Lecture 5b. TBI Flashcards
1
Q
Mild TBI.
- Where are the processes in the hospital first aimed at?
- Is a CT scan performed?
- When is the risk of intracranial pathology almost zero?
- What percentage has no long-term effects beyond 12 months post-injury, and thus recovers completely and relatively quick?
- The other percentage, what risk factors do they have?
A
- At diagnostics and identifying potential medical complications
- For children with low risk not, because CT is iron aiding radiation, which increases the risk for cancer. Alternatively, there could be a night of observation in the hospital, in which the child is monitored for consciousness every hour to see if it drops over time. If it drops, this signifies that there could be intracranial pathology in the brain that is going worse.
- After 24 hours, so then the child can go home.
- 90%
- Dangerous mechanisms of injury, GSC<15, decline of 2 points on GCS, clinical signs of cranial fracture, persistent vomiting, and post-traumatic epileptic insult
2
Q
Moderate/severe TBI.
- Where is the acute phase focused at?
- What things are done?
A
- On survival (potentially there is coma)
- Multiple CTs/MRIs are performed to monitor the progression of neuropathology, there is typically intracranial pressure monitoring, and there is potential neurosurgery (50%).
3
Q
Effects of TBI on intelligence:
- For mild TBI
- For severe TBI
A
- For mild TBI no systematic effects
- For severe TBI, we see effects in the subacute phase as well as the chronic phase –> PIQ is more severely impaired in the subacute phase than VIQ (this difference normalizes over time, but both stay strongly impaired). On Wechsler scales, they scored on average 15 IQ points below the control population, reflecting an IQ of around 85 (quite strong effect on functioning)
4
Q
Effects of TBI on language:
- For mild TBI
- For severe TBI
A
- For mild TBI, no effects
- For severe TBI, potential deficits in the pace of speech, fluency, word finding, and complex comprehension (extracting humor). Aphasia is relatively uncommon.
5
Q
Effects of TBI on motor skills:
- For mild TBI
- For severe TBI
A
- For mild TBI, no impairments
- For severe TBI, motor impairments are almost exclusively observed. Mostly hemiparesis and/or disturbed balance, proportional to the complexity of motor behavior.
6
Q
Effects of TBI on attention:
- For mild TBI
- For severe TBI
A
- For mild TBI, on average no effects, but some specific groups might are at higher risk for long-term attention problems.
- For severe TBI, there are generalized deficits (in all attention processes). Lapses of attention play a central role.
7
Q
Effects of TBI on learning and memory:
- For mild TBI
- For severe TBI
A
- For mild TBI, no problems
- For moderate/severe TBI, slower and incomplete recovery of memory functions (encoding, consolidation and retrieval)
- —- Problems with encoding –> reduce amount of information that a child has to remember at one time (pieces)
- —- Problems with retrieval –> try to make ways that allow a child to more easily remember information that is stored in memory
8
Q
Effects of TBI on behavior:
- For mild TBI
- For severe TBI
A
- For mild TBI, it’s difficult to separate premorbid presence of behavioral problems from the impact of TBI, because the impact of mild TBI on behavior is typically relatively small.
- For severe TBI, 46% has behavioral problems, that may be externalizing or internalizing.
9
Q
Effects of TBI on social/emotional functioning
- For TBI in general
A
Increased risk of impaired social skill and loneliness, unrelated to injury severity. This is typically persistent over time, and there is a central role for the family surrounding of the child
10
Q
Effect of TBI on educational functioning:
- Which domains mostly?
- What percentages special educational services?
A
- Especially observed in math and reading comprehension (predictor is impairments in verbal learning & memory)
- mild TBI = 0%
- moderate TBI = 40%
- severe TBI = 70%
