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UM - Neuro Conditions > TBI > Flashcards

TBI Flashcards

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1
Q

What is a TBI caused by?

A

Bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain

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2
Q

How many TBI hospitalizations in 2018?

A

> 223,000

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3
Q

What percent of HS students report >= 1 concussion within past 12 mo

A

15%

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4
Q

Male or females more likely to be hospitalized for TBI?

A

Males 2x risk and 3x more likely to die

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5
Q

What were the Mech of Inj for TBI 2017?

A

49% Unintentional Falls

24% Motor Vehicle Crash

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6
Q

Which group (age) is effected the most?

A

People 75+ w/32% total hospitalization and 28% of deaths

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7
Q

Leading cause of TBI-related death?

A

Firearm-related suicide

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8
Q

What is a concern w/TBI and older adults?

A

Misdiagnosed as dementia

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9
Q

When should you check older adults for TBI?

A
  • Falls or fall related injury (hip fx)
  • MVC
  • On anticoagulants or antiplatelet medication
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10
Q

What are the health disparities in Racial/ethinic groups with TBI?

A
  • American Indian/Alaskan Natives higher risk
  • Non-hispanic Black and Hispanic Pts less likely follow up
  • Poorer outcomes overall
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11
Q

Homelessness and TBI

A
  • 2-4x more likely to have hx of TBI

- <=10x as likely for moderate/severe TBI

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12
Q

What percent of people in jail/correctional facilities have a TBI

A

At least 46% but hard to know specifics

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13
Q

What are the health disparities in

  • Rural Areas
  • Low income w/o insurance
A
  • Rural: more likely to die

- Low income: less access to care and rehab, more likely to die

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14
Q

What can you do to prevent a TBI?

A

1) Wear seatbelts
2) Avoid Drunk Driving
3) Wear helmets (Bike, sports)
4) Older adults -> review meds
5) Older adults -> annual eye exam
6) Safe areas for children to play w/proper childproofing (window guards and safety railings at stairs)

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15
Q

List (4) types of injury to cause TBI

A
  • External Forces
  • Severe acceleration and Deceleration of the head
  • Blast Injuries
  • Penetrating Objects
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16
Q

What is a

  • closed head injury
  • open head injury
A
  • Closed: An injury without a skull fracture

- Open: An injury w/skull fx

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17
Q

Define:

  • coup injury

- countrecoup injury

A
  • Coup: Occurs at the site of injury

- Countrecoup: Occurs at a distance from the site of injury from hitting the inside of the skull

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18
Q

What is Diffuse Axonal Injury (DAI?)

A

“Shaken baby syndrome” - brain injury caused by shearing among the axons from accel and decel forces

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19
Q

Where does damage often occure with Diffuse Axonal Injury (DAI)?

A

Corpus callosum, BG, BS, and cerebellum

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20
Q

What is the most common type of primary lesion in brain trauma?

A

Diffuse Axonal Injury (DAI)

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21
Q

What occurs in a blast injury?

A

There is an overpressure wave (High Pressure gas away) and then another pressure wave to cause second overpressure wave (from drop in pressure creating relative vacuum in other direction) that will hit the head

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22
Q

List two Penetrating Trauma Injury Types

A

High velocity

Low velocity

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23
Q

What is a high velocity penetrating trauma injury?

A

TBI from bullets or shrapnel that directly damage the tissue it comes in contact with and can also cause damage remote to the injury from shock waves of impact

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24
Q

What is a low velocity penetrating trauma injury?

A

TBI from sticks or sharp toys - causes damage directly to the tissues they come in contact with

