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Neuromuscular management > Lecture 5 - TBI > Flashcards

Lecture 5 - TBI Flashcards

1
Q

What is more expensive, acute care, or inpatient rehab?

A

Acute care

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2
Q

Early medical management of a TBI

A

Establish open airway

check vital signs

fluid replacement

Neuro checks every 15-30 mins

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3
Q

Glasgow Coma Scale:

What does the score range between?

How is it used?

A

3-15 (worst is 3)

Used at scene of accident, in ER, throughout acute care

used as a predictor of outcome

used in research

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4
Q

What are the 3 components of the glasgow coma scale?

A

Eye, Verbal, Motor Response

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5
Q

Glasgow coma score meanings:

3-8

9-12

13-15

A

3-8 Severe injury (defines coma in 90% of cases)

9-12 moderate injury

13-15 mild injury

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6
Q

What are limitations of the glasgow coma scale

A

Pre-existing conditions

aphasia

alcohol or medications

other injuries (example : jaw injury makes it hard to talk)

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7
Q

Local brain injury vs Diffuse axonal Injury

A

Local brain injury : localized to the site of impact on skull

Diffuse axonal injury: widely scattered shearing of axons

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8
Q

Intracranial pressure norms:

0-10

10-20

20-40

60

A

0-10 normal while laying down

10-20 Abnormal

20-40 Contraindication for PT, causes neurological dysfunction

60+ almost always results in death

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9
Q

What can cause an intracranial infection?

A

Foreign objects in brain from the injury

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10
Q

How can a hemmorhage cause cerebral arterial vasospasm

A

blood where its not suppose to be irritates the smooth muscle of the vessels and causes vasospasm

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11
Q

Hydrocephalus vs brain edema?

A

Hydrocephalus : CSF build up where it’s not suppose to be

Brain edema- the brain cells are swollen

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12
Q

What could cause arterial hypoxemia from a TBI

A

Depressed breathing centers

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13
Q

What could cause arterial hypotension from a TBI

A

Bleeding elsewhere in the body

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14
Q

How is anemia caused from a TBI?

Hyponatremia?

A

anemia- bleeding

hyponatermia - sodium loss

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15
Q

Distortion vs midline shift

A

Distortion is a smaller shift than a midline shift, doesn’t move the whole brain over

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16
Q

What is the difference between hypoxemia and ischemia?

A

hypoxemia- less oxygen in blood

Ischemia- bloodflow isnt happened

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17
Q

Where is hypoxemic and ischemic brain damage commonly seen?

A

Hippocampus, basal ganglia, scattered sites of cerebral cortex and cerebellum

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18
Q

What is the difference of a craniotomy vs a craniectomy

A

Craniotomy - Make a hole to let pressure drain

Craniectomy - remove flap that they’ll put back later

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19
Q

What is a ventriculostomy?

A

Used to insert a measurement/drain device into the ventricles to measure intracranial pressure

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20
Q

How does an EVD (external ventricular drain) work?

A

Measures intracranial pressure

Must be kept level with patients head at all times to work

check with nurse before mobilization

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21
Q

an average adult with a TBI in the ICU requires how many calories per day?

A

3000 kcal atleast

note: articifial feeding once bowel souns return via nasogastric tube, gastrotomy, jujunostomy

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22
Q

Damage to the hypothalamus can cause ________ fever

A

Neurogenic fever

note: a fever can be signof iritation with a brain herniation and causes increased caloric/metabolic demand of brain

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23
Q

Systemic arterial hypertension can result in blood brain barrier disruption causing more __________

loss of autoregulation of cerebral bloodflow increases blood-brain volume AKA ____________

A

brain edema

inracranial hypertension

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24
Q

What is the most common side effect related to heart rate stemming from a TBI?

A

Tachycardia

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25
Q

Participation vs Activity vs Body Structure/function scales

What is the definition of each?

A

Participation - how well they’re doing socially ability to participate in life

Activity- Measures their overall physical functional abilities (example: how they walk/run)

Body structure/function: Measures more specific things related to their body. example: spasticity

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26
Q

How is the disability rating scale scored?

What does it measure?

A

0-no disability to 30 - death

It measures PARTICIPATION

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27
Q

What does the CHART (Craig Handicap assessment/reporting technique) measure?

A

Physical independence

Mobility

Occupation

Social Intregration

Economic Self Sufficiency

Cognitive Independence

Note: it’s also a participation measure

28
Q

What does the POPS measure (Participation Objective/ Participation subjective)

A

Measures participation…
26 items in 5 categories

Example: in a typical month how often do you go to the movies?

How important is this to your well being? are you satisified or would you like to be doing more or less?

29
Q

What are the 4 supervision categories on the supervision rating scale?

A

Overnight supervision

Part time supervision

Full time indirect supervision

full time direct supervision

30
Q

When does most improvement on the supervision rating scale happen?

A

First year

note: overall most recovery for everything happens in first year

31
Q

What is the UDS-FIM

A

an ACTIVITY measure

32
Q

What is HIMAT?

HiLevel Mobility Assessment tool

A

Activity measure

note: minimum mobility requirement: independent walking 20 meters

Includes walking, running, jumping, stairs…

33
Q

What is Rancho level 1?

