Exam 3: TBI - Part 1 Flashcards by Madelynn Kahl

True or False:

Over half of people that sustain a TBI, die soon after

False. 2.5 million have them per year and only 50,000 die.

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True or False:

Less than half of those who end up hospitalized after sustaining a TBI, will have permanent disabilities

True. 300,000 are hospitalized and 80-90K will have permanent disabilities

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TBI are a leading cause of death in children, teen and young adult. How does the TBI happen in this population

child abuse or car collisions

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How does the elderly typically sustain a TBI

falls

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True or False:

Females sustain more TBI than men

false, men have more

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What are the four types of MOI in TBI

Fractures
Direct blow without fracture
Penetrating
Loss of blood supply from neck injury.

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What is another name for a fracture TBI

open head injury (OHI)

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What are other terms for a TBI

Head Injury (HI)
Closed head injury (CHI)
Brain injury (BI)

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A (open/closed) fracture leads the injury to be susceptible to infection or rupture of blood vessels leading to hematoma

open

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True or False:

The majority of those who die from a TBI have a fx

True, 80% die from fx

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What are the two types of penetrating TBI

high velocity and low velocity

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Describe the characteristics of a high velocity TBI

Tends to produce a peripheration or a depression fx with a diffuse axonal damagewidespread damage

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A depression fx is a type of (low/high) velocity TBI

high

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Describe the characteristics of a low velocity TBI

Tends to produce a linear fx with a contusion at the site of impact and maybe some tearing of the blood vessels

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A linear fx is a type of (low/high) velocity TBI

low

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True or False:

A direct blow is also called a CHI

true

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Can a direct blow/CHI have devastating effects? Why or why not?

Yes, it can because of the devasting primary and secondary effects

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What term is used to describe a loss blood that equals a loss of oxygen

anoxia

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What is anoxia

A loss of blood that equals a loss of oxygen

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What are the two types of primary damage in TBI

Focal injury and diffuse injury

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(focal/diffuse axonal) injury occurs when the exact area that was impacted is damaged

focal

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(focal/diffuse axonal) injury can be associated with a fx or CHI of any severity

focal

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(focal/diffuse axonal) injury involves acceleration, deceleration, and/or rotation components

diffuse

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(focal/diffuse axonal) injury has a widespread or sloshing effect that tears multiple neurons and tissues

diffuse

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(focal/diffuse axonal) injury involves tissue that is contused by bony surfaces and folds in the brain

diffuse

True or False: The more severe a focal injury is, the more likely neurological signs will be present

True

If a patient has a focal TBI to the front of the head, what might be impacted

decision making and behavior

If a patient has a focal TBI to the back of the head, what might be impacted

Eye sight

True or False: A diffuse axonal TBI can always be diagnosed with imaging

False, it may not show signs initially, but will become more severe as edema prevails

(focal/diffuse axonal) injury can involve posturing as a part of the damage

diffue

True or False: A scan may not pick up on tears of a diffuse axonal TBI

true

What is the term that relates to damage not directly related to the event of the trauma, but deficits that could result second to the injury

secondary damage

Is this a primary or secondary damage of a TBI Increased intracranial pressure

secondary

What could cause an increase of intracranial pressure after a TBI

herniation and hematomas

Where are the three places that a hematoma could occur due to a TBI

epidural, subdural, and intracerebral

The higher the intracranial pressure, the (better/poorer) the outcome of a TBI

poorer

Is this a primary or secondary damage of a TBI Hypoxic-ischemic damage

secondary

What is the prognosis like for someone with hypoxic damage

Poor for mental and physical outcomes

Is this a primary or secondary damage of a TBI infections

second

Is this a primary or secondary damage of a TBI Seizures

second

Is this a primary or secondary damage of a TBI Electrolyte imbalance and acid base imbalance

second

If they occur, when do seizures happen in TBI

can occur right away so a patient will be put on meds so that a seizure doesn't cause extra damage

A TBI patient is at risk for developing epilepsy. When will this occur

onset to 2 years post TBI

Why is having an electrolyte or acid-base imbalance a problem in TBI

The cells will swell and burst, so this is more common in diffuse axonal injuries

Who performs a neurological exam on a TBI patient

Whoever is in charge of the main rehab

Why is neuropsychological testing done in patients with TBI

to screen cognitive or behavior deficits

Why is an xray used in diagnosing a TBI

to dx a fx

Why is an EEG used in diagnosing a TBI

used when patients are nonresponsive to determine the amount of brain activity

Why is a CT scan used in diagnosing a TBI

Used in the ER or for a mass lesion or acute stage

Is and CT scan or MRI better to dx a TBI

MRIs are more sensitive than CT scans, but they may not show signs early on

Why is a PET used in diagnosing a TBI

It shows disturbances in cerebral metabolism

Why is a fMRI used in diagnosing a TBI

Used for functional dynamics and overall neuroplasticity

What are the top three most common diagnostic tools for a TBI

Xray, EEG, and CT scan

What are the 8 primary general typical deficits following a TBI

``` Autonomic nervous system dysfunction Neuromuscular Cognitive Visual Perceptual Behavioral Communication Dysphagia ```

What are the 6 autonomic nervous system deficits that can occur following a TBI

