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DPT 772 - Pediatrics II > Pediatric TBI > Flashcards

Pediatric TBI Flashcards

1
Q

What is a Traumatic Brain Injury (TBI), and what are its characteristics?

A

Traumatic Brain Injury (TBI) is caused by an external mechanical force impacting the head. Characteristics include diminished or altered consciousness ranging from brief lethargy to prolonged unconsciousness or brain death.

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2
Q

What are the differences between open head injury and closed head injury? Provide examples.

A
  • Open Head Injury: Penetration through the skull to the brain (e.g., gunshot wound, knife injury).
  • Closed Head Injury: Brain injury without penetration (e.g., concussion, contusion, hypoxia).
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3
Q

What are the most common causes of TBI in different age groups?

A
  • < 12 months: Falls
  • 1-4 years: Abuse or assault.
  • 4-14 years: Motor vehicle accidents (MVA).
  • School-age/adolescent: Sports (29%) and gunshot wounds.
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4
Q

Define acceleration/deceleration injuries and explain their common forms.

A

Acceleration/Deceleration Injuries occur when a moving head hits a fixed object, causing coup or contrecoup contusions. Forms include translational (lateral displacement) and rotational (skull rotation while the brain remains stationary).

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5
Q

What is the difference between primary brain damage and secondary brain damage?

A
  • Primary Brain Damage: Initial injury caused directly by trauma (e.g., concussion, contusion, skull fractures).
  • Secondary Brain Damage: Evolves from pathophysiologic changes (e.g., cerebral edema, increased intracranial pressure).
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6
Q

What is diffuse axonal injury, and how does it occur?

A

Diffuse Axonal Injury (DAI) involves widespread damage to axons in the brain caused by shearing forces during rotational injuries.

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7
Q

What is the significance of cerebral edema and increased intracranial pressure (ICP) in TBI?

A
  • Cerebral Edema: Swelling of the brain that increases pressure.
  • Increased Intracranial Pressure (ICP): Elevated pressure inside the skull, potentially leading to herniation and brain damage.
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8
Q

What is the role of coma scales in assessing pediatric TBI?

A
  • Coma scales, such as the Glasgow Coma Scale and Pediatric Glasgow Coma Scale, evaluate the depth of unconsciousness and predict recovery.
  • Lower scores (e.g., 3-4) indicate poor prognosis, while higher scores (>7) indicate better outcomes.
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9
Q

What are some non-traumatic causes of brain injury in children?

A

Non-Traumatic Causes

  • include hypoxia/anoxia (e.g., near drowning)
  • cardiac arrest
  • brain tumors (e.g., gliomas)
  • strokes (e.g., IVH, HIE)
  • infections (e.g., encephalitis, meningitis)
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10
Q

What are the common mechanisms of injury in pediatric TBI?

A

Acceleration/Deceleration, Translational, Rotational, and Impression Injuries. Each mechanism involves unique forces acting on the brain during trauma.

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11
Q

Define acceleration/deceleration injuries and their effects on the brain.

A

Acceleration/Deceleration Injuries occur when a moving head strikes a fixed object, causing brain contusions such as coup (injury under impact site) and contrecoup (opposite site). Infants are particularly susceptible.

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12
Q

What is a translational injury, and how does it differ from rotational injury?

A
  • Translational Injury: Lateral displacement of the skull and brain as the head strikes a stationary object.
  • Rotational Injury: Skull rotates while the brain stays stationary, leading to shearing forces.
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13
Q

What are rotational injuries, and why are they significant in TBI?

A

Rotational Injuries occur when the skull rotates but the brain remains stationary, causing shearing of axons and diffuse axonal injury (DAI), common in severe TBI.

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14
Q

Explain impression injuries and their potential outcomes.

A

Impression Injuries occur when a solid object impacts a stationary head, causing focal lesions or skull fractures. Also referred to as blunt force trauma.

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15
Q

How do acceleration/deceleration injuries differ in infants compared to adults?

