These are the goals in acute care management of TBI. 1. Improve ______ 2. Prevent _______ 3. Prevent _______ 4. Preserve _______ 5. Facilitate _____ & _______

1. respiratory function 2. respiratory complication 3. secondary brain damage 4. musculoskeletal integrity 5. arousal and active engagement

S2_L3: TBI Flashcards by MindMed Official

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

Traumatic Brain Injury

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What is the most prevalent cause of TBI?

Falls

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TRUE OR FALSE: Changes in behavior, mood, and personality after TBI are considered the most difficult to manage effectively.

True

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TRUE OR FALSE: Rigidity is an expected finding in TBI pts.

False

Spasticity is expected

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What kind of motor neuron lesion is TBI?

Upper (UMNL)

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The following are neuromuscular impairments seen in TBI, EXCEPT:

A. Sensory impairments
B. Impaired balance
C. Paralysis
D. Abnormal gait
E. None

C. Paralysis

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The following are neuromuscular impairments seen in TBI, EXCEPT:

A. Tremor and chorea
B. Impaired Coordination
C. Abnormal tone
D. Impaired Postural Control
E. None

E. None

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The following are cognitive impairments seen in TBI, EXCEPT:

A. Perseveration
B. Attention deficits
C. Memory loss
D. Altered level of consciousness
E. None

E. None

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The following are cognitive impairments seen in TBI, EXCEPT:

A. Problem making impairments
B. Impaired insight
C. Reasoning impairments
D. Safety awareness impairments
E. None

A. Problem making impairments

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TRUE OR FALSE: TBI pts may be manifest inappropriate repetition of a syllable or word

True

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TRUE OR FALSE: TBI pts have a long attention span, but their memory fails

False

Attention span is also short.

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The following are behavioral impairments seen in TBI pts, EXCEPT:

A. Apathy
B. Egocentricity
C. Irritability
D. Avolition
E. None

D. Avolition

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The following are behavioral impairments seen in TBI pts, EXCEPT:

A. Physical aggressiveness
B. Verbal aggressiveness
C. Sexual Inappropriateness
D. Impulsiveness
E. None

E. None

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This strategy involve rewarding instances of appropriate behavior and set the conditions that trigger the behavior to occur.

Consequence-focused strategies

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This strategy focus on events and circumstances that occur before the behavior and set the conditions that
trigger the behavior to occur.

Antecedent-focused strategies

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These are the goals in acute care management of TBI.

Improve ______
Prevent _______
Prevent _______
Preserve _______
Facilitate _____ & _______

respiratory function
respiratory
complication
secondary brain damage
musculoskeletal integrity
arousal and active engagement

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Patients with TBI are preferably nursed where?

neurological intensive care unit (NICU) or specialized brain-injury intensive care facility

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Intubation consists of using which 2 medical supply?

endotracheal tube
tracheostomy

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What is a chest tube used for?

drain the excess fluid from the lungs

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Match the artery or vein attachment

Radial artery
Vena Cava
Pulmonary Artery

A. Chest Tubes
B. Swan-Ganz Catheters
C. IV lines
D. Central Venous Catheters
E. None

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What is considered an elevated ICP in clinical practice?

A. increase of 10-15 mmHg
B. increase of 20-25 mmHg
C. increase of 20-30 mmHg

B. increase of 20-25 mmHg

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To improve respiratory function, a PT may do (1)______
exercises and (2)______

bed mobility
GBRE

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Match the PT intervention to the respiratory condition.

Brown bag technique
Cupping
Ankle pumping

A. Hypoventilation
B. Hyperventilation

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TRUE OR FALSE: Hyperventilation occurs from impaired mucociliary clearance

False

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PaO2 <60mmHg indicates?

Hypoxemia

PaCO2 >45mmHg indicates?

Hypercapnia

What is the formula to obtain cerebral perfusion pressure?

Mean arterial pressure - intracranial pressure (MAP - ICP)

Interventions must be done at the time of?

maximum pt wakefulness

In LOCF I-III, the head must be positioned to roll in a parallel manner to prevent which movements?

