Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UM - Neuro Conditions > TBI > Flashcards

TBI Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many TBI hospitalizations in 2018?

A

> 223,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Male or females more likely to be hospitalized for TBI?

A

Males 2x risk and 3x more likely to die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What were the Mech of Inj for TBI 2017?

A

49% Unintentional Falls

24% Motor Vehicle Crash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which group (age) is effected the most?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Leading cause of TBI-related death?

A

Firearm-related suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a concern w/TBI and older adults?

A

Misdiagnosed as dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you check older adults for TBI?

A
  • Falls or fall related injury (hip fx)
  • MVC
  • On anticoagulants or antiplatelet medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Homelessness and TBI

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

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

At least 46% but hard to know specifics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List (4) types of injury to cause TBI

A
  • External Forces
  • Severe acceleration and Deceleration of the head
  • Blast Injuries
  • Penetrating Objects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A

Corpus callosum, BG, BS, and cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

Diffuse Axonal Injury (DAI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

List two Penetrating Trauma Injury Types

A

High velocity

Low velocity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Define contusion

A

Bruise or bleeding on the brain

that can occur anywhere, but occipital lobe most vulnerable and CN II, VIII, III, IV and VI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is an epidural hematoma or hemorrhage

A

Occurs where there is tearing of the meningeal vessels and fluid collects between the skull and dura, often associated with a skull fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When does Subdural Hematoma (SDH) occur and where?

A

Accel/Decel injuries and the bridging veins to superior sagittal sinus are torn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are secondary Injuries caused by?

A

Lack of O2 in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What leads to Increased Intracranial Pressure? (ICP)

A

Swelling of the brain tissue itself or hemorrhaging within the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

List some primary injuries of the brain

A
  • Contusions
  • Epidural hematomas or hemorrhages
  • Subdural hematomas (SDH)
  • Diffuse axonal injuries (DAI)
  • Penetrating Injuries
  • Blast injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

List some secondary injuries of the brain

A
  • ICP (increased intracranial pressure)
  • Cerebral hypoxia or ischemia
  • Intracranial hemorrhage
  • Electrolyte or acid-base imbalance
  • Infections
  • Seizures from pressure or scarring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is an example of a diffuse injury?

A

SDH because it is happening underneath the dura and the skull is only so big

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is midline shift?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is acute hydrocephalus

A

Blood accumulates in the ventricles leading to ventricular expansion and increased pressure on brain tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is Increased ICP associated with?

A

(2nd injury)

Poorer outcomes and higher mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q 
How does the Glasgow Coma Scale delineate a:
Mild TBI
- score
- Loss of consciousness
- Posttraumatic amnesia
- Associated S/S
- Potential Outcome
A 
13-15
No LOC
0-1 day Post-traum. amnesia
Vomiting, dizziness, lethargy, mem loss
--> High likelihood of survival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q 
How does the Glasgow Coma Scale delineate a:
Moderate TBI
- score
- Loss of consciousness
- Posttraumatic amnesia
- Associated S/S
- Potential Outcome
A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q 
How does the Glasgow Coma Scale delineate a:
Severe TBI
- score
- Loss of consciousness
- Posttraumatic amnesia
- Associated S/S
- Potential Outcome
A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does the glasgow coma scale asses?

A

Function of BS and Cerebrum

  • Eye opening
  • Best motor response
  • Verbal Response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Initial MGT: Pre-hospital

A
  • O2
  • BP
  • Cognitive function (Use GCS)
  • Pupillary function
  • Signs of brain herniation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the goal of MGT in the ER

A

Resuscitation and prevention of secondary injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What things should be done in the ER for TBI

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Surgical Interventions for TBI

A
  • ICP monitor and/or extra-ventricular drain (EVD) placement
  • Burr Holes (subdural hematoma evacuation)
  • Craniotomy
  • Decompressive craniectomy (remove portion of skull to relieve pressure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is a craniotomy

A

Sx intervention for TBI where the skull is opened to evacuate bleeding, commonly of the fronto-temporo-parietal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What can you do pharmacologically for TBI

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What other injuries are common with TBI

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the categories of Consequences of TBI

A

Cognitive
Physiological
Behavioral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are physiological consequences of TBI

A 
Dysautonomia
Motor
Sensory
Perceptual
Disorders of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are cognitive consequences of TBI

A

Memory problems
Attention disorders
Impaired abstract reasoning
Apathy/lack of initiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are behavioural consequences of TBI

A 
Labile
Aggressive/agitated/irritable
Euphoric
Inappropriate behaviour
Perseveration
Impulsive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is impacted with a ___ Lesion:

- Frontal

A 
Judgement
Reasoning
Concentration
Executive function
behaviour
Impulse control
Voluntary motor function
Expressive aphasia
52
Q

What is impacted with a ___ Lesion:

