Ch 9: Physical Complications

Question 1

What amount of individuals with severe TBI will have ongoing physical or neuromotor abnormalities at the two year time point?

Answer 1

1/3

Question 2

Hydrocephalus

Answer 2

Abnormal accumulation of CSF within the ventricles

Occurs in 2/3 of mid-severe brain injury

Question 3

Obstructive or noncommunicating hydrocephalus

Answer 3

Obstruction of the flow of CSF around the brain after trauma

Question 4

Hydrocephalus ex-vacuo

Answer 4

Occurs after TBI

brain tissue that has been damaged will cause neuronal loss and shrinking of the brain tissue which will lead to a look of ventricular enlargement on scans

Normal pressure hydrocephalus may develop

Question 5

Tx for hydrocephalus

Answer 5

Shunt system placement

Shunt, catheter, valve

Catheter placed into ventricle and valve controls one way flow of CSF into abdominal cavity

Question 6

Symptoms of over and under draining (hydrocephalus)

Answer 6

Over: Headache or even cause development of hemorrhage from tearing of blood vessels

Under: reoccurrence of hydrocephalus symptoms

**watch for fever, neck stiffness or soreness, or changes in level of alertness - require immediate medical attention

Question 7

Heterotopic ossification

Answer 7

Formation of new bone around joints causing decreased ROM and presents with redness and swelling

Hips are most common, then shoulders and elbows

Occurs on the same side of the body where spasticity is worst

Question 8

Vascular thrombus embolism

Answer 8

blood clots in the veins

Question 9

s/s of deep vein thrombosis

Answer 9

Redness in an extremity
Swelling
Pain
Fever

Question 10

Thrombus

Answer 10

Mass of platelets and/or fibrin that forms in a clot vessel (ie: blood clot)

Question 11

Embolus

Answer 11

Piece of thrombus that has broken free and circulates within the bloodstream

Question 12

Motor learning

Answer 12

set of internal processes associated with practice or experience leading to relatively permanent changes in the capability for skilled behavior

Question 13

What are the stages of motor learning?

Answer 13

cognitive- think and plan related to a task
associative- refinement of task with repetition
autonomous- motor program is refined to the point that minimal cognitive processes occur

Question 14

Spasticity

Answer 14

velocity dependent increase in tonic stretch with exaggerated tendon reflexes from excitability of the stretch reflex; the faster the extremity is moved the stronger the spasm

Question 15

Treatment of spasticity

Answer 15

baclofen, dantrolene, diazepam, tizanidine;
Oral meds don’t work- intrathecal baclofen, does not control spasticity in the upper extremities as well as in the lower, Botox can be used in the upper extremities

Question 16

What is the treatment for heterotrophic ossification?

Answer 16

etidronate disodium, indomethacin

joint mobility affecting sitting or limb positioning- surgery but should wait until max motor recovery

Question 17

What is the treatment for venous thrombus embolism?

Answer 17

anticoagulant

Question 18

What are the five coordination disorders associated with TBI?

Answer 18

ataxia- lack of muscle coordination during voluntary movements
athetoid- writhing movements
choreiform- continuous rapid unpredictable movements
dystonia- extreme tone or stiffness limiting movements
tremors- unpredictable movements with motion or at rest

Question 19

What are the outcomes of those with SCI and TBI?

Answer 19

paraplegia and severe TBI- worse outcomes and longer rehab stays than those only with paraplegia

Question 20

Complications of SCI with BI

Answer 20

Bracing and stabilizing
Pressure sores
Bladder and bowel care
Chronic pain