Ch 9: Physical Complications Flashcards
What amount of individuals with severe TBI will have ongoing physical or neuromotor abnormalities at the two year time point?
1/3
Hydrocephalus
Abnormal accumulation of CSF within the ventricles
Occurs in 2/3 of mid-severe brain injury
Obstructive or noncommunicating hydrocephalus
Obstruction of the flow of CSF around the brain after trauma
Hydrocephalus ex-vacuo
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
Normal pressure hydrocephalus may develop
Tx for hydrocephalus
Shunt system placement
Shunt, catheter, valve
Catheter placed into ventricle and valve controls one way flow of CSF into abdominal cavity
Symptoms of over and under draining (hydrocephalus)
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
Heterotopic ossification
Formation of new bone around joints causing decreased ROM and presents with redness and swelling
**11-77% of TBI Incidence
Prevalence of clinically significant HO in TBI is typically reported as 10% to 20%
Hips are most common, then shoulders and elbows
Occurs on the same side of the body where spasticity is worst
Surgical Treatment should wait until the individual has achieved max motor recovery
Vascular thrombus/ emboli (VTE)
Individuals with multisystem or major trauma have a VTE risk exceeding 50%
**and in this population PE is the third leading cause of death
s/s of DVT
Redness in an extremity
Swelling
Pain
Fever
Thrombus
Mass of platelets and/or fibrin that forms in a clot vessel (ie: blood clot)
Embolus
Piece of thrombus that has broken free and circulates within the bloodstream
What is the prevalence of chronic pain in persons with brain injury?
58%
More prevalent among mTBI vs mod/severe
Effects:
Mood, participation, concentration, and sleep quality
Silent Aspiration occurs in what percent of severe TBI?
Nearly 50%
What percent of TBI’s present with significant balance impairments?
75%
Photophobia is associated with which visual impairment?
Binocular impairments (ie: double vision)
**treating diplopia can reduce light sensitivity
Ideomotor apraxia
Inability to perform a task on command or imitate gestures.
Ideational apraxia
Inability to perform a task automatically and on command. These individuals may do better in a familiar home environment vs clinic
Buccofacial apraxia
Limitations in performing purposeful movement of the lips, cheeks, tongue, larynx, and pharynx.
Automatic expressions are easier compared to sequencing more complex language
Labyrinthine concussion (unilateral vestibular hypofunction)
Typically from a bleed in the trauma into the labyrinth. Symptoms include dizziness or loss of balance with head turns, the stag mess present to one side, oscillopsia with head turns, postural instability.
Nearly 95% improve within six months
Post traumatic Ménière’s disease
Often comes from hydrops (area of scarring and intermittent fluid buildup that impacts pressure within the endolymphatic system) and can occur early or later after injury; may result in low tone hearing loss, with or without dizziness.
Intermittent symptoms of dizziness; can worsen over time without therapy as the pt will limit use of the vestibular system
Basilar skull fx
Symptoms Frequently include bleeding or CSF leakage in that year at the time of the injury, severe in balance, or symptoms of dizziness.
Vestibular migraine
Episodic spinning dizziness lasting a few minutes to or three times per month.
Symptoms also may include photophobia, hearing loss, and tonight us, and may or may not be associated with a headache.
Physical and diagnostic exams are normal
Perilymphatic fistula
Abnormal communication between the inner and middle ear
Benign paroxysmal positional vertigo (BPPV)
Sensation of spinning with particular movements which may include rolling in one direction, bending over, and position change in bed, with no loss of hearing involved.
