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Neuro II > Exam 3: TBI - Part 2 > Flashcards

Exam 3: TBI - Part 2 Flashcards

1
Q

What are the three criteria that are looked at when scaling the severity of an acute TBI

A

Glascow coma scale
Loss of consciousness
PTA

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2
Q

What is PTA

A

posttraumatic amnesia

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3
Q

What level of severity would a concussion be scaled at

A

mild

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4
Q

What is the definition of PTA

A

The time between the injury and the time to remember on going events

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5
Q

What is an easy way to tell the difference between a mild and moderate TBI

A

Impairments will go away and return to normal with a mild TBI, but they will not with a moderate TBI

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6
Q

True or False:

Impairments or loss of consciousness that occur with a moderate concussion has the potential to become permanent

A

true

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7
Q

What type of impairments will be seen in a mild TBI

A

Neuro or neuropsychological

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8
Q

What type of impairments might be seen in a moderate TBI

A

physical, cognitive, and/or behavioral changes

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9
Q

How long would you expect any physical, cognitive, and/or behavioral changes to last after a moderate TBI

A

months or even permanently

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10
Q

1/3 of patients with a (mild/moderate/severe) TBI will have extra cranial injuries or multi-trauma

A

severe

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11
Q

___ of patients with a severe TBI will have extra cranial injuries or multi-trauma

A

1/3

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12
Q

A (mild/moderate/severe) TBI is associated with acceleration/deceleration forces with any period of confusion, disorientation, or impaired consciousness

A

mild

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13
Q

How would a mild TBI be scaled

A

GCS: 13-15
Loss of consciousness: less than 30 min
PTA: 0-1 day

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14
Q

How would a moderate TBI be scaled

A

GCS: 9-12
Loss of consciousness: 30min-24 hours
PTA: 1-7 days

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15
Q

How would a severe TBI be scaled

A

GCS: 3-8
Loss of consciousness: over 24 hours
PTA: greater than 7 days

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16
Q

Which clinical rating scale is to be used at the acute level or in an emergency situation

A

Glascow coma scale

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17
Q

When do you use the GCS

A

at the acute level or in an emergency situation

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18
Q

Which clinical rating scale measures post traumatic amnesia

A

Galveston orientation and amnesia test

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19
Q

When do you use the GOAT

A

to test for PTA

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20
Q

Which clinical rating scale determines the overall prognosis of the patients

A

Glascow outcome scale

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21
Q

When do you use the GOS

A

at discharge from acute care and again at 6 months after the injury

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22
Q

Which clinical rating scale measures level of consciousness in the subacute phase or rehab phase

A

Ranchos

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23
Q

When do you use the Ranchos scale

A

During the subacute or rehab phase to measure level of conscious

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24
Q

Which clinical rating scale has a wide range of physical and cognitive function to truly capture where the patient is at in recovery

A

Rappaport’s disability rating scale

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25
Q

What are the two clinical rating scales that measures participation

A

DRS and FAM

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26
Q

When do you use the DRS

A

when you need to truly test where the patient is physically and/or cognitively in their recovery

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27
Q

True or False:

The FIM is no longer used clinically

A

true

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28
Q

What is the difference between the FIM and FAM

A

The FAM is the FIM, but with 12 additional measurement items that target TBI patients

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29
Q

Which clinical rating scales have employable scoring on them

A

FAM and DRS

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30
Q

What are the three activities that are looked at on the GCS

A

eye opening
motor response
verbal response

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31
Q

When is a patient no longer in a coma

A

when their eyes open, even if it is spontaneous eye opening

32
Q

True or False:

A patient in a coma is still responsive to stimulus

A

False, they are not responsive. only to reflexes

33
Q

True or False:

A patient in a coma is still responsive to reflex testing

34
Q

What severity of TBI would a patient classify as with a GCS score of 15

35
Q

What severity of TBI would a patient classify as with a GCS score of 11

36
Q

What severity of TBI would a patient classify as with a GCS score of 9

37
Q

What severity of TBI would a patient classify as with a GCS score of 3

38
Q

What severity of TBI would a patient classify as with a GCS score of 7

39
Q

What are the four levels on the GOS

A

vegetative
severely disabled
moderately disabled
good recovery

40
Q

Describe a patient in the vegetative stage of the GOS

A

The patient will persistently be unresponsive. They may have some eye opening, yawning, localized motor response

