Rehab Guidelines for TBI pt 1

Question 1

which type of TBI patients typically have better outcomes

Answer 1

traumatic have better functional outcomes than non-traumatic

Question 2

what is the majority of TBI?

Answer 2

75% are concussion/mild TBI

Question 3

long term implications of repetitive concussions?

Answer 3

CTE

Question 4

primary TBI pathologies (4)

Answer 4

focal injury (coup-contracoup)
DAI
hypoxic-ischemic
blast

Question 5

secondary TBI pathologies (3)

Answer 5

1. increased ICP/edema
2. hypoxic-ischemic injury
3. chem/NT imbalance

Question 6

what is normal ICP? what ICP is “problematic?”

Answer 6

normal: 5-15 mmHg
problematic: >20 mmHg

Question 7

what is the biggest concern with ICP uncontrollably increasing

Answer 7

brainstem herniation through the foramen magnum

Question 8

describe blast injuries

Answer 8

1. primary - kinetic energy and blast wave
2. secondary - shrapnel
3. tertiary - impact (coup contracoup)

Question 9

what is the polytrauma triad

Answer 9

TBI, PTSD, and pain

Question 10

T/F: TBI is a risk factor for suicide

Answer 10

TRUE

Question 11

what is a coma

Answer 11

unresponsive unarousable unaware (GCS <8)

Question 12

what is a vegetative state

Answer 12

aka unresponsive wakefulness state - sleep-wake cycles with no evidence of awareness or purposefulness

Question 13

what is a MCS

Answer 13

severely altered consciousness with minimal but definite evidence of awareness of self/env

Question 14

what is stupor

Answer 14

general unresponsiveness, brief arousal with vigorous stimulation

Question 15

what is obtunded

Answer 15

heavy sleep but arousable

Question 16

what is a persistent vegetative state

Answer 16

VS/UWS lasting > 1 month

permanent > 1 year

Question 17

how would you measure attention deficits in TBI?

Answer 17

Moss Attention Rating Scale

Question 18

Observable evidence of agitation

Answer 18

restlessness/akathisia(inner restlessness)
fidgeting hands
bouncing legs
pacing

Question 19

medical evidence of agitation

Answer 19

hyperadrenergic state

• tachycardia
• diaphoretic
• febrile
• HTN

Question 20

how would you measure agitation in TBI

Answer 20

agitated behavior scale

Question 21

what can cause dysphagia

Answer 21

CN damage, motor control deficits/apraxia, or poor postural control

Question 22

in what lobe are we concerned about visual problems

Answer 22

occipital

Question 23

Red Nucleus influences ____ of the UEs via the ______ tract

Answer 23

flexion; rubrospinal

Question 24

define decorticate

Answer 24

disinhibition of the RN (UE flexion)

Question 25

define decerebrate

Answer 25

decreased representation of the RN (UE extension)

Question 26

extreme brain swelling may require…..

Answer 26

decompressive craniectomy

Question 27

define craniotomy

Answer 27

cutting into the skull - removal and replace

Question 28

define craniectomy

Answer 28

removal of a piece of skull

Question 29

define cranioplasty

Answer 29

putting a piece of the skull back

Question 30

why use steroids on TBI patients

Answer 30

to decrease swelling in the skull

Question 31

what are two other drugs besides anticonvulsants that you might see in a TBI patient

Answer 31

stimulants for low level TBI and amantadine for increasing CNS dopamine response

Question 32

what are three, common long term impairments of TBI

Answer 32

headaches, (mental) fatigue, and depression