Ch 6: Medical Complications Flashcards
How many people in the US are living with a long term disability as the result of brain injury?
- 2 to 5.3 million
1. 1 to 1.7% of the US population
What is the incidence of DVT in TBI?
54%
What are some musculoskeletal complications of TBI?
Spasticity
Hyperreflexia
Contractures
HO
Tx include:
Exercise, casting/orthotic techniques, ultrasounds/estim, meds, surgery/radiation
Dysphagia level 1
Mod-severe
Puréed diet
No bolus formation required
Dysphagia level 2
Mechanically altered
Mild to moderate and/or pharyngeal dysphagia
Moist, soft and easily form bolus
Dysphagia level 3
Dysphagia advanced
Mild
Includes most textures except hard, sticky, or crunchy foods
Requires chewing ability
How are UTIs sometimes detected in the early and late post injury phase?
Through early cognitive or behavioral changes. (Ie: increased agitation or decreased level of alertness)
In comparison to pre injury, how many calories should a person consume during the acute phase of TBI healing?
40% more calories
Diabetes insipidus
Occurs when too little vasopressin is produced and the person produces significantly more urine d/t increased thirst.
Syndrome of inappropriate anti diuretic hormone (SIADH)
Caused by changes to the hypothalamus or d/t certain medications
Blood sodium level is low and urine is not concentrated
Symptoms: nausea, vomiting, irritability, confusion, seizures, coma
**fluid restriction
Metabolic syndrome
Combination of medical disorders that increase the risk for both cardiovascular disease and diabetes.
Marked by abdominal obesity, insulin resistance, HTN, and dyslipidemia
Affects 40% of adults over 60
UTI and brain injury
60% experience UTI within the first 6 weeks after TBI
What percent of brain injury patients report sleep disorders?
30-70% of TBI patients
Post traumatic hypersomnia
Excessive sleepiness that occurs as a result of traumatic event involving CNS; daytime sleepiness; cognitive and physical fatigue
Cataplexy
Sudden loss of bilateral muscle tone; collapsing affect
Consciousness, memory, and respiration intact
Insomnia
Treatment includes:
Lifestyle changes, exercise, reg sleep schedule, avoiding naps, limiting fluid before bed, and decreasing caffeine
What is the reported occurrence of post traumatic seizures?
4-53%
3 different categories of seizures
Immediate post traumatic convulsions (IPTC)
Early post traumatic seizures (EPTS)
Late post traumatic seizures (LPTS)
Immediate post traumatic convulsions (IPTC)
+LOC and involuntary movement within seconds of impact
Non epileptic events; convulsive syncope
Brief period of tonic positioning followed by clonic or myoclonic jerks of less than 2-3 min
Altered state of consciousness with associated retrograde and anterograde amnesia
Loss of cerebral brain function d/t reflex brainstem activation
Early post traumatic seizures (EPTS)
Occur within 1st week (up to 7 days) following brain injury
Result from primary direct effects of trauma
Incidence report: 2-10% and can occur in mTBI
50% occur within 24hrs of impact; 25% 1st hr
Strong risk factor for LPTS
Status epilepticus
> 30min of continuous seizure activity or two or more consecutive seizures without full recovery of consciousness between seizures
Occurs in 10% of individuals after acute head injury and has a high mortality rate even with mTBI
Early to to prevent secondary damage d/t increased metabolic demands, elevations in ICP, and other seizure induced stressors
Common in children
Late post traumatic seizures (LPTS)
Occur later than 1 week post injury , but usually within the first 18-24 months (has been reported later)
Incidence: 1.9-50%
Interchangeable with post traumatic epilepsy as the occurrence of one seizure likely Leeds to more (seizures reoccur in 86% of pts with moderate brain injuries within a 2 year follow up
Common in 65+
Post traumatic headache (PTH)
Starts within 14 days of LOC
More prevalent in mTBI (95%) in comparison to 22% of mod-severe reporting pain
Most common type of headache reported by all TBI pts?
Migraine
Peripheral nocioception
Peripheral receptors in the head and neck which are very sensitive to pain
Located on the ends of nerves that initiate near the spinal cord and communicate back to pain centers in the brain
CN 5 trigeminal, CN 9 glossopharyngeal, CN 10 vagus nerve, greater occipital nerve, lesser occipital nerve
