatly increases.
Seizures
What are the 4 most common spots for heterotopic ossification to develop?
Shoulders
Elbows
Hips
Knees
PT will notice heterotopic ossification as the patient will present with a sudden decrease in _____ with a ____ end feel.
- ROM
2. Hard end feel
List 2 interventions used to treat heterotopic ossification. What intervention should be avoided?
- Calcium modulating drugs
- Gentle PROM
Avoid surgical interventions
What is the different between anterograde and retrograde amnesia?
- Anterograde – inability to form new memories following brain injury
- Retrograde – inability to recall old memories prior to brain injury
A ______ is used to track amnesia. A score of ___ on ___ consecutive days indicates emergence from post-traumatic amnesia.
Orientation Log
25/30
3 consecutive days
The ____ scale is useful when assess patients with consciousness disorders.
Coma Recovery Scale (CRS)
List 4 classifications of consciousness under the coma recovery scale.
- Coma: no signs of wakefulness or purposeful movement
- Vegetative/Unresponsive Wakefulness: wakefulness returns; no purposeful, consistent, or measurable response to stimuli or environment
- Minimally Conscious – response to stimuli and inconsistent ability to follow commands
- Emerged – consistent ability to follow commands (when structured appropriately), communication, functional object use
List 5 outcome measures used to assess memory and executive function.
- Mini Mental State Exam
- GOAT
- MoCA
- Confusion Assessment Protocol
- Cog-Log
Describe level 1 Coma of Rancho Los Amigos levels. Where are these patients typically found?
No sleep/wake cycles or purposeful response to external stimuli
Found in ICU
List 3 PT interventions used to treat patients in the Level 1 Coma stage.
Passive Range of Motion
Positioning
Spasticity Management (serial casting, splinting)
Describe level 2 Vegetative State of Rancho Los Amigos levels (3). Where are these patients typically found?
- Generalized Response
- Clear sleep/wake cycles return
- No purposeful, consistent, or measurable response to stimuli or environment
Found in acute rehab
List 4 PT interventions used to treat patients in the Level 2 Vegetative state.
- Passive Range of Motion
- Mobilization may begin – tilt table, standing frame
- Positioning
- Spasticity Management (serial casting, splinting)
Describe level 3 Minimally Conscious of Rancho Los Amigos (2)
- Purposeful Response
2. Inconsistent ability to follow commands
What are the 3 criteria for emergence?
- Consistent ability to follow commands (with appropriate setup)
- Communication (can be verbal or non-verbal)
- Functional Object Use
List 5 PT interventions used to treat patients in level 3 minimally conscious state.
- Mobilization continues– tilt table, standing frame
- More “traditional” PT interventions may begin – early gait training
- Passive Range of Motion
- Positioning
- Spasticity Management (serial casting, splinting)
Describe 5 characteristics of level 4 confused/agitated of Rancho Los Amigos.
- Bizarre, non-purposeful, incoherent or inappropriate behaviors
- No short-term recall
- Attention is short and non-selective
- Agitation/Frustration compounded by lack of impulse control – patient may become aggressive at times.
- Motorically restless
List 7 PT interventions used to manage patients in level 4 confused/agitated stage.
- Behavior Management – work in conjunction with medical team and neuropsychologist
- Gait training
- Environmental control
- Choose activities that are repetitive, automatic, and functional to reduce frustration
- Set up a reward system
- Provide choices
- DO NOT MAKE FALSE PROMISES
What is level 5 of the Rancho Los Amigos classification?
Confused and Inappropriate (similar to level 4 but less agitation and aggression)
List 2 characteristics of level 6 confused/appropriate of Rancho Los Amigos
- Patient is not consistently oriented to person /place/time/situation, but is more easily re-directed
- Responses to stimuli are more appropriate
List 3 PT interventions used to treat level 6 confused and appropriate stage.
- Encourage use of external cues to guide patient
- Facilitate recall
- Introduce new skills and transfer of old skills
List 4 characteristics of level 7 Automatic and Purposeful of Rancho Los Amigos.
- Appropriate behavior in familiar settings
- Performs daily routine automatically
- Carries over new learning at a slower rate
- Judgment remains impaired
List 2 characteristics of level 8 Purposeful and appropriate of Rancho Los Amigos.
- Oriented and responds to environment appropriately
2. Abstract reasoning is still impaired compared to pre-morbid baseline
List 4 PT interventions used to treat levels 7-8 automatic and purposeful stage.
- Support residual cognitive deficits via remediation or adaptation
- Emphasis on safety awareness
- Improve mental flexibility
- Manage stress
____ is the primary cause of mild TBI (mTBI) in older adults. Mortality rate is ____.
Primary Cause = Falls
HIGH mortality rate
List the 8 levels of the Rancho Los Amigos Scale.
Level I: No Response Level II: Generalized Response Level III: Localized Response Level IV: Confused-agitated Level V: Confused-inappropriate Level VI: Confused-appropriate Level VII: Automatic-appropriate Level VIII: Purposeful-appropriate