- Temporal

A 
Senses
Receptive aphasia
Learning
Memory
Conversation
Artistic expression
53
Q

What is impacted with a ___ Lesion:

- Occipital

A

Vision and visual reflexes

54
Q

What is impacted with a ___ Lesion:

- Cerebellum

A

Fine motor movement
Balance
Coordination

55
Q

What is impacted with a ___ Lesion:

- BS

A

CN Functions
Cardiac
Respiratory and motor functions
Wakefulness

56
Q

List the Clinical Features of TBI

A
  • 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
Q

List 4 disorders of consciousness

A

Impaired arousal and consciousness
Coma
Vegetative State//Unconscious Wakefulness Syndrome
Minimally Conscious State

58
Q

What is impaired arousal and consciousness

A

Direct damage to systems regulating arousal and awareness

Indirect damage to systematic neural connections

59
Q

What is Coma

A

Loss of sleep-wake cycles on EEG and lack of interaction with the environment

60
Q

What is a Vegetative State//Unconscious Wakefulness Syndrome

A

No signs of consciousness after their eyes are open - no evidence that they are processing stimuli

61
Q

What does Vegetative State//Unconscious Wakefulness Syndrome come from

A

Diffuse cerebral hypoxia or severe diffuse white matter impact damage

62
Q

What is Minimally Conscious State

A

No longer comatose or vegetative, but they can still display significant deficits

63
Q

ANS Changes

A 
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
Q

Why do ANS Changes occur

A

ANS Dysfunction occurs due to connections between frontal cortex and the ANS

65
Q

What is a sympathetic storm

A

Tachycardic, BP rises, pupils dilate, often becomes diaphoretic/sweaty

66
Q

What severity TBI is likely to have sympathetic storms?

A

Moderate to severe TBIs

67
Q

List some motor deficits seen in TBI

A
  • Paralysis or paresis
  • CN injury
  • Impaired coordination
  • Abnormal reflexes
  • Abnormal tone
  • Poor balance
  • Loss of bowel or bladder control
68
Q

List some sensory and perceptual deficits

A

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
Q

List some communication deficits

A

Aphasia
Dysarthria
Impaired auditory and reading comprehension
Impaired social communication

70
Q

Cognitive Changes

A 
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
Q

List the behavioural changes

A 
Agitation/Aggression/Irritability
Substance Abuse/Behaviours that lead to legal consequences
Apathy
Depression
Anxiety
PTSD
OCD
Psychosis
Suicidal ideation and attempts, suicide
72
Q

What is capacity

A

What you measure in the clinical environment

73
Q

What is performance

A

How the patient does in their own environment

74
Q

What are some activity deficits

A 
Impaired Fun. Mobility
Balance
ADLs
Gait
Stairs
75
Q

What are some participation deficits

A

Return to community
Return to work
Driving
Family and social roles

76
Q

Define retrograde amnesia

A

Unable to recall events that occured during the period immediately preceding the event

77
Q

Define PTA (posttraumatic amnesia)

A

Time b/t the event and the point at which memory is restored - duration assoc w/severity of injury

78
Q

Define anterograde memory

A

Ability to form new memories

79
Q

What are the factors we look at for a prognosis

A 
GCS
Age
Health disparities
CT Scan Abnormalities
PTA Duration
80
Q

T or F: It takes an interdisciplinary team to care for a TBI Pt

A

True

81
Q

What is the RLA Levels of Cognitive Functioning (LOCF)

A

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
Q

What is Level 1 of RLA LOCF

A

No response

- Comatose w/o response to stimuli

83
Q

What is Level 2 of RLA LOCF

A

Generalized Response

- Opens eyes, some sleep/wake cycle, Patient inconsistently and non-purposefully reacts to stimuli.

84
Q

What is Level 3 of RLA LOCF

A

Localized Response
- Reacts specifically but inconsistently to stimuli.
May follow simple commands in an inconsistent and delayed manner

85
Q

What is Level 4 of RLA LOCF

A

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
Q

What do you do w/Levels 1,2,3 of RLA LOCF

A
  • 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
Q

Managing Level 4 of RLA LOCF

A
  • Stage where most Pts begin IPR
  • Avoid overstimulation and encourage breaks
  • Provide structure and allow as much mvmt as is safe
88
Q

What is Level 5 of RLA LOCF

A

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
Q

What is Level 6 of RLA LOCF

A

Confused, appropriate response

  • Show goal directed behaviour but still dependent on external direction
  • Follows schedule with some assistance
90
Q

What is Level 7 of RLA LOCF

A

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
Q

Managing Level 5 of RLA LOCF

A
  • Repeat w/short and simple commands
  • Re-orient Pt at start and end of session
  • Help Pt get organized
92
Q