A

No response

34
Q

What is Rancho level 2?

A

Generalized Response

non-purposeful responses, often to pain only

35
Q

What is Rancho level 3?

A

Localized response

purposeful responses, can follow simple commands or focus on object.

36
Q

What is rancho level 4?

A

Confused Agitated

37
Q

What is rancho level 5?

A

Confused, inappropriate, non-agitated

appears alert, verbally inappropriate, unable to learn new information

38
Q

What is rancho level 6

A

Confused, Appropriate

good directed behavior, can relearn old skills, serious memory problems, has self awareness

39
Q

What is Rancho level 7?

A

Automatic Appropriate

Robot-like appropriate behavior with minimal confusion

poor insight into condition, poor judgement and problem solving

40
Q

What is rancho level 8?

A

Purposeful Appropriate

Alert/oriented can recall and integrate past events

cogntitively independent

many function at reduced levels in society at this level

41
Q

How is mild traumatic brain injury defined?

A

By atleast one of these:

Any period of loss of conciousness

any loss of memory

any change in meental state at time of accident

focal neuro deficits

42
Q

What is the JFK Coma/near coma scale?

A

scale used to monitor alertness for patients in a coma/PVS

more sensitive than glassgow and rancho

shows emergence from coma/PVS to a minimally concious state

43
Q

What is the average duration of unconciousness after a traumatic brain injury

A

7.87 days

Most have under 1 day though. (46%)
25% have between 2-7 days of unconciousness

44
Q

How will TBI patients typically present?

A

Lots of tubes

asleep or awake

high risk for skin breakdown

unstable vital signs

increased risk of seizures

NPO (nothing by mouth)

Extreme levels of hypertonicity

45
Q

How will a patient in a coma appear?

A

no eye opening (even spontaneously), nor movements or vocalization

45
Q

How long does a coma usually last?

A

Not more than 2 weeks

46
Q

How will a patient in a persistent vegetative state appear?

A

Can have eyes open, move spontaneously, but unable to follow commands or speak, they will have sleep/wake cycles

47
Q

How long can a persistent vegetative state last for

A

indefinitely

48
Q

How is the JFK coma scale scored?

A

0 is worst, 23 is best

49
Q

What are the categories of the JFK coma scale?

A

auditory, visual, motor, oromotor/verbal, communication, and arousal.

50
Q

What is post traumatic amnesia PTA

A

Period of time from the accident to the time a patient starts having ongoing short term memory

patients will often not remember the accident or the events immediately preceding it

51
Q

How long does PTA usually last?

A

Generally lasts 3-4 times the length of unconciousness

so if you were unconcious for 24 hours you wouldnt remember 3-4 days

52
Q

What is the average duration of PTA (post traumatic amnesia)

A

23 days

53
Q

What is the galveston orientation and amnesia scale?

How is it scored?

A

Used to determine when a patient is progressing out of PTA

Must have 3 consecutive scores of 75+ to be out of PTA

54
Q

Causes of agitation

A

Actual site of injury:
Slyvian Fissure
Temporal Lobe
Diffuse axonal injury Esp of corpus callosum and dorsolateral columns of midbrain

secondary effects of hypoxia and compression, neuro hormones

Or pre-morbid personality

Environment (sensory overload or deprevation)

55
Q

What are reversable factors of agitation?

A

Seizures

Sleep disturbances

Electrolytes

Medication

Nutrition

56
Q

How can physical therapy help patients with agitation

A

get them up and walking and change enviroments

57
Q

What scale measures agitation from a TBI?

A

Agitated behavior scale

minimum score of 14, max of 56

higher score = more agitation

58
Q

What scale measures attention after a TBI

A

Moss Attention Scale

Scores 22-110

Higher score = better attention

not appropriate for patients in PVS or coma

59
Q

What is the classification for a mild traumatic brain injury?

A

Traumatic induced disruption of brain manifested by atleast one of these:

Any period of LOC

Any memory loss

any change in mental state at time of accident

Focal neuro deficits (transient or lasting)

60
Q

In order to have a MILD traumatic brain injury, the severity should not exceed:

A

LOC greater than 30 mins

After 30 mins they must score no less than 13-15 on the Glassgow coma scale

61
Q

Symptoms of mild TBI are not commonly reported initially but ______________

what is the most common reported symptom?

A

Surface later and last 1 year or more

headaches

62
Q

What are symptoms of a mild TBI

A

Physical: Headache, dizziness, balance, sleep disturbances, fatigue, tinnitis, diplopia,

Cognitive: attention, concentration, perception, memory, executive functions

Behavioral: irritability, disinhibition, emotional lability

63
Q

How long is the period of rapid recovery after a TBI?

What happens after?

A

Most recovery happens in 1 year at inpatient rehab

activity and participation levels tend to plateau between 1-2 years post injury

64
Q

What should you say and not say when working with TBI patients and families

A

dont: “I know just how you feel”

DO: show empathy, be mindful w/ words

educate and reinterate

provide resources

remind them of loved ones progress

Neuromuscular management (19 decks)

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