Exam 3- TBI part 1 Flashcards
Cultural sensitivity (some details on it)
~Check your baggage at the door
~Leave religious beliefs at the door
~They have the right to not believe in a type of treatment
~If you work at a hospital that is faith based, you can talk about faith
~If ok to ask if there is anything that will offend them
~If its unsafe, then you can tell them not to do something
CTE- stands for
chronic traumatic encephalopathy
chronic traumatic encephalopathy
~progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head
~has been known to affect boxers since the 1920s
~recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma
~trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau
~these changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement
~brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia
Different types of TBI
~traumatic
~atraumatic
~acquired brain injuries
~secondary injuries
Traumatic (type types)
A trauma to the body (duh)
~open
~closed
Traumatic- closed
~Coup-contra coup- injury-the inside of the skull is very sharp
~what direction was the force, etc (twisting, head down, head up
~hard to figure out where the injury is
Traumatic- open
~the head has to open
~GWS, baseball bat, hit a stair and the skull comes open, a horse kicks you
~you know where the injury is
~you can have a contra-coup as well
What is something you need to look out for when you have an open traumatic injury?
INFECTION!- secondary problems from the cranial vault being opened up
Traumatic- Closed can lead to DAI (stand for)
diffused axonal injury
Traumatic- Closed can lead to DAI
~lots of micro trauma ~has little deficits ~everything else looks fine, but they have a few little problems/ some changes ~emotions are usually involved- changed **Shaken baby (closed, acquired, anoxic)
Non traumatic (2 main types)
~Infection
~Anoxic
Non traumatic- some examples
Drowning, CO victim, strangulation
Non traumatic- anoxic details
~loss of oxygen
~pediatrics can happen a lot in peds
~affects every single cell in your brain- every cell is starting to die
Acquired brain injury
~a lot of peds
~When you have it at birth/ during the birthing process
~If you have the cord stuck coming out of the wound (deprived of O2)
MB: Did you mean womb? Lol!
Secondary injuries ((there’s lots of them))
~Inflammation/ swelling
~Need to watch closely for the 1st 24 hours to see if there are any changed in mental status
~Uncal Herniation, herniation through the hole (you will keep the craniotomy open if there is increased pressure)
~**don’t walk them without the helmet
~Lack of oxygen- can create cell death
~Infection
~Cell mediators that can kill some brain tissues
~Hydrocephalus- can occlude our normal sinuous that can cause it
~*when in doubt, go to the doctor
Secondary injuries- inflammation/ swelling details
~can make the injury worse
~can create the bleed that was not there at first
~we vasodialate to make better
Differentiating concussions/ LOC
~mild
~moderate/ severe
Differentiation- Mild defining
~Concussion/ LOC- less than 30 minutes
Differentiation- Mild s/s
~Memory problem ~headaches ~attention deficits ~mood swings ~irritable ~a disconnect ~cant focus ~frustration
Differentiation- Mild details
~Over looked a lot- in football a lot
~Can last, but these problems are most prominent the next day
~15% of these people will still have these symptoms in upwards of a year
Differentiation- Mild- Post-concussive symptom
*the long term symptoms
*A lot of the military comes home with
~Fatigue
~HA
~coup-contracoup
~balance
~vision
~attention
~sleep problems (all the time or they don’t need to sleep)
~irritability
~depression
~seizures (can last)
~nausea
~vomiting
~olfactory N- loss or sense of smell (decrease in appetite)
~slowness in thinking
~get lost
Moderate- defining
Concussion/ LOC- great than 30 to 6 hours
Severe- defining
Concussion/ LOC greater than 6 hours
Moderate/ Severe- cognitive s/s
**A lot more cognitive problems ~attention ~concentration ~memory ~distractibility ~processing speed ~confusion ~perseveration ~impulsiveness ~language processing ~executive functions
Moderate/ Severe- Speak and language s/s
~Broca’s and Wernicke’s aphasia (and other aphasias)
~inability to form words
~speak fast/ slow
~foreign accent syndrome (change how you pronounce things)
Moderate/ Severe- Sensitivity s/s
Light touch/ pain/ etc can be gone
Moderate/ Severe- Vision s/s
~complete ~partial loss ~diplopia from weakness of muscles ~blurred vision ~depth perception ~nystagmus ~photophobia (light sensitivity)
Moderate/ Severe- Hearing s/s
~complete loss or decrease or increase
~tinnitus (ringing in the ear)
Moderate/ Severe- Smell s/s
loss or diminished
Moderate/ Severe- taste s/s
loss or diminished
Moderate/ Severe- autonomic s/s
~temp issues
~B/B issues
~menstrual cycles
~seizures
Moderate/ Severe- Physical changes s/s
~weakness
~flaccidly
~tone
~chronic P
Moderate/ Severe- Social emotional s/s
~dependent behavior ~childlike ~emotions(more/less/childlike/ etc) ~lack of motivation ~irritability ~aggression ~depression ~disinhibition ~denial
what’s a STORM
~It’s the partner of autonomic dysreflexia in a brain injury
~Sweating a lot, tons of tone, end range that you normally cant get to
~Cant find the factor that caused it like in AD
~try and move them into other positions to stop the STORM
~Try to get the brain to calm down
~Can be a life threatening situation, but normally not
Levels of conciseness
~awake and alert ~Lethargic ~Obtunded ~stupor ~MSC (minimally conscious state) ~coma
LOC: Awake and alert
~AAO x3, x4
~Awake attentive
LOC: Lethargic
Drowsy
LOC: Obtunded
~Sleeps often
~Difficulty to arouse, actions largely non-productive, frequently confused when awake
LOC: Stupor
~Unresponsive, but can be aroused with noxious stimulus
~You can do thing in this state
~Only respond to hard, strong noxious stimulus
~Sternal rub, pick the nail bad, nipple twist, thenar pinch
LOC: MSC
~The person with make some purposeful movements
~Will open eyes up, reach for things, but wont know what to do with the objects then they get it
MSC stands for?