1. lateral flexion 2. rotation

In LOCF I-III, PT must utilizes a (1)____ in the hand if fingers are in flexion, and a (2)_____ if the fingers are adducted.

1. cone 2. wedges

In LOCF I-III, hips and knees are supported in a slightly (1)______ position

1. flexed

In LOCF I-III, there must be no pressure on (1)_____ of the foot (2)_____

1. ball 2. medially

TRUE OR FALSE: A PT may expect egocentricity and carry over in a pt in LOCF IV.

False There is no carry over

Pts in LOCF V-VI rely on what?

routines/ schedules

Match the following PT Intervention per stage. 1. Wean patient from structure and supervision to get them out of the routine 2. Manage effects of abnormal tone & spasticity 3. Maximize functional recovery of patient and prepare him and his family for discharge to home and to community A. LOCF I-III B. LOCF IV C. LOCF V-VI D. LOCF VII-VIII

1. D 2. A 3. C

Match the following PT Intervention per stage. 1. Use of behavior modification techniques 2. Involve patient in decision-making and problem-solving 3. Improve arousal through sensory stimulation A. LOCF I-III B. LOCF IV C. LOCF V-VI D. LOCF VII-VIII

1. B 2. D 3. A

Which area of the brain is commonly affected in diffuse axonal injuries, a severe form of traumatic brain injury? A) Frontal lobe B) Temporal lobe C) Occipital lobe D) White matter tracts

D) White matter tracts

In TBI rehabilitation, what does the Glasgow Coma Scale (GCS) assess? A) Cognitive function B) Cranial nerve function C) Level of consciousness D) Motor strength

C) Level of consciousness

Which motor impairment is often seen in individuals with a TBI due to damage to the corticospinal tract? A) Hypertonia B) Hypotonia C) Spasticity D) Rigidity

C) Spasticity

In the context of TBI rehabilitation, what does the term "cognitive restructuring" refer to?

Modifying cognitive-behavioral patterns and beliefs

Which intervention technique in TBI rehabilitation involves the use of a controlled environment to simulate real-world challenges and tasks?

Virtual reality rehabilitation

TBI pts exhbit a ____ pattern of behavior

Frontal

1. CNS has limited potential for repair and reorganization. 2. CNS can repair and reorganize itself after injury. 3. Direct training of deficient functional skills 4. Does not assume automatic carry-over to dissimilar tasks A. Remedial approach B. Adaptive approach

1. B 2. A 3. B 4. B

1. Therapist works on underlying cognitive/perceptual problems 2. Training in underlying skills will carry- over to tasks requiring such skills 3. Use of reminders 4. Training of perceptual components of motor behavior A. Remedial approach B. Adaptive approach

1. A 2. A 3. B 4. A

_____ is often described as laziness or slowness

Apathy

TRUE OR FALSE: Some TBI patients may manifest with euphoria or emotional lability

True

Determine the LOCF. Shows carry-over for relearned tasks with little or no carry-over for new tasks A. I-V B. VI C. VII D. VIII

B. VI

Determine the LOCF. Shows carry-over for new learning and needs no supervision once activities are learned A. I-V B. VI C. VII D. VIII

D. VIII

Determine the LOCF. Unable to learn new information A. I-V B. VI C. VII D. VIII

A. I-V

Determine the LOCF. Shows carry-over for new learning but at a decreased rate A. I-V B. VI C. VII D. VIII

C. VII

Patient makes frequent stops, is easily annoyed, throws things, may request frequent toilet visits, escalate into a crisis This means that the given task for the pt is? A. Suitable B. Easy C. Complex

C. Complex

Patient is quiet, focused, not distractible This means that the given task for the pt is? A. Suitable B. Easy C. Complex

A. Suitable

Patient will be too talkative, laughs too much, keeps looking around, does unnecessary things, twists hair This means that the given task for the pt is? A. Suitable B. Easy C. Complex

B. Easy

Patients will have excuses This means that the given task for the pt is? A. Suitable B. Easy C. Complex

C. Complex

The following are to remediate memory disorders, EXCEPT: A. Reducing the amount of information given at any time B. Ensuring maximal distraction C. Use of external aids D. Simplifying information E. None

B. Ensuring maximal distraction

The following are to remediate memory disorders, EXCEPT: A. Encouraging to ask questions B. Make sure learning occurs in different contexts C. Adapting the environment D. Encouraging associating information with unknown material E. None

D. Encouraging associating information with unknown material

This is a strategy when you tell the pt what you will do if they perform certain bad behavior.

