Chapter 8: TBI Flashcards
Trauma
Serious and potentially life-threatening levels of physical injury
Common causes of TBI
Falls
Motor vehicle accidents
Incidents of a person being struck by an object
Sports accidents
Violent assaults
Risk populations
Children younger than 4
Adults holder than 75
Adolescent males
Law enforcement and Military personnel
Closed head injuries
damage to the brain that doesn’t break open the skull and penetrate the cerebral meninges surrounding the brain
Two primary categorizations of TBI
Acceleration-Deceleration injuries
Impact-based injuries
Acceleration-deceleration closed head injuries
When the brain is moving very fast through space (acceleration) and then come to a very abrupt halt (deceleration)
Coup-contrecoup
Coup: severe hit or impact - the first impact of the brain
Countercoup: secondary impact of the brain
Diffuse axonal shearing
when neuronal connections are pulled apart, microlesions are created across large areas of the brain
Impact-based TBI
traumatic injury to the brain that occurs when head is being struck by a moving object
open head TBI
object penetrates the skull into the brain
Ballistic trauma
when a projectile (bullet or piece of shrapnel) passes through the skull and into the brain
often seen: police, military, suicide attempts, violent assaults
Intracranial pressure
amount of pressure present within the skull and therefore the amount of pressure exerted on the brain
Increased intracranial pressure
when intracranial pressure rises above normal
If becomes higher than blood pressure, the heart will have difficulty pushing blood to the brain
Cerebral edema
swelling of brain tissue and can occur following trauma to the brain
Traumatic hydrocephalus
can raise intracranial pressure to a life threatening level
Traumatic hemorrhage
bleeding as a result of trauma
Subdural hemorrhage
bleed between the dura and arachnoid mater
Epidural hemorrhage
bleed occurs between dura mater and the skull
Hematoma
gathering of blood outside a blood vessel after a hemorrhage
Subdural hematoma
occurs when blood vessels between the dura mater and the brain are broken
Epidural hematoma
Blood vessel bursts between the dura mater and the skull and can cause increased intracranial pressure
Post-traumatic epilepsy
seizures occurring consequent to TBI
Shaken baby syndrome
caregiver hitting or violently shaking an infant, likely causes death to the infant
Common symptoms of shaken baby syndrome
Vomiting
Difficulty feeding
Lethargy
Altered consciousness
Irritability
Retinal hemorrhages
Impaired tracking of eyes
Seizures
Lack of smile and vocalizations
Respiratory difficulties
Polytrauma
the various types of trauma experienced by military service members following exposure to en IED blast
Barotrauma
trauma induced by exposure to intense levels of pressure changes following an explosion
Chronic traumatic encephalopathy
degenerative disease of the brain caused by repeated head trauma
sports related
Iconic flux
Cell membranes that maintain flow of ions across cell membranes
Allowing an unregulated release of ions
Glucose hyper metabolism
the brain attempts to restore homeostasis after ionic flux and metabolizes all glucose available
Glucose hypometabolism
after the brain uses all glucose available in an attempt to restore homeostasis, the brain suffers from a lack of glucose needed to operate normally
Motor deficits following TBI
- Abnormal muscle tone
- apraxia of speech
- spastic
- flaccid
- ataxic dysarthria
Cognitive deficits following a TBI
Orientation, attention, memory, problem solving, inference, personality changes
Coma
Period of unconsciousness lasting more than 6 hours with individual unable to be awakened and is unresponsive to sensory stimuli
Vegetative state
Person is minimally responsive to stimuli, but lacking consciousness and cognition
Minimally conscious state
Person displays inconsistent but definite behavioral signs of consciousness
Persistent vegetative state
Vegetative state continues longer than 4 weeks
Post-traumatic amnesia
Retrograde and anterograde memory loss in those who recover from comas and vegetative states
Personality changes
May result in inappropriate sexual advances, inappropriate statements at times, loss of awareness of social and cultural conventions, and more subtle changes such as preferences in food and music
Language deficits
Anomia, aphasia, decreased arousal, and cognitive deficits often follow closed head TBI
Ranchos Los Amigos Scale
Levels 1-10 (level 1 is no response)
Pediatrics
Glasgow scale
We want 15 points
Eye opening, verbal response, motor response
Assessment of Memory
Long-term memory, visual memory, immediate recall, short-term recall
Assessment of agitation
Agitated behavior scale
Overt aggression scale
Restorative memory approach
Spaced retrieval training
Sensory stimulation therapy
attempting to heighten arousal is limited or nonexistent
Internal memory strategies
Rehearsal training and imaging visual association
Rehearsal training
Training the person to repeat information to themselves to increase the likelihood of retaining the information
Imaging and visual association
Training the individual to create a visual image in their mind of the information to be recalled
External memory strategies
Low-tech devices and high tech devices
Low-tech devices
Checklists, alarm clocks, memory pads, calendars, schedules, memory books, diaries
High-tech devices
Smartphones and computers
Open Head Traumatic Brain Injuries
Open head TBI and Ballistic trauma
Secondary Mechanisms of Damage in Traumatic Brain Injury
Intracranial pressure
Increased Intracranial pressure
Cerebral edema
Traumatic hydrocephalus
Traumatic hemorrhage
Post-traumatic epilepsy
Types of Traumatic hemorrhage
Subdural hemorrhage
epidural hemorrhage
Hematoma
Subdural hematoma
Epidural hematoma
Military Traumatic Brain Injury
Polytrauma and barotrauma
Sports-Related Traumatic Brain Injury
Chronic traumatic encephalopathy
Neurometabolic Cascade of Concussion
iconic flux, glucose hyper metabolism, glucose hypo metabolism
Motor deficits
Fine motor movement deficits
Abnormal muscle tone
Swallowing disorders
Cognitive Deficits
May affect any level of
Orientation, attention, memory, problem solving, inference, personality changes
Assessments of trumatic brain injury
Ranchos Los Amigos Scale and glasgow scale