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25
Define contusion
Bruise or bleeding on the brain | that can occur anywhere, but occipital lobe most vulnerable and CN II, VIII, III, IV and VI
26
What is an epidural hematoma or hemorrhage
Occurs where there is tearing of the meningeal vessels and fluid collects between the skull and dura, often associated with a skull fracture
27
When does Subdural Hematoma (SDH) occur and where?
Accel/Decel injuries and the bridging veins to superior sagittal sinus are torn
28
What are secondary Injuries caused by?
Lack of O2 in the brain
29
What leads to Increased Intracranial Pressure? (ICP)
Swelling of the brain tissue itself or hemorrhaging within the brain
30
List some primary injuries of the brain
- Contusions - Epidural hematomas or hemorrhages - Subdural hematomas (SDH) - Diffuse axonal injuries (DAI) - Penetrating Injuries - Blast injuries
31
List some secondary injuries of the brain
- ICP (increased intracranial pressure) - Cerebral hypoxia or ischemia - Intracranial hemorrhage - Electrolyte or acid-base imbalance - Infections - Seizures from pressure or scarring
32
What is an example of a diffuse injury?
SDH because it is happening underneath the dura and the skull is only so big
33
What is midline shift?
When the midline of the brain is no longer in the middle - indicative that there is more damage than just at the site of injury
34
What is acute hydrocephalus
Blood accumulates in the ventricles leading to ventricular expansion and increased pressure on brain tissue
35
What is Increased ICP associated with?
(2nd injury) | Poorer outcomes and higher mortality
36
``` How does the Glasgow Coma Scale delineate a: Mild TBI - score - Loss of consciousness - Posttraumatic amnesia - Associated S/S - Potential Outcome ```
``` 13-15 No LOC 0-1 day Post-traum. amnesia Vomiting, dizziness, lethargy, mem loss --> High likelihood of survival ```
37
``` How does the Glasgow Coma Scale delineate a: Moderate TBI - score - Loss of consciousness - Posttraumatic amnesia - Associated S/S - Potential Outcome ```
``` 9-12 LOC of 30 min - 24 hr PT Amnesia: >1-<=7 days Signs of trauma, contusions, and/or bleeding on imaging --> Good survival w/some LT Disability ```
38
``` How does the Glasgow Coma Scale delineate a: Severe TBI - score - Loss of consciousness - Posttraumatic amnesia - Associated S/S - Potential Outcome ```
3-8 LOC > 24 hours PT Amnesia: >7 days No obvious sleep/wake cycles, trauma on neuroimaging --> poor likelihood of survival and high likelihood of LT Disability
39
What does the glasgow coma scale asses?
Function of BS and Cerebrum - Eye opening - Best motor response - Verbal Response
40
Initial MGT: Pre-hospital
- O2 - BP - Cognitive function (Use GCS) - Pupillary function - Signs of brain herniation
41
What is the goal of MGT in the ER
Resuscitation and prevention of secondary injury
42
What things should be done in the ER for TBI
- CT scan - NeuroSx Eval - GCS if not done in field - Airway protection and ventilation - Monitor cerebral profusion pressure (CPP) and BP - Fluid MGT - Hyperosmolar therapy - Sedation - Prophylaxis of infection, DVT, seizures, hypothermia
43
Surgical Interventions for TBI
- ICP monitor and/or extra-ventricular drain (EVD) placement - Burr Holes (subdural hematoma evacuation) - Craniotomy - Decompressive craniectomy (remove portion of skull to relieve pressure)
44
What is a craniotomy
Sx intervention for TBI where the skull is opened to evacuate bleeding, commonly of the fronto-temporo-parietal)
45
What can you do pharmacologically for TBI
- Decrease ICP - Control BP and CPP (cerebral profusion pressure ) - Decrease intracranial bleeding - Control seizures - Prevent brain cell death - Prevent infection - Affect behaviour and cognitive functions - Affect motor function
46
What other injuries are common with TBI
- Other organs (cardiac, pulmonary, liver, bowel) - Fx (limbs, spinal, facial) - Ligament damage (often not noted or treated until after healing of other injuries) - Other Sx repairs
47
What are the categories of Consequences of TBI
Cognitive Physiological Behavioral
48
What are physiological consequences of TBI
``` Dysautonomia Motor Sensory Perceptual Disorders of consciousness ```
49
What are cognitive consequences of TBI
Memory problems Attention disorders Impaired abstract reasoning Apathy/lack of initiation
50
What are behavioural consequences of TBI
``` Labile Aggressive/agitated/irritable Euphoric Inappropriate behaviour Perseveration Impulsive ```
51
What is impacted with a ___ Lesion: | - Frontal
``` Judgement Reasoning Concentration Executive function behaviour Impulse control Voluntary motor function Expressive aphasia ```
52
What is impacted with a ___ Lesion: | - Temporal
``` Senses Receptive aphasia Learning Memory Conversation Artistic expression ```
53
What is impacted with a ___ Lesion: | - Occipital
Vision and visual reflexes
54
What is impacted with a ___ Lesion: | - Cerebellum
Fine motor movement Balance Coordination
55
What is impacted with a ___ Lesion: | - BS
CN Functions Cardiac Respiratory and motor functions Wakefulness
