Medical Complications and TBI

Question 1

obstructive / non communicating hydrocephalus

Answer 1

occurs when there is an obstruction of the CSF

can occur AFTER brain injury

Question 2

hydrocephalus ex-vacuo

Answer 2

after brain injury, there is neuronal loss and shrinking of tissues which can cause enlarged ventricles (appearance) - this leads to “normal pressure hydrocelphalus”

Question 3

types of hydrocephalus

Answer 3

obstructive or non communicating hydrocephalus

normal pressure hydrocephalus or hydrocephalus ex-vacuo

Question 4

Treatment of hydrocephalus

Answer 4

shunt - placed from ventricles to abdominal
- promotes CSF flow
- overdrainage - headache and possible brain bleed
other risks - fever, neck pain, change in alertness

Question 5

spasticity

Answer 5

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

Question 6

spasticity tx

Answer 6

1. remove irritating factors that cause increased spasticity
2. oral antispasmodics: baclofen, dantrolene, diazepam, tizanidine, monitor for SEDATING effects
3. intrathecal baclofen (ITB) pump - implated reservoir that delivers baclofen to the spine - standard for severe spasticity - only considered at 1 year post
4. neurotoxins - botox and phenol injections

Question 7

spasticity management

Answer 7

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

Question 8

heterotrophic ossification (HO)

Answer 8

formation of new bone around joints as a consequence of trauma/ immobility

Question 9

Heterotrophic ossification identification

Answer 9

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

Question 10

heterotrophic ossification intervention

Answer 10

1. medications used might include Etidronate disodium or NSAIDS
2. surgery may be required once abnormal bone has matured and maximal recovery has occurred

Question 11

vascular thrombosis- DVT

Answer 11

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

Question 12

cranial nerve dysfunction

Answer 12

may cause: 
visual disturbances (acuity, diplopia, CN VI palsy) 
facial droop
postural instability
dysphagia
 autonomic dysregulation

Question 13

somatosensory issues

Answer 13

deficits in proprioception, tactile sensation, thermal sensation, pressure sensation, pain

Question 14

functional movement dysfunction

Answer 14

overall mobility - consider bed mobility, transfers, gait, balance

object manipulation - consider reaching, grab/release, object with 1 or both hands

Question 15

interlimb coordination

Answer 15

coordination disorder caused by corpus callosum damage - motor impairments affect upper extremities and bimanual coordination
- can affect timing, sequencing, and force production

Question 16

ataxia

Answer 16

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

Question 17

athetoid

Answer 17

coordination disorder
slow, involuntary, convoluted hand and feet writhing movements
sometimes tongue, arm, neck

Question 18

ballisms

Answer 18

coordination disorder

quick flailing movements

Question 19

choreiform

Answer 19

coordination disorder

continuous rapid and unpredictable movements

Question 20

tremors

Answer 20

coordination disorder

unintentional trembling or shaking movements in one or more parts of the body

Question 21

Visual Perception deficits

Answer 21

aka interpretation deficits

Question 22

visual acuity

Answer 22

clarity of vision (Snellen chart to test)

Question 23

eye movements

Answer 23

tracking, saccades, smooth pursuit, fixation

Question 24

visual fields

Answer 24

zone of vision, central vs. peripheral and quadrants

Question 25

binocular vision

Answer 25

left and right eye move together (conjugate)

Question 26

vergence

Answer 26

eyes semmetrically turn inward/ outward to adjust to object distance

Question 27

vestibular interactions

Answer 27

vestibular ocular reflex (VOR) to maintain gaze during head turning

Question 28

Sensation vs. perception

Answer 28

sensation = appreciation of stimuli through senses and peripheral cutaneous and internal receptors perception = incorporates sensation and interprets information

Question 29

visual impairments

Answer 29

``` visual field loss decreased acuity decreased contrast sensitivity diplopia (double vision) photophobia (light sensitivity) ```

Question 30

unilateral neglect

Answer 30

perceptual deficit | - not integrating stimuli from one side of body or environment

Question 31

anosognosia

Answer 31

lack of awareness or denial of paralysis or limb itself

Question 32

right/ left discrimination

Answer 32

cannot identify one's own left and right | or distinguish with verbal commands

Question 33

somatognosia

Answer 33

lack of awareness of body structures and body part relationship

Question 34

spatial relation disorder: | form discrimination

Answer 34

challenges with objects if in different orientation or close in shape (eg pen and toothbrush)

Question 35

spatial relations disorder

Answer 35

inability to perceive relationships between objects or between one's self and object (e.g. difficulty crossing midline)

Question 36

spatial relation disorder: | vertical disorientation

Answer 36

difficulty maintaining upright position - noted in posture/ balance

Question 37

depth and distance perception disorder

Answer 37

inaccurately judging depth, distance, and direction

Question 38

figure ground discrimination disorder

Answer 38

cannot tell a figure from background

Question 39

visual object agnosia

Answer 39

cannot recognize objects visually

Question 40

auditory agnosia

Answer 40

inability to distinguist sounds unrelated to speech - | ex. doorbell vs. car alarm

Question 41

tactile agnosia

Answer 41

cannot recognize object with touch and manipulation

Question 42

ideomotor apraxia

Answer 42

inability to perform a task on command or imitate gestures

Question 43

ideational apraxia

Answer 43

inability to perform task automatically and on command

Question 44

buccofacial apraxia

Answer 44

limitations in performance of movements of the lips, cheeks, tongue, larynx, pharynx