41
Q

Describe a patient in the severely disabled stage of the GOS

A

The patient has some consciousness but need 24 hour care

42
Q

Describe a patient in the moderately disabled stage of the GOS

A

The patient has some independence. Can complete self care skills and most ADL’s independently but still have some varying other disablements

43
Q

Describe a patient in the good recovery stage of the GOS

A

Still have some sequela, but is able to integrate back into social and work life

44
Q

The categories of the GOS are (directly/indirectly) related to prognosis

A

directly, the longer the coma or PTA the poorer the outcome

45
Q

To receive a prognosis of moderate to severe for cognitive functioning, the patient must have what criteria

A

Been in a coma for greater than two weeks
and/or
Have PTA greater than 12 weeks

46
Q

To receive a prognosis of moderate disability to good recovery for cognitive functioning, the patient must have what criteria

A

Been in a coma less than a week
and/or
Have TPA less than 4 weeks

47
Q

Is it better to have a patient with cognitive impairments and normal physical function, or a patient with normal cognition, and physical impairments

A

Better for normal cognitive and physical impairments. It will be easier to integrate into every day life.

48
Q

What are the 8 levels of the ranchos scale

A
  1. No response
  2. Generalized response
  3. Localized response
  4. Confused- agitated
  5. Confused - inappropriate
  6. Confused- appropriate
  7. Automatic- appropriate
  8. Purposeful - appropriate
49
Q

What is the lowest level on the ranchos scale that a modified MMT can be done for testing

A

5: confused and inappropriate

50
Q

What levels on the ranchos scale make it appropriate to assess the patients posture and alingment

51
Q

There are several factors that influence patient outcomes after a TBI. Examples of these can be either static or dynamic. Explain what this means

A

static factors do not change over time, dynamic factors will change with good therapy

52
Q

What is the lowest level of ability that is measured on the DRS

A

eye opening

53
Q

What is the main goal of medical/emergency management of a patient that just sustained a TBI

A

To monitor ICP

54
Q

What are the precautions for monitoring ICP

A

keep the head elevated at least to 30 degrees, NO LOWER to ensure that the ventricles drain properly

55
Q

Which rancho scale level is appropriate to gather patient history

A

all levels

56
Q

Which rancho scale level is appropriate to gather a systems review

A

all levels

57
Q

Which rancho scale level is appropriate to determine a cognitive status

A

all levels

58
Q

Which rancho scale level is appropriate to gather skin integrity

A

all levels

59
Q

Which rancho scale level is appropriate to gather the patients ability to feel sensation

A

Unable to do formal testing 1-4
Modified testing can be done at 5 and 6
Normal testing done at 7 and 8

60
Q

True or False:

When we test for sensation, visual fields and auditory functions are included

61
Q

Which rancho scale level is appropriate to gather a motor exam
Ex: reflexes, spasticity, movement patterns and quality of movement, posture, coordination, and balance

A

all levels but will be modified with levels 1-6

62
Q

before performing a MMT, what should the PT make sure of first

A

that the patient can follow instructions

63
Q

Which rancho scale level is appropriate to test a patient’s balance

A

7 or higher

64
Q

Which rancho scale level is appropriate to perform timed tests for coordination

A

Can just observe coordination in levels 3-4 or formally by levels 7 or higher

65
Q

What is lowest level at which coordination can be tested

A

3 if observing

7 if doing timed testing

66
Q

Which rancho scale level is appropriate to gather information regarding fatigability

A

level 4 and higher

67
Q

What is diadokokinesia

A

rapid alternating movements

68
Q

Which rancho scale level is appropriate to gather a functional status

A

4 if observing
5-6 if modified
7 or higher if for outcome measures

69
Q

At what level can we perform the full set of outcome measurements on a TBI patient

A

7 at the very very lowest, some not until level 8

70
Q

What are the core set of movement tasks for an adult that can be done by observing

A 
sitting/standing
sit to stand/stand to sit
walking
step up/down
reach, grasp, and manipulation
71
Q

What are the core set of movements tasks for pediatrics that can be done by observing

A

floor to stand/stand to floor

floor mobility

72
Q

True or False:

Rancho levels have nothing to do with physical abilities/performance and are only cognitive related

73
Q

True or False:

Movement system diagnoses are about cognitive function and not physical function

A

False, it is physical

74
Q

What is the most likely movement system diagnosis for TBI

A

Anything goes here

75
Q

What are the best functional outcome measures

A

DRS and the FIM/FAM

76
Q

Would the DRS or FIM/FAM be better for inpatient rehab

Neuro II (3 decks)

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