Chapter 31: Trauma Induced Conditions

Question 1

Post-trauma continuum of care

Answer 1

ICU-acute-inpatient-outpatient

Question 2

Post-trauma OT interventions

Answer 2

Preparatory methods
Purposeful activity/occupation based
Education

Question 3

Pediatric SCI incidence

Answer 3

1.99 times per 100,000 children
1455 new injuries per year

Question 4

Pediatric SCI gender discrepancy

Answer 4

Boys are twice as likely to experience SCI than girls
- Risk takers, fast drivers, more likely to be impulsive

Question 5

Causes of SCI

Answer 5

Traumatic (motor vehicle accident, violence (guns), falls, sports injury)
Medical (spinal tumor, spinal procedure, disease process)

Question 6

Children are more likely to have what type of SCI and why?

Answer 6

Upper cervical (C1-C3) due to having a larger head in proportion to their body and weak ligaments

Question 7

What level of SCI allows a child to use an adapted environmental control?

Answer 7

C6

Question 8

What is the major muscle innervated by C7 that is a major help with ADLs?

Answer 8

Triceps
- Provides extension movement

Question 9

What is the main focus of intervention for a child with a SCI?

Answer 9

Play
Community mobility
Emotional aspects
Social interaction
Self care
Bowel-bladder control

Question 10

Pediatric TBI incidence

Answer 10

Approximately 1.7 million people per year
Ages most likely to incur TBI
Young children: 0-4 years
Teenagers: 15-19 years
Senior citizens: over 65 years

Question 11

Traumatic causes of TBI

Answer 11

Falls
Car accidents
Sports related injuries
Non-accidental trauma
Violence-related

Question 12

Acquired stroke causes of TBI

Answer 12

Anoxia
Arteriovenous
Malformation rupture
Tumor resection
Seizure activity
Infection
Metabolic disorders

Question 13

Seizure foci resection

Answer 13

Taking out part of the brain to stop seizures from occurring

Question 14

Infection (meningitis and encephalitis)

Answer 14

Brain inflammation

Question 15

Metabolic disorders TBI

Answer 15

Condition leads to high BP or stroke that causes TBI

Question 16

Functional prognosis of TBI

Answer 16

Severity
Location
Extent

Question 17

Localized injury

Answer 17

Hit on one section of head

Question 18

Diffuse injury

Answer 18

Brain shifts and rotates (worse)

Question 19

Premorbid factors of TBI

Answer 19

Low SES
Behavior issues/poor academic performance

Question 20

Glasgow Coma Scale

Answer 20

Hope for improvement, measures how they improve over time

Question 21

Mild TBI brain injury

Answer 21

Loss of consciousness: <30 mins
Glasgow Coma Scale score : 13-15
Post-traumatic amnesia: <24 hours

Question 22

Moderate TBI brain injury

Answer 22

Loss of consciousness: 30 minutes-24 hours
Glasgow Coma Scale score: 9-12
Observable finding on EEG, CT, or MRI

Question 23

Severe TBI brain injury

Answer 23

Loss of consciousness: > 24 hours
Glasgow Coma Scale score: 3-8
Significant findings on EEG, CT, or MRI

Question 24

Rancho Levels of Cognitive Functioning

Answer 24

Progression of recovery

Question 25

What kind of impairments occur for a pediatric TBI?

Answer 25

Motor, neurological, cognitive
Return of function is much less predictable- younger can rewire better

Question 26

Pediatric burn injury incidence

Answer 26

Approximately 450,000 per year.
Over 50% of that number consists of children.
Approximately 30,000 children per year require hospitalization for burns.

Question 27

Causes of burns

Answer 27

Scald- 60% (steam or hot water)
Flame- 25%
Contact- 10%
Electrical/chemical- 5%

Question 28

First degree burns

Answer 28

Does not enter dermis

Question 29

Second degree burns

Answer 29

Enters dermis
Blister, painful
Can heal on own but might take ~2 weeks

Question 30

Third degree burns

Answer 30

Entire dermis is damaged
White/charred
Need most attention

Question 31

What is the first layer of skin?

Answer 31

Epidermis

Question 32

What is the second layer of skin?

Answer 32

Dermis

Question 33

What is the third layer of skin?

Answer 33

Subcutaneous

Question 34

What is the #1 way to treat a burn that is not healing on its own?

Answer 34

Skin grafting

Question 35

Autografting

Answer 35

Using person’s own skin for graft

Question 36

Sheet grafting

Answer 36

Take piece of healthy skin with dermatome and replace it over burn, donor site becomes painful

Question 37

Meshed grafting

Answer 37

Covering a large wound, run good skin through machine making it into a grid to cover more areas, not used often

Question 38

What is a scar?

Answer 38

Develops any time the dermal layer of the skin is damaged.

Question 39

Hypertrophic scarring

Answer 39

The collagen fibers in hypertrophic scarring are orientated in a “whorl-like” pattern, as compared to normal skin in which collagen aligns in a parallel pattern (Bumpy scar)

Question 40

Keloid scar

Answer 40

Scar grows beyond original wound

Question 41

Why is scar management important?

Answer 41

Scar tissue is estimated to have 12 times the contractile strength of normal skin, which is clearly strong enough to pull features and joints out of place.
- Affects function

Question 42

Functional problems that occur from scarring

Answer 42

If a scar crosses a joint, it can limit range of motion and cause functional deficits.
Can’t talk or eat as well

Question 43

Where are major impairments with pediatric burns?

Answer 43

Soft tissue, result in motor deficits

Question 44

Treatment focus for burns

Answer 44

Maximizing skin integrity and function, then resuming participation in occupations
- Scar management
- Functional positioning to stop scars from taking over joints
- Discuss changes with patient (disfiguring disability is traumatizing)

Question 45

In pediatric trauma care, who experiences orthostatic hypotension?

Answer 45

ALL (burns, SCI, TBI)

Question 46

Who experiences autonomic storming?

Answer 46

TBI

Question 47

Who experiences autonomic dysreflexia?

Answer 47

SCI