Module 5

Question 1

_ _ _ is an alteration in brain function , or other evidence of brain pathology, caused by an external force.

Answer 1

Traumatic brain injury (TBI)

Question 2

Symptoms of TBI can be _ or _ depending on the?

Answer 2

Temporary or permanent depending on the extent of the neurological damage

Question 3

_ includes non traumatic insults to the brain.

Answer 3

ABI- acquired brain injury

Question 4

Average age of onset, gender usually affected and incidence (ER and Hospital), and mortality rate of TBI

Answer 4

Age on onset 15-24 year old Males

1.7 million to ER, 300,000 to hospital

Mortality: 50k

Question 5

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?

Answer 5

Diagnostic procedures used to identify TBI

Question 6

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?

Answer 6

DTI- Diffusion Tensor Imaging: White matter

Single-Photon emission computerized tomography (SPECT)

Question 7

Which diagnostic procedure uses neurochemical profiles? 3 types of neurochemicals that are profiled? And associated structures involved?

Answer 7

MR spectroscopy

Neurochemicals:

• N-acetyl aspartate (NAA): Brain cells
• Lactate: Indicates cell death
• Choline: RElated to cell membrane phospholipids

Question 8

MR spectroscopy is up to _ accurate by itself in predicting disability. Up to _ when combined with?

Answer 8

84% accurate by itself

90% when combined with Evoked Potentials

Question 9

Focal injury, diffuse axonal injury (DAI), coup-contrecoup, and blast injury are common forms of?

Answer 9

Primary Injuries that can contribute to TBI

Question 10

_ _ is a cascade of injuries that occurs due to primary injuries.

Answer 10

SEcondary injuries

Question 11

Examples of secondary injuries: chain of _ _, - injury, _ _, elevated _, _ and _.

Answer 11

Chain of cellular events
Hypoxic- ischemic injury
Intracranial hematoma
ICP- inter rainfall pressure
Edema
Seizures

Question 12

What is the difference between secondary injury and secondary impairment?

Answer 12

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

Question 13

DVT, heterotrophic ossification, pressure ulcers, chronic pain, contractures, muscle atrophy and pneumonia are examples of?

Answer 13

Secondary impairment

Question 14

Spinal cord injury, fractures, open wounds, soft tissue damage, peripheral nerve injury, and internal organ injuries are examples of?

Answer 14

Concurrent/ concomitant injuries (secondary injury0

Question 15

What scale uses a patient’s responses (eye opening, verbal response, motor response) in order to classify the extent of brain injury?

Answer 15

Glasgow Coma Scale

Question 16

What is the scale/ point that classify a patient as severe, moderate, and mild using the Glasgow coma scale?

Answer 16

Severe: less than or equal to 8

Moderate: 9-12

Mild: 13-5

Question 17

The Glasgow coma scale is not _ _, but is? Most valid in?

Answer 17

Not very valid

But is commonly used in the field in an emergency situations

Most valid in the early stages

Question 18

90% of patients with a Glasgow coma number of the less than 8? 50% of those?

Answer 18

90% are in a coma (long-term)

50% of those people die

Question 19

What scale do we as PT use to classify a patient who has had a TBI?

Answer 19

Rancho Los Amigos levels of cognitive functioning

Question 20

A coma is described as a patient that has some _ _, and may _ or have _ _ or other types of _ _, and is otherwise non-responsive.

Answer 20

A coma is described as:

• patient has some wake/ sleep cycles
• may have reflexive crying or other types of emotional outbursts

Question 21

How many levels exist in the Rancho Los amigos scale?

Answer 21

10

Question 22

Which levels of Rancho Los amigos scale are described and general definition of each:

• No response
• Generalized response
• localized response

Answer 22

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

Question 23

Rancho Levels I-III general description: _ functioning, _ _ care needs, _ _ engagement with?

Answer 23

Low Functioning, high acuity care needs, minimal cognitive engagement with their environment

Question 24

What level of Rancho Los Amigos scale is being described and give a general description: Confused Agitated, and confused and inappropriate

Answer 24

Level IV: Confused agitated (confused, edgy)

Level V: Confused Inappropriate (Less agitated but still confused)

Question 25

General Description of Rancho Levels IV-V: _ _ care needs, _ _ is needed for _, _ _ with their environment.

Answer 25

High acuity care needs
Constant supervision is needed for safety
Challenging interactions with their environment

Question 26

What is the description of Rancho Los Amigos levels VI and VII?

Answer 26

Level VI: Confused Appropriate

Level VII: Automatic appropriate

Question 27

General description of Rancho levels VI-VII: progressing with - and _, _ _ with their environment, _ _and _ is often still needed.

Answer 27

Progressing with self-care and mobility

Improving interactions with their environment

Frequent cues and assistance is often still needed (greater independence)

Question 28

Corresponding description and assistance levels for Rancho levels VIII-X

Answer 28

Level VIII: Purposeful Appropriate (Stand-by Assistance)

Level IX: Purposeful Appropriate (SBA on request)

Level X: Purposeful Appropriate (Moderate Indepence)

Question 29

General description of Rancho levels VIII-X: _ their own _ to _ _, often become _ as they become more aware, _ with _ _ to develop - skills.

Answer 29

Developing their own strategies to manage deficits

Often become depressed as they become aware

Progressing with all interactions to develop life-long skills

Question 30

What are the 3 main factors that affect rehabilitation?

Answer 30

Pre-morbid status

Family support and involvement

Insurance/ financial resources

Question 31

Cryotherapy, medications, maintaining blood flow and oxygen to the brain, and assignment of Glasgow coma scale are all?

Answer 31

Life-sustaining medical techniques used at the scene to minimize the extent of damage

Question 32

What are two common medical techniques to used reduce edema and inter cranial pressure in a patient with a TBI

Answer 32

Ventriculostomy or external ventricular drain

Craniectomy/ surgical decompression

Question 33

What are the following medications used for in patients with TBI: Dilantin, baclofen/ Botox, Haldol, Ritalin/ adderall, and Valium/ Paxil

Answer 33

Dilantin- seizures

Baclofen/ Botox- spasticity

Haldol- Antipsychotics

Ritalin/ Adderall- Psychostimulants

Valium/ Paxil- anti-anxiety/ anti-panic

Question 34

What are these medications used for in patients with TBI: Atenolol, Tramadol, Ambien, Paxil/ Prozac, Reglan, Lithium

Answer 34

Atenolol- dis inhibited behavior

Tramadol- pain

Ambien- sleep

Paxil/ Prozac- anti-depressant

Reglan- nausea/ gastric stasis

Lithium- mood stabilizer