Rehab Guidelines for TBI pt 1 Flashcards
which type of TBI patients typically have better outcomes
traumatic have better functional outcomes than non-traumatic
what is the majority of TBI?
75% are concussion/mild TBI
long term implications of repetitive concussions?
CTE
primary TBI pathologies (4)
focal injury (coup-contracoup)
DAI
hypoxic-ischemic
blast
secondary TBI pathologies (3)
- increased ICP/edema
- hypoxic-ischemic injury
- chem/NT imbalance
what is normal ICP? what ICP is “problematic?”
normal: 5-15 mmHg
problematic: >20 mmHg
what is the biggest concern with ICP uncontrollably increasing
brainstem herniation through the foramen magnum
describe blast injuries
- primary - kinetic energy and blast wave
- secondary - shrapnel
- tertiary - impact (coup contracoup)
what is the polytrauma triad
TBI, PTSD, and pain
T/F: TBI is a risk factor for suicide
TRUE
what is a coma
unresponsive unarousable unaware (GCS <8)
what is a vegetative state
aka unresponsive wakefulness state - sleep-wake cycles with no evidence of awareness or purposefulness
what is a MCS
severely altered consciousness with minimal but definite evidence of awareness of self/env
what is stupor
general unresponsiveness, brief arousal with vigorous stimulation
what is obtunded
heavy sleep but arousable
what is a persistent vegetative state
VS/UWS lasting > 1 month
permanent > 1 year
how would you measure attention deficits in TBI?
Moss Attention Rating Scale
Observable evidence of agitation
restlessness/akathisia(inner restlessness)
fidgeting hands
bouncing legs
pacing
medical evidence of agitation
hyperadrenergic state
- tachycardia
- diaphoretic
- febrile
- HTN
how would you measure agitation in TBI
agitated behavior scale
what can cause dysphagia
CN damage, motor control deficits/apraxia, or poor postural control
in what lobe are we concerned about visual problems
occipital
Red Nucleus influences ____ of the UEs via the ______ tract
flexion; rubrospinal
define decorticate
disinhibition of the RN (UE flexion)
define decerebrate
decreased representation of the RN (UE extension)
extreme brain swelling may require…..
decompressive craniectomy
define craniotomy
cutting into the skull - removal and replace
define craniectomy
removal of a piece of skull
define cranioplasty
putting a piece of the skull back
why use steroids on TBI patients
to decrease swelling in the skull
what are two other drugs besides anticonvulsants that you might see in a TBI patient
stimulants for low level TBI and amantadine for increasing CNS dopamine response
what are three, common long term impairments of TBI
headaches, (mental) fatigue, and depression
