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PMR 03 - TBI > Day 2 - Consciousness & Prognosis > Flashcards

Day 2 - Consciousness & Prognosis Flashcards

1
Q

Define severity of TBI and what is the best acutre predector?

A

Motor response, particularly 2 weeks postinjury, is the best acute predictor of outcome.

Ref: ERABI

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2
Q

Mention the system that is responsible for consciousness state

A
  1. Reticular activating system (RAS)
  2. Thalamic and extrathalamic pathways.
  3. Cerebral cortex.
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3
Q

Mention disorders of consciousness 🔑

A

MINIMALLY CONSCIOUS STATE

  • Patient is awake
  • Evidence of awareness of self or environment

VEGETATIVE STATE

  • Evidence sleep-wake cycle
  • No awareness of self or environment.

COMA

  • No sleep-wake cycles
  • No awareness of self or environment.
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4
Q

List 6 descriptive features of patient who is Minimally Conscious State 🔑

A
  1. Evidence of self or environmental awareness.
  2. Reproducible (or sustained) purposeful behaviors.
  3. Simple command following
  4. Comprehensive verbalization
  5. Gestural or verbal yes/no responses
  6. Smooth pursuit tracking
  7. Visual fixation
  8. Emotional or motor behaviors with specific stimuli
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5
Q

When patient is considered off Minimally Conscious State?

A
  1. Interactive communication
  2. Functional object use
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6
Q

Etiology of Vegetative State and Coma. 🔑

A

Damage to consciousness center:

  1. Related to diffuse cortical injury
  2. Bilateral thalamic lesions
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7
Q

List 4 descriptive features of patient who is Vegetative State 🔑

A

Awake but not aware, GCS <8

  1. Evidence of sleep–wake cycle on EEG
  2. No awareness of self or environment
  3. Patient opens eyes (either spontaneously or with noxious stimuli).
  4. No purposeful behavior
  5. No evidence of language comprehension or expression
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8
Q

List 4 descriptive features of patient who is Comatose 🔑

A

Not awake nor aware, GCS <8

  1. Lack of wakefulness as evidenced by the lack of sleep wake cycles on EEG.
  2. No awareness of self or environment
  3. Patient’s eyes remain closed.
  4. No spontaneous purposeful movement or localization of noxious stimuli
  5. No evidence of language comprehension or expression
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8
Q

List 4 descriptive features of patient who is Comatose 🔑

A

Not awake nor aware, GCS <8

  1. Lack of wakefulness as evidenced by the lack of sleep wake cycles on EEG.
  2. No awareness of self or environment
  3. Patient’s eyes remain closed.
  4. No spontaneous purposeful movement or localization of noxious stimuli
  5. No evidence of language comprehension or expression
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9
Q

Decorticate vs Decerebrate Posturing. What is the clinical significance?

A

Decorticate

  1. Flexion of the upper limbs (elbows bent)
  2. Extension of the lower limbs

Decerebrate

  1. Opisthotonus: spasm of the muscles causing backward arching of the head, neck, and spine.
  2. clenched jaws
  3. stiff, extended limbs internal rotation of arms
  4. ankle plantar flexion

Decerebrate posturing is worse and indicates significant brain stem (midbrain) damages.

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10
Q

List 3 main prognostic indicators 🔑🔑

A
  1. Glasgow Coma Scale within 24 hours
  2. Duration of unconsciousness (LOC)
  3. Duration of posttraumatic amnesia (PTA)
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11
Q

List 3 main prognostic indicators 🔑🔑

A
  1. Glasgow Coma Scale within 24 hours
  2. Duration of unconsciousness (LOC)
  3. Duration of posttraumatic amnesia (PTA)
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12
Q

List 4 Parameters of ImPACT Trial for TBI severity.

A
  1. I = Injury severity
  2. P = Pupillary reactions
  3. A = Age
  4. CT = Midline shift
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13
Q

List 4 outcome measures for ABI patient.

A
  1. Glasgow Outcome Scale (GOS)
  2. Functional Independence Measure (FIM)
  3. Disability Rating Scale (DRS)
  4. Ranchos Los Amigos Scale (RLAS)
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14
Q

What does Posttraumatic Amnesia (PTA) patient look alike?

A
  1. Patient doesn’t remember his daily activities.
  2. He can’t think ahead.
  3. He goes robotically from place to place and from task to task as directed by her therapists.
  4. If he’s able to speak, he asks the same questions repeatedly because he can’t remember the answers.
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15
Q

Definition of PTA

A

State of generalized cognitive disturbance characterized:

  1. Confusion
  2. Disorientation
  3. Retrograde amnesia
  4. Inability to store new memories
  5. Sometimes agitation and delusions

ERABI Model 2

16
Q

When is the end of Posttraumatic Amnesia? 🔑

A

Galveston Orientation and Amnesia Test (GOAT)

The end of PTA can be defined as the date when the patient scores 75 or higher in the GOAT for 2 consecutive days

17
Q

List 2 scales to asses PTA in TBI patient.

A
  1. Galveston Orientation and Amnesia Test (GOAT)
  2. Orientation Log (O-Log)
18
Q

List 2 general assessment tools for motor and sensory deficits.

A
  1. Berg (Balance) Scale: Score ≤45 indicates an increased risk of falling
  2. Modified Ashworth Scale (Spasticity)
  3. Functional Independence Measure
  4. Fugl-Myer for Assessment of Sensorimotor Function
  5. Six Minute Walk Test
19
Q

What factors influence quality of life following injury?

A
  1. Severity of post-injury symptoms
  2. Depression and anxiety
  3. Self-esteem and self-awareness
20
Q

What factors influence return to productivity?

A
  1. Better injury severity indicators
  2. Shorter duration of post-traumatic amnesia
  3. Shorter lengths of stay in hospital
  4. Better functional recovery
  5. Fewer cognitive deficits
  6. Younger age
  7. Higher level of education prior to injury
21
Q

Write a plan for PT & OT for ABI patient.

A
  1. Static and dynamic balance
  2. Sit-to-stand
  3. Strength
  4. Gait training
  5. Fine motor skills (Meal preparation & Block assembly)
22
Q

How to manage school in pediatric TBI patient?

A

Goal

  • Minimizing absences
  • Avoid social isolation, depression, and anxiety

More

  • frequent breaks
  • additional time to complete assignments
  • preferential seating for better attention & focus

Less

  • reduced workload
  • modified assignments
  • reduced auditory stimulation
  • reduced visual stimulation.
  • avoidance of electronic screens
  • frequent visual breaks
  • preprinted notes in large font, audiobooks, and oral teaching.

PMR 03 - TBI (8 decks)

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