Medical Complications and TBI Flashcards
obstructive / non communicating hydrocephalus
occurs when there is an obstruction of the CSF
can occur AFTER brain injury
hydrocephalus ex-vacuo
after brain injury, there is neuronal loss and shrinking of tissues which can cause enlarged ventricles (appearance) - this leads to “normal pressure hydrocelphalus”
types of hydrocephalus
obstructive or non communicating hydrocephalus
normal pressure hydrocephalus or hydrocephalus ex-vacuo
Treatment of hydrocephalus
shunt - placed from ventricles to abdominal
- promotes CSF flow
- overdrainage - headache and possible brain bleed
other risks - fever, neck pain, change in alertness
spasticity
motor disorder characterized by velocity dependent increase in tonic stretch
- increased muscle tone, exaggerated tendon reflexes, and clonus
- sudden flexing or extending of a limb which is not voluntary
- can occur with minimal triggers like movement of limb or stretching
- result of UMN damage
spasticity tx
- remove irritating factors that cause increased spasticity
- oral antispasmodics: baclofen, dantrolene, diazepam, tizanidine, monitor for SEDATING effects
- intrathecal baclofen (ITB) pump - implated reservoir that delivers baclofen to the spine - standard for severe spasticity - only considered at 1 year post
- neurotoxins - botox and phenol injections
spasticity management
treatment of spasticity should include therapy
PT, OT - address secondary complications such as skin breakdown and contractures and help with positioning
treatment should be multimodal - consider a combination of options to optimize recovery and reduce disability
heterotrophic ossification (HO)
formation of new bone around joints as a consequence of trauma/ immobility
Heterotrophic ossification identification
surface around the joint may be red / swollen and have increased pain, decreased range of motion, and / or spasticity
- lab studies and x-rays will detect HO
heterotrophic ossification intervention
- medications used might include Etidronate disodium or NSAIDS
- surgery may be required once abnormal bone has matured and maximal recovery has occurred
vascular thrombosis- DVT
DVT = deep vein thrombosis - occurs after a clot (thrombus) forms in one or more vein
- usually legs
- occurs from immobility
- tx= prophylaxis of anti coagulant - heparin, lovenox, coumadin
- without tx of prophylaxis a PE can occur - can damage breathing and cause death
cranial nerve dysfunction
may cause: visual disturbances (acuity, diplopia, CN VI palsy) facial droop postural instability dysphagia autonomic dysregulation
somatosensory issues
deficits in proprioception, tactile sensation, thermal sensation, pressure sensation, pain
functional movement dysfunction
overall mobility - consider bed mobility, transfers, gait, balance
object manipulation - consider reaching, grab/release, object with 1 or both hands
interlimb coordination
coordination disorder caused by corpus callosum damage - motor impairments affect upper extremities and bimanual coordination
- can affect timing, sequencing, and force production
ataxia
coordination disorder caused by injury to cerebellum - motor impairment is characterized by lack of muscle coordination during voluntary movements
- may include trunk posture, facial muscles affecting swallow
athetoid
coordination disorder
slow, involuntary, convoluted hand and feet writhing movements
sometimes tongue, arm, neck
ballisms
coordination disorder
quick flailing movements
choreiform
coordination disorder
continuous rapid and unpredictable movements
tremors
coordination disorder
unintentional trembling or shaking movements in one or more parts of the body
Visual Perception deficits
aka interpretation deficits
visual acuity
clarity of vision (Snellen chart to test)
eye movements
tracking, saccades, smooth pursuit, fixation
visual fields
zone of vision, central vs. peripheral and quadrants
binocular vision
left and right eye move together (conjugate)
vergence
eyes semmetrically turn inward/ outward to adjust to object distance
vestibular interactions
vestibular ocular reflex (VOR) to maintain gaze during head turning
Sensation vs. perception
sensation = appreciation of stimuli through senses and peripheral cutaneous and internal receptors
perception = incorporates sensation and interprets information
visual impairments
visual field loss decreased acuity decreased contrast sensitivity diplopia (double vision) photophobia (light sensitivity)
unilateral neglect
perceptual deficit
- not integrating stimuli from one side of body or environment
anosognosia
lack of awareness or denial of paralysis or limb itself
right/ left discrimination
cannot identify one’s own left and right
or distinguish with verbal commands
somatognosia
lack of awareness of body structures and body part relationship
spatial relation disorder:
form discrimination
challenges with objects if in different orientation or close in shape
(eg pen and toothbrush)
spatial relations disorder
inability to perceive relationships between objects or between one’s self and object (e.g. difficulty crossing midline)
spatial relation disorder:
vertical disorientation
difficulty maintaining upright position - noted in posture/ balance
depth and distance perception disorder
inaccurately judging depth, distance, and direction
figure ground discrimination disorder
cannot tell a figure from background
visual object agnosia
cannot recognize objects visually
auditory agnosia
inability to distinguist sounds unrelated to speech -
ex. doorbell vs. car alarm
tactile agnosia
cannot recognize object with touch and manipulation
ideomotor apraxia
inability to perform a task on command or imitate gestures
ideational apraxia
inability to perform task automatically and on command
buccofacial apraxia
limitations in performance of movements of the lips, cheeks, tongue, larynx, pharynx