A

Infants are more vulnerable due to weaker neck muscles and a softer skull, leading to more significant coup/contrecoup injuries and brain contusions.

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16
Q

What role do mechanisms of injury play in determining TBI severity?

A

Understanding the mechanism (e.g., rotational vs. impression) helps predict injury patterns (e.g., diffuse vs. focal damage), guiding assessment and treatment plans.

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17
Q

What is the difference between primary brain damage and secondary brain damage in TBI?

A
  • Primary Brain Damage: Direct result of trauma at the moment of injury (e.g., concussion, contusion, skull fractures).
  • Secondary Brain Damage: Evolving damage due to pathophysiological changes (e.g., cerebral edema, hypoxic-ischemic injury).
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18
Q

What are the types of injuries included in primary brain damage?

A
  • Concussion: Temporary functional disruption.
  • Contusion: Bruising of the brain.
  • Skull Fractures: Linear or depressed fractures.
  • Intracranial Hemorrhages: Extradural and intradural hematomas.
  • Diffuse Axonal Injury (DAI): Widespread axonal shearing.
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19
Q

What complications are commonly associated with secondary brain damage?

A
  • Cerebral Edema: Brain swelling.
  • Increased Intracranial Pressure (ICP): Elevated pressure in the skull.
  • Herniation Syndromes: Brain tissue displacement.
  • Hypoxic-Ischemic Injury: Lack of oxygen and blood flow.
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20
Q

How does diffuse axonal injury (DAI) contribute to TBI severity?

A

Diffuse Axonal Injury (DAI) results from shearing forces during rotational injuries, leading to widespread axonal damage and severe neurological impairment.

21
Q

What is the role of intracranial hemorrhages in TBI, and what types are there?

A

Intracranial Hemorrhages: Bleeding within the skull caused by trauma. Types include extradural hematomas (bleeding between dura and skull) and intradural hematomas (bleeding beneath the dura).

22
Q

What are the potential long-term consequences of secondary brain damage in pediatric TBI?

A

Long-term consequences include chronic hydrocephalus, seizures, infections, dysautonomia, and endocrine disorders, significantly impacting recovery and function.

23
Q

Why is it critical to manage increased intracranial pressure (ICP) in TBI patients?

A

Uncontrolled ICP can lead to brain herniation, reduced cerebral perfusion, and irreversible brain damage, making its management a priority in acute care.

24
Q

What are the key predictors of TBI severity and recovery in children?

A
  • Duration of Coma: Shorter duration (< 1 night) predicts better recovery; > 1 week indicates poor outcomes.
  • Depth of Coma: Glasgow scores (3-4 poor, >7 good).
  • Duration of Post-Traumatic Amnesia (PTA): Longer PTA suggests worse outcomes.
25
Q

How does the Pediatric Rancho Scale assess TBI severity?

A

Levels include:

  • V: No response
  • IV: Generalized response
  • III: Localized response
  • II: Responsive to the environment
  • I: Oriented to self and surroundings.
26
Q

Why is age an important factor in TBI recovery for children?

A

Younger children often recover motor skills quickly but may experience profound cognitive deficits due to the impact of TBI on the developing brain.

27
Q

What functional deficits are associated with mild TBI in children?

A

Mild TBI may lead to balance deficits, affecting return to sports, and other subtle impairments despite an overall good prognosis.

28
Q

What tools are used to evaluate post-traumatic amnesia (PTA) in pediatric TBI?

A

The Children’s Orientation and Amnesia Test (COAT) is used for ages 4-15 to assess orientation and memory deficits.

29
Q

What environmental factors can influence TBI recovery in children?

A

Supportive home and school environments, early rehabilitation, and access to age-appropriate therapy significantly enhance recovery outcomes.

30
Q

What components are evaluated during the PT examination for pediatric TBI?

A

Medical history, social/home environment, cognition (arousal, attention, memory, language, executive functions), neuromotor (tone, spasticity, posturing), strength, endurance, ROM, balance, and sensory functions.

