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NCS Prep > TBI > Flashcards

TBI Flashcards

1
Q

Grades of DAI (diffuse axonal injury)

3 grades

A

Grade 1: microscopic axonal injury only

Grade 2: grade 1 + corpus callosum lesion

Grade 3: grade 2 + brain stem lesion

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2
Q

Norm value of ICP

Norm Value of CPP (central perfusion pressure)

A

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

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3
Q

GCS - Glasgow Coma Scale

Norm Values

A 
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

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4
Q

Ranches Los Amigos Scale (RLA)

Or Level of Cognitive Functioning Scale (LCFS)

Level 1- 8

(9&10)

A

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)

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5
Q

Disorders of Consciousness (DOC)

RLA 1-3 includes:

Brain death

Coma

Vegetative State

Minimally Conscious State

Coma:

A

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
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6
Q

Vegetative State or Unresponsive Wakefulness

A

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
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7
Q

Minimally Conscious State

A

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
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8
Q

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
A 
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
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9
Q

Disability Rating Scale (DRS)

A 
30: dead 
29-22: vegetative state 
21-8: severe disability 
5-3: moderate disability 
3-0: good recovery
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10
Q

Modified Ashworth Scale

A

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

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11
Q

Agitated Behavior Scale (ABS)

14-56

A

21 or below: normal

22-28: mild agitation

29-35: moderate agitation

> 35: severe agitation

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12
Q

Trunk Impairment Scale (TIS)

  • static, dynamic sitting balance and coordination of trunk movement

Diagnoses: stroke, brain injury, MS, CP, PD

A

0-23 (maximum)

If patient scores 0 on the first item, total score is 0

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13
Q

Dynamic Gait Index (DGI)

A

Not validated for brain injury

0-24

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14
Q

Functional Gait Assessment (FGA)

A

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

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15
Q

FIM +FAM

A 
Scale: 
7- complete independence 
6- modified independence (time, devices) 
5- supervision 
4- minimal assistance 
3- moderate assistance 
2- maximum assistance 
1- total assist
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16
Q

Predictors of outcomes with disorders of consciousness

At initial hospital admission

AND

Initial acute rehab admission

“Predictors of short term outcome in brain injured patients with disorders of consciousness” article

A
  1. Earlier the sign of consciousness after brain injury
  2. Etiology of injury (traumatic is better than non traumatic) - acute admission
  3. Younger age - acute admission
  4. Absence of medical history (alcoholism, drug abuse, mental illness)
  5. Time between injury and rehab admission - rehab admission
17
Q

Sharp purser test

How to perform

What it’s testing

Positive/ negative sign

Other symptoms

Next steps

A
  • hand on forehead, finger on spinous process of C2, pt flexes neck while pushing posteriorly
  • testing atlantoaxial instability- transverse ligament
  • positive with relief of symptoms
  • can have leakage of CSF from nose or ears
  • notify MD immediately
18
Q

Normal Pressure Hydrocephalus

Area of brain

Signs and symptoms

A
  • buildup of CSF causes ventriculomegaly
  • enlarged temporal and lateral horns of ventricles
  • gait ataxia, gait hypometria, incontinence and dementia
    (Corticospinal tracts run medially and proximally to ventricles)
19
Q

Parasympathetic storming symptoms (3)

A

Bradycardia, posturing, agitation

20
Q

Stereognosis

A
  • ability to recognize objects by shape (cortical control)
21
Q

Life expectancy for severe TBI

A

7 years shorter than general pop

22
Q

SBP after TBI for pts
50-69
15-49 or >70

A 
>/= 100
>/= 110
23
Q

Kennard principle

A

Younger patient may do better than an adult with the same lesion

NCS Prep (11 decks)

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