Minimally conscious state
LOC: coma (2 types)
~Vegetative state
~Persistence vegetative state
LOC: coma- vegetative state
~No words, does not follow commands, does not make any response that is physiologically meaningful
~Intact eye opening, has wake and sleep cycles
~We don’t know if they
~Our job is to start to interact with the outside world- “emerge”
LOC: coma- persistent vegetative state
~No meaningful motor or cognitive function
~Lasts for a year (a noxious brain injury only takes 3 months to get this title)
~Not on a vent, have a lot of their brain stem functions- will be on a peg tube to get
some info on how to get pts better
~Stabilize the pt so that they live through the event
~Prevent secondary: Skin, DVT, contractures, infections, pneumonia
~Look at: How much can they interact with env; Equipment that they may need
~Do they need to go to a rehab, voc rehab
~Some of the things that will impact- mental, emotional, behavioral (emotional side issues- Don’t trigger the negative emotions)
~Behaviors: What was the premorbid behavior; The effects of the injury, phys, emotion, sec, etc
~Act of abuse, someone died in the injury, etc
~The nature of the env that you will be in during therapy- will it promote good/bad behavior
~Talk to family members if possible
~Disinhibition: Will be saying inappropriate things- don’t agree with them/ don’t laugh/ wear bigger scrubs
Glascow Coma Scale: the levels
~mild
~moderate
~sever
Glascow Coma Scale: Mild TBI
13-15
Glascow Coma Scale: Moderate TBI
9-12
Glascow Coma Scale: Sever TBI
3-8
Rachos Los Amigos LoCF: levels
1- 8
Rachos Los Amigos LoCF: name of 1
No response
Rachos Los Amigos LoCF: name of 2
generalized response
Rachos Los Amigos LoCF: name of 3
localized response
Rachos Los Amigos LoCF: name of 4
confused- agitated
Rachos Los Amigos LoCF: name of 5
confused inappropriate, non-agitated
Rachos Los Amigos LoCF: name of 6
confused appropriate, non-agitated
Rachos Los Amigos LoCF: name of 7
automatic appropriate
Rachos Los Amigos LoCF: name of 8
purposeful appropriate
Rachos Los Amigos LoCF: level 1 from book
Pts appear to be in a deep sleep and is completely unresponsive to any stimuli
Rachos Los Amigos LoCF: level 1 from bringman
Pt appears to be in a deep sleep
Rachos Los Amigos LoCF: level 1’s therapy
~prevent sensory deprivation, don’t overload, but keep sensory going in (if we don’t, the body will stop looking for sensory)
~5-15 mins more for a couple seasons a day
~brain is still trying to heal; tactile, auditory, olfactory stimulation
~ROM (and teach family)
~may do splinting/ serial casting (DF can cause constant stimulation)
~watch out for wound
Rachos Los Amigos LoCF: Level 2 from book
Pts react inconsistently and nonpurposefully to stimuli in a nonspecific manner; responses are limited and often the same regardless of stimulus presented; responses may be physiological changes, gross body movements, and/or vocalization
Rachos Los Amigos LoCF: level 2 from bringman
Non purposeful responses that Doesn’t change no matter the stimulus
Rachos Los Amigos LoCF: level 2’s therapy
~sensory deprivation
~try and link a response to a stimulus and have a certain response to a response (pattern will show that there is a connection forming)
~will get them out of bed- stand to wheelchair, etc
~pre-feeding (good stimulus); decorate the pts room in everything that they like (pictures, tv, songs, etc)
Rachos Los Amigos LoCF: level 3 from book
Pt reacts specifically but inconsistently to stimuli; reposes are directly related to the type of stimulus presented; may follow simple commands such as closing eyes or squeezing hand in an inconsistent, delayed manner
Rachos Los Amigos LoCF: level 3 from bringman
Vague awareness of self; should be able to grab
Rachos Los Amigos LoCF: level 3 therapy
~try and get other type of response and decrease the time from the stimulus to the response
~improve grabs (can throw soft object to them)
~as little distraction as possible
~1 step task with 2 choices (red and blue card- pick the red)
~may have to tick them off to get a response
~bathing and showering (pt wont be able to do much, but good response)
Rachos Los Amigos LoCF: level 4 from book