56
List the Clinical Features of TBI
- Disorders of consciousness - ANS changes - Motor, sensory, perceptual, and functional changes - Cognitive, personality, and behavioural changes - Other (Infections, contractures, skin breakdown, pulmonary problems, etc)
57
List 4 disorders of consciousness
Impaired arousal and consciousness Coma Vegetative State//Unconscious Wakefulness Syndrome Minimally Conscious State
58
What is impaired arousal and consciousness
Direct damage to systems regulating arousal and awareness | Indirect damage to systematic neural connections
59
What is Coma
Loss of sleep-wake cycles on EEG and lack of interaction with the environment
60
What is a Vegetative State//Unconscious Wakefulness Syndrome
No signs of consciousness after their eyes are open - no evidence that they are processing stimuli
61
What does Vegetative State//Unconscious Wakefulness Syndrome come from
Diffuse cerebral hypoxia or severe diffuse white matter impact damage
62
What is Minimally Conscious State
No longer comatose or vegetative, but they can still display significant deficits
63
ANS Changes
``` Variabilities HR and RR IBS Elevated Temp BP Changes Excessive sweating, salivation, tearing, and sebum secretion Dilated pupils Vomiting Anxiety, panic disorder, and PTSD ```
64
Why do ANS Changes occur
ANS Dysfunction occurs due to connections between frontal cortex and the ANS
65
What is a sympathetic storm
Tachycardic, BP rises, pupils dilate, often becomes diaphoretic/sweaty
66
What severity TBI is likely to have sympathetic storms?
Moderate to severe TBIs
67
List some motor deficits seen in TBI
- Paralysis or paresis - CN injury - Impaired coordination - Abnormal reflexes - Abnormal tone - Poor balance - Loss of bowel or bladder control
68
List some sensory and perceptual deficits
Impaired proprioception, touch, stereognosis - hypersensitivity to light or noise - impaired hearing and vision Numbness and tingling, dizziness or vertigo - Sensory selection and weighting deficits - Visual-spatial abnormalities - Agnosia and apraxia
69
List some communication deficits
Aphasia Dysarthria Impaired auditory and reading comprehension Impaired social communication
70
Cognitive Changes
``` Temporary or permanent disorders of intellectual function Memory Loss Impaired attention span Concentration problems Confusion Changes in motivation Loss of executive function Impaired problem-solving skills Lack of intiation Lack of reasoning Poor abstract reasoning ```
71
List the behavioural changes
``` Agitation/Aggression/Irritability Substance Abuse/Behaviours that lead to legal consequences Apathy Depression Anxiety PTSD OCD Psychosis Suicidal ideation and attempts, suicide ```
72
What is capacity
What you measure in the clinical environment
73
What is performance
How the patient does in their own environment
74
What are some activity deficits
``` Impaired Fun. Mobility Balance ADLs Gait Stairs ```
75
What are some participation deficits
Return to community Return to work Driving Family and social roles
76
Define retrograde amnesia
Unable to recall events that occured during the period immediately preceding the event
77
Define PTA (posttraumatic amnesia)
Time b/t the event and the point at which memory is restored - duration assoc w/severity of injury
78
Define anterograde memory
Ability to form new memories
79
What are the factors we look at for a prognosis
``` GCS Age Health disparities CT Scan Abnormalities PTA Duration ```
80
T or F: It takes an interdisciplinary team to care for a TBI Pt
True
81
What is the RLA Levels of Cognitive Functioning (LOCF)
An eval tool that is used to describe stages of recovery seen after a brain injury - Pts can start anywhere and progress at any rate through the levels
82
What is Level 1 of RLA LOCF
No response | - Comatose w/o response to stimuli
83
What is Level 2 of RLA LOCF
Generalized Response | - Opens eyes, some sleep/wake cycle, Patient inconsistently and non-purposefully reacts to stimuli.
84
What is Level 3 of RLA LOCF
Localized Response - Reacts specifically but inconsistently to stimuli. May follow simple commands in an inconsistent and delayed manner
85
What is Level 4 of RLA LOCF
Confused, Agitated Response - Confused and frightened w/overreactions and restlessness - Highly focused on basic needs - Short attention span - Can do simple routine activities w/help and has difficulty following directions
86
What do you do w/Levels 1,2,3 of RLA LOCF
- Explain in a normal tone w/clear and concise commands. - Tell them who you are and orient them - Calm environment w/rest periods - Bring in favorite objects
87
Managing Level 4 of RLA LOCF
- Stage where most Pts begin IPR - Avoid overstimulation and encourage breaks - Provide structure and allow as much mvmt as is safe
88
What is Level 5 of RLA LOCF
Confused, Inappropriate, not agitated - Alert and able to respond to simple commands fairly consistently - Highly distractible & w/o structure non-purposeful - Wander off and try to go home
89
What is Level 6 of RLA LOCF
