Module 5 Flashcards
_ _ _ is an alteration in brain function , or other evidence of brain pathology, caused by an external force.
Traumatic brain injury (TBI)
Symptoms of TBI can be _ or _ depending on the?
Temporary or permanent depending on the extent of the neurological damage
_ includes non traumatic insults to the brain.
ABI- acquired brain injury
Average age of onset, gender usually affected and incidence (ER and Hospital), and mortality rate of TBI
Age on onset 15-24 year old Males
1.7 million to ER, 300,000 to hospital
Mortality: 50k
Computerized tomography (CT), MRI, Positron EMission Tomography (PET), Diffusion Tensor Imaging (DTI), Single-Photon emission computerized tomography (SPECT), Functional MRI, and MR spectroscopy are all?
Diagnostic procedures used to identify TBI
Which diagnostic procedure is best for viewing white matter (reveals the extent of the damage)? Which uses gamma rays in order to detect brain activity?
DTI- Diffusion Tensor Imaging: White matter
Single-Photon emission computerized tomography (SPECT)
Which diagnostic procedure uses neurochemical profiles? 3 types of neurochemicals that are profiled? And associated structures involved?
MR spectroscopy
Neurochemicals:
- N-acetyl aspartate (NAA): Brain cells
- Lactate: Indicates cell death
- Choline: RElated to cell membrane phospholipids
MR spectroscopy is up to _ accurate by itself in predicting disability. Up to _ when combined with?
84% accurate by itself
90% when combined with Evoked Potentials
Focal injury, diffuse axonal injury (DAI), coup-contrecoup, and blast injury are common forms of?
Primary Injuries that can contribute to TBI
_ _ is a cascade of injuries that occurs due to primary injuries.
SEcondary injuries
Examples of secondary injuries: chain of _ _, - injury, _ _, elevated _, _ and _.
Chain of cellular events Hypoxic- ischemic injury Intracranial hematoma ICP- inter rainfall pressure Edema Seizures
What is the difference between secondary injury and secondary impairment?
Secondary injury
- can happens in concert with a primary injury, that is directly related to the primary injury
Secondary impairment
- is indirectly related, can happen down the line
DVT, heterotrophic ossification, pressure ulcers, chronic pain, contractures, muscle atrophy and pneumonia are examples of?
Secondary impairment
Spinal cord injury, fractures, open wounds, soft tissue damage, peripheral nerve injury, and internal organ injuries are examples of?
Concurrent/ concomitant injuries (secondary injury0
What scale uses a patient’s responses (eye opening, verbal response, motor response) in order to classify the extent of brain injury?
Glasgow Coma Scale
What is the scale/ point that classify a patient as severe, moderate, and mild using the Glasgow coma scale?
Severe: less than or equal to 8
Moderate: 9-12
Mild: 13-5
The Glasgow coma scale is not _ _, but is? Most valid in?
Not very valid
But is commonly used in the field in an emergency situations
Most valid in the early stages
90% of patients with a Glasgow coma number of the less than 8? 50% of those?
90% are in a coma (long-term)
50% of those people die
What scale do we as PT use to classify a patient who has had a TBI?
Rancho Los Amigos levels of cognitive functioning
A coma is described as a patient that has some _ _, and may _ or have _ _ or other types of _ _, and is otherwise non-responsive.
A coma is described as:
- patient has some wake/ sleep cycles
- may have reflexive crying or other types of emotional outbursts
How many levels exist in the Rancho Los amigos scale?
10
Which levels of Rancho Los amigos scale are described and general definition of each:
- No response
- Generalized response
- localized response
Level I: no response (comatose)
Level II: Generalized response
- patient exhibits same response no matter what the stimulus
Level III: Localized Response
- patient exhibits varying responses depending upon stimulus
Rancho Levels I-III general description: _ functioning, _ _ care needs, _ _ engagement with?
Low Functioning, high acuity care needs, minimal cognitive engagement with their environment
What level of Rancho Los Amigos scale is being described and give a general description: Confused Agitated, and confused and inappropriate
Level IV: Confused agitated (confused, edgy)
Level V: Confused Inappropriate (Less agitated but still confused)
General Description of Rancho Levels IV-V: _ _ care needs, _ _ is needed for _, _ _ with their environment.
High acuity care needs
Constant supervision is needed for safety
Challenging interactions with their environment
What is the description of Rancho Los Amigos levels VI and VII?
Level VI: Confused Appropriate
Level VII: Automatic appropriate
General description of Rancho levels VI-VII: progressing with - and _, _ _ with their environment, _ _and _ is often still needed.
Progressing with self-care and mobility
Improving interactions with their environment
Frequent cues and assistance is often still needed (greater independence)
Corresponding description and assistance levels for Rancho levels VIII-X
Level VIII: Purposeful Appropriate (Stand-by Assistance)
Level IX: Purposeful Appropriate (SBA on request)
Level X: Purposeful Appropriate (Moderate Indepence)
General description of Rancho levels VIII-X: _ their own _ to _ _, often become _ as they become more aware, _ with _ _ to develop - skills.
Developing their own strategies to manage deficits
Often become depressed as they become aware
Progressing with all interactions to develop life-long skills
What are the 3 main factors that affect rehabilitation?
Pre-morbid status
Family support and involvement
Insurance/ financial resources
Cryotherapy, medications, maintaining blood flow and oxygen to the brain, and assignment of Glasgow coma scale are all?
Life-sustaining medical techniques used at the scene to minimize the extent of damage
What are two common medical techniques to used reduce edema and inter cranial pressure in a patient with a TBI
Ventriculostomy or external ventricular drain
Craniectomy/ surgical decompression
What are the following medications used for in patients with TBI: Dilantin, baclofen/ Botox, Haldol, Ritalin/ adderall, and Valium/ Paxil
Dilantin- seizures
Baclofen/ Botox- spasticity
Haldol- Antipsychotics
Ritalin/ Adderall- Psychostimulants
Valium/ Paxil- anti-anxiety/ anti-panic
What are these medications used for in patients with TBI: Atenolol, Tramadol, Ambien, Paxil/ Prozac, Reglan, Lithium
Atenolol- dis inhibited behavior
Tramadol- pain
Ambien- sleep
Paxil/ Prozac- anti-depressant
Reglan- nausea/ gastric stasis
Lithium- mood stabilizer