Pt is in a heightened state of activity; behavior is bizarre and nonpurposeful relative to immediate env; does not discriminate among persons or obj; is unable to cooperate directly with treatment efforts; verbalizations frequently are incoherent and/or inappropriate to the env; confabulation may be present; gross attention to env is very brief; selective attention is often nonexistent; pt lacks short- and long-term recall
Rachos Los Amigos LoCF: level 4 from bringman
Decrease ability or process info; confused/ agitated
Rachos Los Amigos LoCF: level 4’s therapy
~need a quiet env ~don’t demand activities ~more ball throwing ~simple gross motor skills ~lots of compliments ~don’t bring up the negative ~end therapy on a positive note ~the more you can explain, the less likely they will get agitated
Rachos Los Amigos LoCF: level 5 from book
Pt is able to respond to simple commands fairly consistently. However, with increased complexity of commands or lack of ay external structure, responses are non-purposeful, random, or fragmented. Demonstrates gross attention to the env but is highly distractible and lacks ability to focus attention on a specific task. With structure, may be able to converse on a social automatic level for short periods of time. Verbalization is often inappropriate and confabulatory. Memory is severely impaired; often shows inappropriate use of objects; may perform previously learned tasks w structure but unable to learn new info
Rachos Los Amigos LoCF: level 5 from bringman
Highly distractible; will bring friends and family in more; working towards ADL, disinhibition will come out more
Rachos Los Amigos LoCF: level 5’s therapy
~establish a morning routine, working towards ADL, step by step
~crafts, stand up and do connect four
~more fine motor skills
~is able to attend long enough for strength training
~bring people together and doing group activities as long as they can be more appropriate than inappropriate
Rachos Los Amigos LoCF: level 6 from book
Pt shows goal-directed behavior but is dependent on external input or direct. Follows simple directions consistently and shows carryover for relearned tasks such as self care. Responses may be incorrect due to memory problems, but they are appropriate to the situation. Past memories show more depth and details than recent memory
Rachos Los Amigos LoCF: level 6 from bringman
Very dependent on order; short term memory still affected; time is a difficult thing
Rachos Los Amigos LoCF: level 6’s therapy
~increase group activity increase complexity of task
~make a daily log on what they need to do
~working toward being more independent in tasks
Rachos Los Amigos LoCF: level 7 from book
Pt appears appropriate and oriented within the hospital and home setting; does through daily routine automatically, but frequently robot-like. Pt shows minimal to no confusion and has shallow recall of activities. Show carryover for new learning but at a decrease rate. With structure is able to initiate social or recreational activities; judgement remains impaired
Rachos Los Amigos LoCF: level 7 from bringman
~Appears app and oriented in a safe known env
~they can do things automatically
~don’t need as much queuing, but a lack of awareness for future planning
~what are the pts goals
Rachos Los Amigos LoCF: level 7’s therapy
~memory ~abstract skills ~function independent ~voc rehab ~take the pts out into the outside world- see how they react when things don’t go their way ~safety awareness and emergency skills
Rachos Los Amigos LoCF: level 8 from book
Pt is able to recall and integrate past and recent events and is aware of and responsive to env. Shows carryover for new learning and needs no supervision once activities are learned. May continue to show a decrease ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgment in emergencies or unusual circumstance.
Rachos Los Amigos LoCF: level 8 from bringman
Pt is independent in home and community; may still have some deficits compared to where they were before
Rachos Los Amigos LoCF: level 8’s therapy
push towards being as close to as they were before (cogn, motor, etc) so that they can work toward being more apart of society
Name the Rancho los Amigos levels and names:
I: No response II: generalized response III: localized response IV: confused- agitated V: confused inappropriate, non-agitated VI: confused appropriate, non-agitated VII: automatic appropriate VIII: purposeful appropriate
