TBI Flashcards
Grades of DAI (diffuse axonal injury)
3 grades
Grade 1: microscopic axonal injury only
Grade 2: grade 1 + corpus callosum lesion
Grade 3: grade 2 + brain stem lesion
Norm value of ICP
Norm Value of CPP (central perfusion pressure)
Want it 20 mm Hg or below
About 60 mmH Hg (peds between 40-50)
CPP = MAP - ICP
MAP = 1/3 SBP + 2/3 DBP
GCS - Glasgow Coma Scale
Norm Values
Eye Response: 4- opens spontaneously 3- opens to speech 2- open in response to pain 1- no response
Verbal Response: 5- talking/oriented 4- confused speech but coherent 3- inappropriate words, jumbled phrases 2- incomprehensible sounds 1- no response
Motor Response:
6- Obeys commands fully
5- localizes to pain
4- flexion/withdrawal from noxious stim
3- abnormal flexion/ decorticate posturing
2- extensor response/ decerebrate posturing
1- no response
Mild: 13-15
Moderate: 9- 12
Severe:<9
Ranches Los Amigos Scale (RLA)
Or Level of Cognitive Functioning Scale (LCFS)
Level 1- 8
(9&10)
Level 1- no response
Level 2- generalized response
- responds to external stimuli in non- specific way
Level 3- localized response
- responds specifically and inconsistently with delays , may follow simple commands
Level 4- confused, agitated response
Level 5- confused, inappropriate, non-agitated response
Level 6- confused, appropriate response
Level 7- automatic, appropriate response
Level 8- purposeful, appropriate response
Level 9- purposeful-appropriate
Level 10- purposeful- appropriate (modified independent)
Disorders of Consciousness (DOC)
RLA 1-3 includes:
Brain death
Coma
Vegetative State
Minimally Conscious State
Coma:
Coma:
- state of unarousable responsiveness, eyes remain continuously closed, no understandable response to stimuli
- no sleep/wake cycle
- reflexive activity only
- temporary: becomes vegetative or minimally conscious
- emergence in 2-4 weeks results in favorable outcome
Vegetative State or Unresponsive Wakefulness
No conscious awareness of self or environment, with preserve autonomic or functions
- eyes open
- including sleep/wake cycle
- no purposeful or reproducible responses to stimuli
- no command following
- autonomic system intact for basic functions
- “persistent” defined as 1 month
- “permanent” defined as 12 months
Minimally Conscious State
Severely altered consciousness with minimal behavior evidence of self or environmental awareness
- inconsistent
- may follow commands/ verbalizations, yes/no
- responses/movements in response to environment, not reflexive
Coma Recovery Scale - revised (CRS-R)
0-23
Lower scores= reflexive, brain stem level activity
- oral reflexive movement
- visual pursuits
Higher scores = cortical involvement
- functional object use
- object recognition
- also helps to distinguish MCS or emerging from MCS
- present functional object use and/or functional/accurate communication considered emerging
Auditory Function Scale 4 - consistent movement to command 3- Reproducible movement to command 2- localization to sound 1- auditory startle 0- none
Visual Function Scale: 5- object recognition 4- object localization (reaching) 3- visual pursuit 2- fixation 1- visual startle 0- none
Motor Function scale: 6- functional object use 5- automatic motor response 4- object manipulation 3- localization to noxious stimulation 2- flexion withdrawal 1- abnormal posturing 0- none/flaccid
Oromotor/Verbal Function Scale: 3- intelligible verbalization 2- vocalization/oral movement 1- oral reflexive movement 0- none
Communication Scale: 3- oriented 2- functional, accurate 1- non-functional, intentional 0- none
Arousal Scale: 3 - Attention 2- eye opening without stimulation 1- eye opening with stimulation 0- unarousable
Disability Rating Scale (DRS)
30: dead 29-22: vegetative state 21-8: severe disability 5-3: moderate disability 3-0: good recovery
Modified Ashworth Scale
0- no increase in muscle tone
1- slight increase in muscle tone, catch and release, minimal resistance at end of range of motion
1+ - a catch, followed by minimal resistance throughout the remainder of the range of motion (less than half)
2- more increase in muscle tone through most of the range of motion, affected part is moved easily
3- considerable increase in muscle tone, passive movement is difficult
4- affected part is rigid in flexion or extension
Agitated Behavior Scale (ABS)
14-56
21 or below: normal
22-28: mild agitation
29-35: moderate agitation
> 35: severe agitation
Trunk Impairment Scale (TIS)
- static, dynamic sitting balance and coordination of trunk movement
Diagnoses: stroke, brain injury, MS, CP, PD
0-23 (maximum)
If patient scores 0 on the first item, total score is 0
Dynamic Gait Index (DGI)
Not validated for brain injury
0-24
Functional Gait Assessment (FGA)
Elderly cutoff: < 22
PD cutoff: < 15
Norms: 40s: 28.9 50s: 28.4 60s: 27.1 70s: 80s: Revised version of DGI To reduce ceiling effect
0-30
FIM +FAM
Scale: 7- complete independence 6- modified independence (time, devices) 5- supervision 4- minimal assistance 3- moderate assistance 2- maximum assistance 1- total assist
