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TBI > Midterm > Flashcards

Midterm Flashcards

1
Q

TBI definition

A

alteration in brain fx or other pathology caused by external force; not congenital or degenerative

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2
Q

leading causes of TBI

A

falls (35%), MVA (17%), struck by/against (17). Blasts for military. 2.2 million ER visits a year

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3
Q

why is TBI underreported?

A

have to lose consciousness to count?; coding by dr/ER; don’t go to ER

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4
Q

TBI ages

A

15-24; under 5 and over 75

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5
Q

primary injuries

A

localized brain injury (OHI); polar damage (CHI, contracoup); diffuse injury (DAI)

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6
Q

localized head injury/open-head injury

A

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

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7
Q

diffuse/polar damage/closed head injury

A

acceleration/deceleration (MVA); linear/translation vs. angular/rotational; coup/countrecoup; more brain tissue involved; often front and back

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8
Q

coup/contrecoup

A

coup= site of impact/front, contrecoup = side opposite injury/back

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9
Q

diffuse axonal injury (DAI)

A

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

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10
Q

midline shift

A

ventricles moved over after impact

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11
Q

systemic TBI issues: concomitant injuries

A

hypoxemia (02); hypotension (BP); anemia, hyponatremia (sodium–action potential), infection

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12
Q

hyponatremia and dysphagia =

A

pontine injury b/c salt converted too quickly

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13
Q

hematoma

A

bleeding out: epidural (solid, clotted blood separating dura mater and skull), subdural (clotted blood between inner surface and dura), intracerebral (blood thinners first)

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14
Q

intracranial pressure

A

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

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15
Q

other intracranial concerns

A

infections (meningitis, encephalitis, abscess); epilepsy (anti-seizure meds can also be cognitively dulling); vasospasm (constriction in arteries)

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16
Q

coma

A

after CNS damage or depression; state without eye opening, obeying commands, uttering words

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17
Q

Glasgow Coma Scale

A

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

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18
Q

likelihood for a second or more TBI?

A

3-4 x more likely

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19
Q

coma scales

A

Disability Rating Scale; Glasgow Outcome Scale; Sickness Impact Profile; Katz Adjustment Scale; Galveston Orientation and Amnesia Test

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20
Q

decorticate vs. decerebrate

A

flexion (body inward) vs. extension (body outward)

21
Q

neuro eval early stages

A

consciousness, motor response (decorticate vs. decerebrate), muscle tone (spastic/flaccid), orbicularis reflex (tap on head and blink), pupil size, resting eye position, other ocular

22
Q

neuro eval later stages

A

smell and taste, visual acuity and fields, facial symmetry and mvm’t, motor function (body), hearing, phonation and swallow, gait and balance, cognition

23
Q

psychosocial considerations

A

premorbid factors (personality, hx, substance), impaired cog. fx. (memory and attention), emotional status (depression), environmental responses

24
Q

Reitan and Wolfson Model of Cog Fx

A

sensory input–attention, concentration, memory–lang. and visuospatial skills–concept formation, reasoning, logic

25
Q

neurpsych eval components

A

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

26
Q

ancillary testing

A

personality, mood, psychosocial measures such as intelligence (Wechsler, Peabody)

27
Q

attention components

A

must be alert, need capacity to attend to multiple, need selection (selective attention–i.d. most imp. piece of info.)

28
Q

memory

A

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)

29
Q

attention deficits after TBI

A

selective attention, perseveration, vigilance, hemi-inattention or neglect

30
Q

retrograde amnesia vs. anterograde

A

remember before onset vs. ability with new learning

31
Q

post tramautic amnesia ( PTA)

A

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

32
Q

cog-lang connection

A

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

33
Q

Rancho stages

A

early=1-3; mid = 4-6; late = 6-8/10; based on level of fx and cooperation behaviors

34
Q

TBI evals

A

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)

35
Q

motor speech deficits

A

impairment (strucure/fx); disability (activity); handicap (participation)

36
Q

initiation/planning disorders

A

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)

37
Q

apraxia

A

numerous phon. errors, inconsistency, difficulty initiating, increased error with length/complexity, discrepancy b/w production and perception, increased diff. with words carrying little meaning

38
Q

testing apraxia

A

informal; Apraxia Battery for Adults; automatized speech or singing

39
Q

apraxia tx

A

PACER (pacing board/tap); Rosenbeck Continuum for Apraxia; MIT

40
Q

dysarthria

A

test with AIDS/CAIDS or Frenchay and oral peripheral; consistent but slow, weak, imprecise, uncoordinated; occurs in 75-80% of severe TBI; DAB checklist

41
Q

dysarthria components

A

artic, resonance, respiration, largyneal fx, prosody

42
Q

dysarthria types

A

spastic, flaccid, ataxic, hyperkinetic, hypokinetic, mixed (TBI usually here)

43
Q

swallow phases

A

oral prep, oral, pharyngeal, esophageal

44
Q

oral prep disorders

A

primitive/pathological reflexes (rooting, biting, munchy chewing), abnormal muscle tone, sensation, movement disorders

45
Q

oral phase deficits

A

tone, sensation, movement, munch or suckle-swallow, premature spillage, inadequate buccal/labial tension

46
Q

pharyngeal issues

A

delayed swallow, absent (20 sec. or more), inadequate V-P closure, reduced hyol. excursion, reduced airway protection

47
Q

esophageal issues

A

cricopharyngeal dysfunction, distal esophageal issues

48
Q

dysphagia assessment

A

history/feedings, BSE, MBS, FEES

TBI (2 decks)

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