``` Changes in pulse/RR Temp elevations Blood pressure changes Excessive sweating, salivation, and tearing Dilated pupils Vomiting ```

What are the neuromuscular deficits that can occur following a TBI

``` Sensory impairments Abnormal tone Rigidity/posturing Motor control issues Balance Bowel/bladder CN involvement/pediatric reflex return Locked in syndrome ```

True or False: TBI patients will present abnormal tone in a full spectrum. Could be high tone, normal, or low tone.

True

What are the two types of posturing that can occur following a TBI

decorticate and decerebrate

Under which general category of primary effects does rigidity and posturing fall under

Neuromuscular

True or False: Severe TBI will more than likely have neuromuscular problems

true

Describe the decorticate posturing

LE in extension | UE in flexion

Describe the decerebrate posturing

Rigidity with all extremities in an extension posture

In both decorticate and decerebrate posturing, the extremities will _____ each other

mirror

Locked in syndrome falls under which general primary effect following a TBI

neuromuscular

What are the 8 cognitive deficits that can occur following a TBI

``` Coma/altered state of consciousness Memory loss/PTA Altered orientation x 4 Attentional deficits Impaired insight/safety Problem solving/reasoning Perseveration Impaired executive control (self control) ```

Are cognitive deficits more or less common in TBI patients than they are in CVA patients

more cognitive deficits in TBI

If a patient has PTA, they might also show signs of confabulation. What is this?

When the brain fills in the gaps with false information but they think its the truth.

True or False: Impaired memory in a TBI patient can be task related and only effect certain things

true

What does altered orientation x 4 mean

4 meaning person, place, time and situation

Explain why impaired insight falls under cognitive primary effects

because it involves understanding within yourself

What is perseveration

When a patient is hyper-focused on one thing and can't get past whatever it is because the brain won't allow them too.

What are the two visual impairments that can occur following a TBI

Cortical blindness | Hemianopsia

What visual impairment will occur is there is a complete lesion of the right optic nerve

total blindness of the right eye

What visual impairment will occur is there is a complete lesion of the left optic nerve

total blindness of the left eye

What visual impairment will result due to a lesion in the midline chiasmal

bipolar hemianopsia

What visual impairment will occur due to a lesion or pressure on the right optic tract or right occipital lobe

left homonymous hemianopsia

What are the perceptual impairments seen following a TBI

Body scheme and body image disorders Apraxia Agnosias Spatial relations disorders

What is anosognosia

The patient does not perceive or is unaware of their own mental health condition

What is somatoagnosia

The patient doesn't understand what their body is

What is finger agnosia

The inability to name, move, or touch specific fingers when asked to

What is figure ground discrimination

unable to distinguish background from foreground; everything blends together

What is form discrimination

Using once senses, like vision and touch, to judge/identify the shape, size, and texture of an object

What is topographic disorientation

The patient gets disoriented or lost easily. Doesn't have a sense of direction

What does body scheme relate to

The orientation of the body in relationship to the environment

What does body image relate to

How you feel about your looks/body style

What are the 8 behavioral impairments that can occur following a TBI

``` Disinhibition Impulsiveness Physical and verbal aggression Apathy Lability/mood swings Sexual inappropriateness Irritability Egocentricity ```

What is disinhibition

Basically having no filter

True or False: How a person acted prior to a TBI is a good indicator of the behavioral changes that might occur

False, there is no correlation or way to predict

If a patient following a TBI completely changes their behavior, it is important to help _____ understand that it is not voluntary behavior

The family

What is the impairment of dysphagia that could occur

swallowing impairments

What are the communication impairments that might occur following a TBI

``` Receptive/expressive aphasia Dysarthria Auditory deficits Impaired reading comprehension Impaired written expression Impaired pragmatics ```

How could receptive and expressive aphasia be described as

A language processing deficit or motor problem

Is this a primary or secondary impairment Contracture

secondary

Is this a primary or secondary impairment Skin breakdown

secondary

Is this a primary or secondary impairment DVT

secondary

Is this a primary or secondary impairment Heterotopic ossifications

secondary

Is this a primary or secondary impairment Decreased bone density

secondary

Is this a primary or secondary impairment Muscle atrophy

secondary

Is this a primary or secondary impairment Decreased endurance/deconditioned

secondary

Is this a primary or secondary impairment Muscle atrophy

secondary

Is this a primary or secondary impairment Infection/Pneumonia

secondary

Is this a primary or secondary impairment Dysarthria

Primary

Is this a primary or secondary impairment Lability

Primary

Is this a primary or secondary impairment Disinhibition

Primary

Is this a primary or secondary impairment Apraxia

Primary

Is this a primary or secondary impairment Vertical disorientation

Primary

Is this a primary or secondary impairment Memory loss

Primary

Is this a primary or secondary impairment Attentional deficits

Primary

Is this a primary or secondary impairment Paresis

Primary

Is this a primary or secondary impairment Sensory impairments

Primary

Is this a primary or secondary impairment Dilated pupils

Primary

Is this a primary or secondary impairment Vomiting

Primary

Is this a primary or secondary impairment BP/RR and temp changes

Primary