Antecedent-Focused Strategies

This is a strategy when you actually do the consequence of their bad behavior

Consequence-Focused Strategies

The following are strategies in decreasing behavior, EXCEPT: A. Withhold rewards that maintain maladaptive behavior B. Withhold all sources of positive reinforcement for a brief period after an instance of maladaptive behavior C. Apply a predeclared penalty following a maladaptive behavior D. Apply aversive consequences following severe or resistant maladaptive behavior E. None

E. None

Enumerate the strategies for increasing behavior.

1. prompting 2. chaining 3. expanding rehearsal

Task Related Training: Direct the individual’s attention to the critical (1)_____ features of the action with appropriate (2)____ and (3)_____

1. biomechanical 2-3. cues and feedback

Task Related Training: Communicate (1)_____ and practice routines using (2)____ verbal cues

1. respectfully 2. same

Task related training is applicable for RLA?

7-8

Modifying the Environment: 1. Observe patient’s behavior in different (1)____ with (2)_____ 2. Analyze environmental variables that affect behavior (3)____ or ____

1. settings 2. people 3. positively or negatively

TRUE OR FALSE: Verbal input is avoided during guided activity

True

Determine the classification of skills. 1. Assertiveness 2. Housekeeping 3. Nonverbal communication 4. Map reading 5. Giving/receiving feedback A. Daily Living B. Social Living C. Community skills

1. B 2. A 3. B 4. C 5. B

Determine the classification of skills. 1. Money management 2. Leisure planning 3. Telephone use 4. Listening skills A. Daily Living B. Social Living C. Community skills

1. A 2. C 3. A 4. B

TRUE OR FALSE: Only the superficial sensation are affected in TBI pts.

False

This measures the cognitive recovery of patient and his capacity to interact effectively with the environment

Ranchos Los Amigos Level of Cognitive Function (RLA-LOCF)

Preservation of (1)_____ and prevention of (2)______ are the first priorities in the emergency treatment of the brain-injured and multi-injured individual.

1.life 2. secondary brain damage

When the patient arrives at the emergency department, a _______ should be performed as soon as possible

non-contrast enhanced CT scan

What is the anatomical landmark for tracheostomy?

Adam’s Apple / Laryngeal Prominence (C4-C5)

Blood sample, dextrose, medicine, electrolytes, saline solution A. Central venous line/catheters B. Swan-Ganz catheters C. IV lines / arterial lines

C. IV lines / arterial lines

goes through the pulmonary vein to measure heart activities A. Central venous line/catheters B. Swan-Ganz catheters C. IV lines / arterial lines

B. Swan-Ganz catheters

Medications can be passed through here; Near the extra jugular vein A. Central venous line/catheters B. Swan-Ganz catheters C. IV lines / arterial lines

A. Central venous line/catheters

The following are secondary impairments of TBI, EXCEPT: A. Fractures B. Heterotopic Ossification (HO) C. Contractures D. Atrophy E. Abnormal Tone

E. Abnormal Tone

What must be avoided to minimize the risk of secondary brain damage?

1. hypotension (systolic blood pressure < 90mmHg) 2. hypoxemia (PaO2 < 60mmHg)

TRUE OR FALSE: The major aims of physiotherapy intervention as part of the team involved in the initial management of the person with TBI are to improve respiratory function and prevent respiratory complications and secondary brain damage by ensuring adequate ventilation and clearing of excessive secretions.