31
Q

What are common abnormal postures seen in pediatric TBI?

A
  • UE Flexor Synergy: Flexed elbow, wrist, and fingers.
  • LE Extensor Synergy: Extended knee and plantarflexed ankle.
  • Whole-body Posturing: Decorticate (flexed UE, extended LE), Decerebrate (extended UE and LE).
32
Q

What balance assessment tools are used for children with TBI?

A

BOT-2, Berg Balance Scale, and Timed Up and Go (TUG) are common tools to evaluate balance impairments.

33
Q

What sensory deficits might occur in pediatric TBI?

A

Sensory deficits include hearing loss, visual disturbances, and impaired visuospatial skills, impacting functional mobility.

34
Q

What functional measures are commonly used in pediatric TBI assessment?

A

WeeFIM, AIMS, PDMS-2, and BOT evaluate functional mobility, gross motor skills, and independence in activities of daily living.

35
Q

How is strength assessed in pediatric TBI patients?

A

Strength is assessed through observation of active movements, resistance testing, and manual muscle testing (MMT) where appropriate.

36
Q

What is heterotopic ossification (HO), and how is it managed in pediatric TBI?

A

HO is abnormal bone growth in soft tissue, leading to reduced joint ROM, pain, and swelling. Management includes gentle ROM exercises, spasticity management, and surgical excision if severe.

37
Q

What orthopedic complications are common with TBI in children?

A

Pelvic and lower extremity fractures, requiring proper alignment and maintenance of weight-bearing status. Spinal conditions may necessitate cervical collars or CTO braces.

38
Q

How is endurance evaluated in pediatric TBI patients?

A

Endurance is assessed by observing fatigue during physical and mental tasks, considering lethargy and tolerance to activities.

39
Q

What tools are used for vestibular assessment in pediatric TBI?

A

Vestibular assessments may include head righting tests, gaze stability, and dynamic postural control evaluations.

40
Q

What are the main differences in PT management for pediatric vs. adult TBI?

A

Pediatric TBI incorporates age-appropriate gross motor skill development and cognition-focused rehab, adapting strategies used for adults with stroke or children with CP.

41
Q

What are the goals of PT management in the acute care phase for pediatric TBI?

A

Goals include positioning to prevent contractures, managing dystonia, maintaining joint ROM, and encouraging upright positioning where medically appropriate.

42
Q

How is sensory stimulation used for low-cognitive-level pediatric TBI patients?

A

Sensory stimulation involves vestibular, visual, tactile, auditory, and olfactory stimuli with brief exposure, response time, and stable vital signs monitoring.

43
Q

What are considerations for PT management of agitated pediatric TBI patients?

A

Limit overstimulation, identify triggers, co-treat if needed, and provide structured tasks with gradual progression.

44
Q

What interventions are used for mid-cognitive-level TBI patients?

A

Simplify tasks, use orientation tools (calendar, clock), repeat previously mastered gross motor skills, and incorporate assistive devices for mobility.

45
Q

What interventions are critical for high-cognitive-level TBI patients?

A

Focus on school/community reintegration, dynamic balance, obstacle courses, AD training, and curriculum adaptations under IDEA or 504 plans.

46
Q

How do PTs address residual motor deficits in pediatric TBI patients?

A

Residual motor deficits are managed through transfer training, gait training with ADs or BWSTT, and functional mobility exercises.

47
Q

What are key strategies for preventing TBI in children under 12 months?

A

Parent supervision and home safety measures, such as removing hazards and ensuring safe sleeping environments.

48
Q

What are safety recommendations for reducing TBI risk during sports and recreation?

A

Use of helmets, appropriate playground equipment (height <5 feet, safe materials), and adherence to safety protocols in sports.

49
Q

What traffic safety measures can help prevent TBI in children?

A

Using car restraints (e.g., car seats, seat belts) and teaching traffic safety behaviors to children and caregivers.

DPT 772 - Pediatrics II (17 decks)

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