Managing Level 6 of RLA LOCF

A
  • 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
Q

What is Level 8 of RLA LOCF

A

Purposeful and Appropriate Response

  • Realize they have cognitive deficits
  • Alert and Oriented
  • Shows carry-over of new learning
  • May have poor judgements
94
Q

Management of Level of VII and VIII

A
  • Allow them to be as independent as possible
  • Monitor level of distractions
  • Decrease barriers to isolation
95
Q

What can we do as PT to monitor agitation

A

Modify environment to decrease stimuli
Avoid restraints
Stay calm
Do not leave Pt alone

96
Q

T or F: A Pt can take meds for agitation

A

True! Beta blockers

97
Q

How long does agitation typically last

A

<= 14 days, could be longer in some cases

98
Q

What are some examples of restless behaviours

A

Rocking
Pacing
Fidgeting
Sliding back and forth in WC

99
Q

What are behaviours of poor attention span

A
  • Distraction during meal times or toileting

- Poor participation in therapy

100
Q

What are some examples of impulsive behaviour

A

Pt drinks water when NPO
Forgets to lock WC
Stands up to walk to bathroom w/o walker

101
Q

How to help Pt w/Impulsivity

A
  • 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
Q

What to do about Pt Disinhibition

A
  • Remain calm and provide concrete feedback
  • Identify issue as “self-control”
  • Avoid emotional responses
103
Q

What to do about Pt Perseveration

A

Allow Pt time to disengage from one activity before proceeding to the next

  • Lots of structure
  • Cue to redirect away
104
Q

Define confabulation

A

Unconscious filling in of gaps in memory with fabricated facts and experiences - Pt believes these to be real

105
Q

What to do about confabulation in Pt

A

Low function: Ignore it

High function: Provide nonthreatening feedback on inaccuracy of memory; then, redirect

106
Q

What does decreased insight look like in a Pt

A
  • Overestimation of their abilities

- Inability to self-reflect

107
Q

What to do about apathy in a Pt

A
  • Have treatment target choices and acknowledge accomplishments
  • Do not present yes/no choices
  • Ask what Pt wants to do
108
Q

What to do about lack of initiation in a Pt

A
  • VC at beginning of movement using same cue for each step
109
Q

What medications might be used to help with behaviour management

A
  • Psychostimulants
  • Antidepressants
  • AntiPD meds
  • Anticonvulsants
  • Meds for sleep/wake cycle promotion
110
Q

T or F: A concussion is a mild brain injury

A

True

111
Q

What types of symptoms can you see for a Concussion?

A

Cognitive
Physical
Emotional
Sleep

112
Q

When do symptoms typically occur with a concussion

A

Begin w/in first 7-10 days and go away w/in 3 months

113
Q

What symptoms are common of Post-concussive syndrome

A

Headache
Dizziness
Difficulty w/concentration and memory

114
Q

List the subtypes of concussions

A 
Ocular
Cervical
Vestibular
Cognitive/Fatigue
Anxiety/Mood
Post-traumatic Migraine
115
Q

What do you see w/ocular concussion

A

Visual issues

116
Q

What do you see w/cervical concussion

A

MSK - C-Spine stiffness and pain, headaches

117
Q

What do you see w/vestibular concussion

A

Dizziness; issues w/sensory system weighting

118
Q

What do you see w/Cognitive/Fatigue concussion

A

Overwhelmed by busy environments; feel better in am worse in pm; fatigued and low energy but trouble sleeping at night

119
Q

What do you see w/Anxiety/mood concussion

A

Overwhelmed by busy environments; feel better in am worse in pm; fatigued and low energy but trouble sleeping at night; Feelings of anxiety

120
Q

What do you see w/Post traumatic migraine concussion

A

Severe H/A esp in morning
Nausea
Photophobia and phonophobia
Sleep disturbances

121
Q

What is Chronic Traumatic Encephalopathy (CTE)

A

Brain degeneration likely caused by repeated head trauma

Symptoms develop over years post-head trauma

122
Q

List the types of Nontraumatic Brain Injury

A

Infections
Tumors
Metabolic Causes

123
Q

What are causes of infectious NTBI

A

Bacteria, Viruses, Parasites, Prions, Abscesses

124
Q

Define Encephalopathy

A

Brain disease, damage, or malfunction

125
Q

What can cause a hypoxic/anoxic brain injury

A

Cardiac Arrest
Prolonged Seizures
Prolonged Asthma Attacks
COPD Exacerbations

126
Q

What are symptoms of hypoxic/anoxic brain injury

A 
Lethargy 
altered mental state
Tremors
Altered Breathing Patterns
Coma
127
Q

What causes Toxic/Metabolic Encephalopathy

A

Metabolic Disorders (Ketoacidosis)
Toxic Chemicals (mercury, lead, ammonia)
Severe ETOH use
Uremia in kidney failure

UM - Neuro Conditions (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions