Midterm Flashcards
TBI definition
alteration in brain fx or other pathology caused by external force; not congenital or degenerative
leading causes of TBI
falls (35%), MVA (17%), struck by/against (17). Blasts for military. 2.2 million ER visits a year
why is TBI underreported?
have to lose consciousness to count?; coding by dr/ER; don’t go to ER
TBI ages
15-24; under 5 and over 75
primary injuries
localized brain injury (OHI); polar damage (CHI, contracoup); diffuse injury (DAI)
localized head injury/open-head injury
penetrating or missile injuries producing focal damage (less tissue involved); acts of violence; localized can also be CHI; OHI has better outcome due to less intracranial pressure
diffuse/polar damage/closed head injury
acceleration/deceleration (MVA); linear/translation vs. angular/rotational; coup/countrecoup; more brain tissue involved; often front and back
coup/contrecoup
coup= site of impact/front, contrecoup = side opposite injury/back
diffuse axonal injury (DAI)
shearing of nerve tissue b/c of ridges of cranium= white matter injured; key to prognosis; damage to white matter, corpus callosum, internal capsule (everything passes through here!), grey matter, brain stem tracts
midline shift
ventricles moved over after impact
systemic TBI issues: concomitant injuries
hypoxemia (02); hypotension (BP); anemia, hyponatremia (sodium–action potential), infection
hyponatremia and dysphagia =
pontine injury b/c salt converted too quickly
hematoma
bleeding out: epidural (solid, clotted blood separating dura mater and skull), subdural (clotted blood between inner surface and dura), intracerebral (blood thinners first)
intracranial pressure
edema (with blood) and hydrocephalus (CSF–VP shunt); ventricles may be enlarged when losing brain tissue; craniectomy may be done to relieve pressure (cut skull); Richmond bolts can monitor ICR pressure
other intracranial concerns
infections (meningitis, encephalitis, abscess); epilepsy (anti-seizure meds can also be cognitively dulling); vasospasm (constriction in arteries)
coma
after CNS damage or depression; state without eye opening, obeying commands, uttering words
Glasgow Coma Scale
subjective assessment of consciousness related to E (eye opening) + M (motor response) + V (verbal response); severe = 8 or below; mod = 9-12; mild =13-15; also used for predictions of outcome; eyes out of 4, motor out of 6, verbal out of 5
likelihood for a second or more TBI?
3-4 x more likely
coma scales
Disability Rating Scale; Glasgow Outcome Scale; Sickness Impact Profile; Katz Adjustment Scale; Galveston Orientation and Amnesia Test
decorticate vs. decerebrate
flexion (body inward) vs. extension (body outward)
neuro eval early stages
consciousness, motor response (decorticate vs. decerebrate), muscle tone (spastic/flaccid), orbicularis reflex (tap on head and blink), pupil size, resting eye position, other ocular
neuro eval later stages
smell and taste, visual acuity and fields, facial symmetry and mvm’t, motor function (body), hearing, phonation and swallow, gait and balance, cognition
psychosocial considerations
premorbid factors (personality, hx, substance), impaired cog. fx. (memory and attention), emotional status (depression), environmental responses
Reitan and Wolfson Model of Cog Fx
sensory input–attention, concentration, memory–lang. and visuospatial skills–concept formation, reasoning, logic
neurpsych eval components
general neuropsych function, intellectual and academic, attention and concentration, memory, processing speed, visual-spatial and perceptual motor, sensory perceptual and motor, problem solving and abstract reasoning
ancillary testing
personality, mood, psychosocial measures such as intelligence (Wechsler, Peabody)
attention components
must be alert, need capacity to attend to multiple, need selection (selective attention–i.d. most imp. piece of info.)
memory
first need attention (30 sec.), then short-term for 30 sec. -2 min., then long-term forever (this includes episodic, semantic (declarative), procedural, non-declarative)
attention deficits after TBI
selective attention, perseveration, vigilance, hemi-inattention or neglect
retrograde amnesia vs. anterograde
remember before onset vs. ability with new learning
post tramautic amnesia ( PTA)
one of best predictors of cog. outcome: from moment of injury till continuous memory returns; 1-2 or even up to 5 yrs. till can ascertain status and recovery potential
cog-lang connection
impaired attention, memory, perception; inflexible, impulsive, disorganized; inefficient info. processing; difficulty processing abstract, learning new info, inefficient retrieval, impaired problem solving and judgment, inappropriate social behavior, impaired exec fx
Rancho stages
early=1-3; mid = 4-6; late = 6-8/10; based on level of fx and cooperation behaviors
TBI evals
lower: Rancho scale, Comm. Abilities Record, BRIEF Test of Head Injury; mid: SCATBI, RIPA, Ross Test of Higher Cognitive Fx, CLQT (for lang. BASA, WAB, CADL)
motor speech deficits
impairment (strucure/fx); disability (activity); handicap (participation)
initiation/planning disorders
persistent veg state; locked-in syndrome; apraxia ; apraxia and dysarthria often comorbid (volitional v. spontaneous); limb apraxia and verbal always follows (wait till limb resolves)
apraxia
numerous phon. errors, inconsistency, difficulty initiating, increased error with length/complexity, discrepancy b/w production and perception, increased diff. with words carrying little meaning
testing apraxia
informal; Apraxia Battery for Adults; automatized speech or singing
apraxia tx
PACER (pacing board/tap); Rosenbeck Continuum for Apraxia; MIT
dysarthria
test with AIDS/CAIDS or Frenchay and oral peripheral; consistent but slow, weak, imprecise, uncoordinated; occurs in 75-80% of severe TBI; DAB checklist
dysarthria components
artic, resonance, respiration, largyneal fx, prosody
dysarthria types
spastic, flaccid, ataxic, hyperkinetic, hypokinetic, mixed (TBI usually here)
swallow phases
oral prep, oral, pharyngeal, esophageal
oral prep disorders
primitive/pathological reflexes (rooting, biting, munchy chewing), abnormal muscle tone, sensation, movement disorders
oral phase deficits
tone, sensation, movement, munch or suckle-swallow, premature spillage, inadequate buccal/labial tension
pharyngeal issues
delayed swallow, absent (20 sec. or more), inadequate V-P closure, reduced hyol. excursion, reduced airway protection
esophageal issues
cricopharyngeal dysfunction, distal esophageal issues
dysphagia assessment
history/feedings, BSE, MBS, FEES