Confused, appropriate response - Show goal directed behaviour but still dependent on external direction - Follows schedule with some assistance
90
What is Level 7 of RLA LOCF
Automatic, Appropriate Response - Follows schedule & does routine activ w/o help - Superficial awareness of but lack insights into own condition - Shows carry-over for new learning at a decreased rate
91
Managing Level 5 of RLA LOCF
- Repeat w/short and simple commands - Re-orient Pt at start and end of session - Help Pt get organized
92
Managing Level 6 of RLA LOCF
- Repeat things as needed - Discuss what happened during day to work on memory - Help person w/starting and continuing activities - Encourage Participation in all therapies
93
What is Level 8 of RLA LOCF
Purposeful and Appropriate Response - Realize they have cognitive deficits - Alert and Oriented - Shows carry-over of new learning - May have poor judgements
94
Management of Level of VII and VIII
- Allow them to be as independent as possible - Monitor level of distractions - Decrease barriers to isolation
95
What can we do as PT to monitor agitation
Modify environment to decrease stimuli Avoid restraints Stay calm Do not leave Pt alone
96
T or F: A Pt can take meds for agitation
True! Beta blockers
97
How long does agitation typically last
<= 14 days, could be longer in some cases
98
What are some examples of restless behaviours
Rocking Pacing Fidgeting Sliding back and forth in WC
99
What are behaviours of poor attention span
- Distraction during meal times or toileting | - Poor participation in therapy
100
What are some examples of impulsive behaviour
Pt drinks water when NPO Forgets to lock WC Stands up to walk to bathroom w/o walker
101
How to help Pt w/Impulsivity
- Use strategy with a Pt and verbally review the steps for each activity at the start - Have Pt think about how to complete the task before starting it
102
What to do about Pt Disinhibition
- Remain calm and provide concrete feedback - Identify issue as "self-control" - Avoid emotional responses
103
What to do about Pt Perseveration
Allow Pt time to disengage from one activity before proceeding to the next - Lots of structure - Cue to redirect away
104
Define confabulation
Unconscious filling in of gaps in memory with fabricated facts and experiences - Pt believes these to be real
105
What to do about confabulation in Pt
Low function: Ignore it | High function: Provide nonthreatening feedback on inaccuracy of memory; then, redirect
106
What does decreased insight look like in a Pt
- Overestimation of their abilities | - Inability to self-reflect
107
What to do about apathy in a Pt
- Have treatment target choices and acknowledge accomplishments - Do not present yes/no choices - Ask what Pt wants to do
108
What to do about lack of initiation in a Pt
- VC at beginning of movement using same cue for each step
109
What medications might be used to help with behaviour management
- Psychostimulants - Antidepressants - AntiPD meds - Anticonvulsants - Meds for sleep/wake cycle promotion
110
T or F: A concussion is a mild brain injury
True
111
What types of symptoms can you see for a Concussion?
Cognitive Physical Emotional Sleep
112
When do symptoms typically occur with a concussion
Begin w/in first 7-10 days and go away w/in 3 months
113
What symptoms are common of Post-concussive syndrome
Headache Dizziness Difficulty w/concentration and memory
114
List the subtypes of concussions
``` Ocular Cervical Vestibular Cognitive/Fatigue Anxiety/Mood Post-traumatic Migraine ```
115
What do you see w/ocular concussion
Visual issues
116
What do you see w/cervical concussion
MSK - C-Spine stiffness and pain, headaches
117
What do you see w/vestibular concussion
Dizziness; issues w/sensory system weighting
118
What do you see w/Cognitive/Fatigue concussion
Overwhelmed by busy environments; feel better in am worse in pm; fatigued and low energy but trouble sleeping at night
119
What do you see w/Anxiety/mood concussion
Overwhelmed by busy environments; feel better in am worse in pm; fatigued and low energy but trouble sleeping at night; Feelings of anxiety
120
What do you see w/Post traumatic migraine concussion
Severe H/A esp in morning Nausea Photophobia and phonophobia Sleep disturbances
121
What is Chronic Traumatic Encephalopathy (CTE)
Brain degeneration likely caused by repeated head trauma | Symptoms develop over years post-head trauma
122
List the types of Nontraumatic Brain Injury
Infections Tumors Metabolic Causes
123
What are causes of infectious NTBI
Bacteria, Viruses, Parasites, Prions, Abscesses
124
Define Encephalopathy
Brain disease, damage, or malfunction
125
What can cause a hypoxic/anoxic brain injury
Cardiac Arrest Prolonged Seizures Prolonged Asthma Attacks COPD Exacerbations
126
What are symptoms of hypoxic/anoxic brain injury
``` Lethargy altered mental state Tremors Altered Breathing Patterns Coma ```
127
What causes Toxic/Metabolic Encephalopathy
Metabolic Disorders (Ketoacidosis) Toxic Chemicals (mercury, lead, ammonia) Severe ETOH use Uremia in kidney failure

UM - Neuro Conditions (12 decks)

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