TBI 1: Intro Flashcards
What are the 2 types of brain injury?
Closed - no skull fracture, and dura mater is not penetrated
Open - skull fractured. Tiny bones penetrate dura mater.
Sources of damage for TBI?
> Mechanical force
- tension + compression - blunt force trauma
> Acceleration + deceleration
- Rebounding effect =leads=> coup + contre coup - coup => damage @ site of impact - countre coup injure => opp. - Frontal + occipital lobes damaged - Frontal contusions - V common
> Haemorrhage
Cause:
- Damaged sinus and/or
- Bleeding –> burst aneurysm, weakened vessel
- Swelling & pressure increase
> Diffuse axonal injury
- Stretching, deformation and shearing of axons - Widespread area damage of white matter - Extensive lesions
Classifications of external haemorrhages
> Subdural (SDH)
- Blood gathers between dura mater + brain
> Extradural (EDH)
- Blood gathers btw skull + dura mater - Can occur in spine - Leads to brain shift
Internal haemorrhages
> Sub-arachnoid (SAH)
- Bleed in subarachnoid space
> Intra-cerebral (ICH)
- Occurs within brain tissue
> Intra-ventricular (IVH)
- Bleeding in brains ventricular system
===> where cerebrospinal fluid produced
- Blood is circulated towards subarachnoid space
What are the secondary effects of brain injury?
Mainly due to lack of oxygen. Cause further brain damage.
> Increased intercranial pressure > Acute hydocephalus > Infection > Hypoxia > Seizures
Due to these secondary effects, it’s essential that the client’s condition fist stabilises before the beginning of treatment.
Whats the rehab pathway?
Injury > acute care > rehab > return home
What is post traumatic amnesia?
> Period TBI where confused + disorientated
- unable to lay down new memories
> Can be measured retrospectively/prospectively
- Retro mostly used in UK
==> pre-injury
> Stage follows emergence from coma
> Considerable behaviour variation patient 2 pat.
> 20-40% of cases develop aphasia during PTA
PTA severity scale
Severity + duration
> V mild => less than 5 mins > Mild => 5-60 mins > Moderate => 1-24 hours > Severe => 1-7 days > V Severe => 1-4 weeks > Ex Severe => 1 month +
Some people never leave PTA
Describe management during PTA
> Quite + low stim environment => reduce aggression
Encourage fam to bring photos + personal items
- See what they remember
- Family should avoiding pressing patient to
remember.
- Identify agitation triggers
Avoiding asking questions about past
Manage behavioural triggers in environment
Non-confrontational group work?
Physical changes of TBI?
> Epilepsy
- Drinking/drugs incr risk
- Reason why x driving for 1 year
Headaches (frontal common)
Fatigue and reduced pain tolerance
- Aim for morning/afternoon sessions
Sensory deficits
- Visual disturbances (VF deficits, blurred, tunnel)
Auditory disturbances
- Sensory overload - see what like in busy setting
- Uni/bilateral, tinnitus
Diminished taste and smell
- Work on food textures
Balance and proprioception disturbances
Why may people with TBI experience behavioural changes?
What damage causes what?
> frontal lobe regulates emotions and behaviours
- this area may be damaged
> Orbito-frontal area
- aggression and frustration
> Dorsolateral
- Low motivation and drive as initiation damaged
Medical management of TBI
> ICP monitor > Pharmological treatments > Decompressive craniectomy > Craniotomy > Cranioplasty > Ventriculo-peritoneal shunt (VP shunt) > Lobectomy
Examples of behaviours as a result of TBI
> Dis-inhibition, impulsiveness, poor self-control > Ego-centricity, self-aborption > Rigidity + inflexibility > Perseveration > Poor self monitoring > Apathy and inertia > Blunt > Restlessness + agitation > Verbal + physical aggression > Reduced social skills > Reduced insight + awareness
Managing behavioural problems
> Observe & record to identify triggers
> Work w family and MDT
- Training & education => eff comm
> Medication
> Behaviour control
- positive reinforcement
- avoid negative reinforcement
- Consider insight + awarenessCognitive changes that may occur
Hierarchical (top to bottom of pyramid)
> Executive functioning > Memory > Spatial + lang ability > Attention + concentration > Sensory + motor skills > Arousal + alertness
> Significant overlap btween these domains.