True

TRUE OR FALSE: Physiotherapy interventions such as positioning, percussion, manual hyperinflation, and suctioning can't affect intracranial variables

False

When the patient is comatose and therefore immobilized, prevention of _________ is a major goal in PT in order to maintain musculoskeletal integrity

muscle and soft tissue contracture

What handling technique must be done in the UE in LOCF I-III?

1. relax scapula 2. dec flexor tone

What handling technique must be done in the trunk in LOCF I-III when stable?

segmental rolling

A (+) PLR indicates what? (1-2)

1. intact brainstem 2. good prognosis

TRUE OR FALSE: Agitation may be defined as attempting to hit, bite, or pinch others

True

TRUE OR FALSE: Problems in functional performance may be due not only to primary sensorimotor impairments but also to distraction from performing the task because of other impairments such as irritability, short-term memory loss, short attention span, apathy or lack of motivation

True

TRUE OR FALSE: Slowed mobility, poor communication and impaired initiation contribute to incontinence.

True

Post-traumatic epilepsy is a risk within the _____ post-injury

12 months or 1st yr

TRUE OR FALSE: In TBI pts, only a short duration exercise session is allowed for the individual

False a longer duration exercise session may be required to allow more time for the individual to reach their training heart rate or to compensate if they are only able to exercise at a lower intensity

What will be the PTs goal for a TBI pt?

community re-integration

______ is the leading indicator of recovery after TBI.

Return to work

commenting the pt that it is good and suggest to continue that good behavior A. prompting B. chaining C. expanding rehearsal

A. prompting

increase the opportunity when pt actually do a good behavior A. prompting B. chaining C. expanding rehearsal

C. expanding rehearsal

Management of attention impairment and dysfunction is done on what RLA stage?

7-8

prompt the pt to continue that good behavior A. prompting B. chaining C. expanding rehearsal

B. chaining

This approach is where you make modifications to the environment.

adaptive approach

During RLA 1-3, rolls should be behind where in the trunk area?

shoulders and hip (if rotation is occurring)

During RLA 1-3, rolls should be behind where in the head area?

behind neck and parallel to head

TRUE OR FALSE: During RLA 1-3, pts may be turned onto one side for weight bearing of an arm.

True

During RLA 1-3, what must be done to the scapula? Give the movement that PTs must administer.

rhythmical protraction/retraction, elevation/depression

During RLA 1-3, what must be done to the hand in an increased extensor tone?

hand over biceps

During RLA 1-3, what must be done to the hand in an increased flexor tone?

hand over triceps

Determine the RLA stage based off the presented management. 1. Maximize functional recovery to prepare for discharge to home and to community 2. Wean patient from structure and supervision to get them out of the routine 3. Improve arousal through sensory stimulation A. RLA 1-3 B. RLA 4 C. RLA 5-6 D. RLA 7-8 E. A & B

1. C 2. D 3. A

Determine the RLA stage based off the presented management. 1. Incorporate endurance training 2. Family education 3. Safety and environmental modification A. RLA 1-3 B. RLA 4 C. RLA 5-6 D. RLA 7-8 E. A & B

1. D 2. E 3. B

Determine the RLA stage based off the presented management. 1. Perform GBREs 2. Involve patient in decision-making and problem-solving 3. Prevent indirect impairments A. RLA 1-3 B. RLA 4 C. RLA 5-6 D. RLA 7-8 E. A & B

1. A 2. D 3. A

Determine the RLA stage based off the presented management. 1. Expect no carry over 2. Expect egocentricity 3. rely heavily on following routines A. RLA 1-3 B. RLA 4 C. RLA 5-6 D. RLA 7-8 E. A & B

1. B 2. B 3. C

Determine the RLA stage based off the presented management. 1. Manage effects of abnormal tone & spasticity 2. Use of behavior modification techniques 3. Focus on advanced activities A. RLA 1-3 B. RLA 4 C. RLA 5-6 D. RLA 7-8 E. A & B

1. A 2. B 3. D

______ seeks to improve functional skills by compensating for the lost ability

Compensatory approach

______ seeks to restore the normal use of affective limbs

Restorative approach