TBI Flashcards
Males are often more affected by TBI than females (true/false)
true
Which cause of TBI is the most common?
a. MVA
b. Sports
c. falls
d. other collisions
falls
This mechanism of injury in TBI causes more susceptibility to brain damage, infection and rupture of blood vessels
a. open head injury
b. high velocity injury
c. closed head injury
d. low velocity injury
open head injury
This mechanism of injury in TBI is more perforation or depressed fracture with diffused axonal damage
a. low-velocity injury
b. high-velocity injury
c. penetration
d. hypoxia
high velocity injury
This mechanism of injury in TBI is more linear with fracture contusion at side of impact and possible tear or blood vessels
a. low-velocity injury
b. hypoxia
c. penetration
d. high-velocity injury
low velocity injury
What are potential mechanisms of injury with TBI?
fractures
direct blow without fracture
penetrating
loss of blood supply from neck injury
A direct blow without fracture will have brain damage due to
anoxia
What are the types of primary damage in TBI?
focal injury
diffuse axonal injury
This type of TBI is shown as damage to the exact area where hit, with any severity and more severe neurological signs
focal injury
This primary damage is acceleration, deceleration and/or rotational damage to the brain
diffuse axonal injury
this type of damage may not show signs initially but it will get more severe with edema over time
diffuse axonal injury
What is secondary damage with TBI?
increased intracranial pressure hypoxic-ischemic damage infection seizures electrolyte imbalance
Increased intracranial pressure can be due to
herniation
hematomas
increased intracranial pressure is related to
poorer outcomes
increased mortality rates
A direct blow to the head is a cause of diffuse axonal injury (true/false)
false
A bruise directly at site of impact is called
a. open head injury
b. closed head injury
c. coup
d. contrecoup
coup
As the brain is jolted back, it can hit the skull on the opposite side, this is defined as
a. open head injury
b. closed head injury
c. coup
d. contrecoup
countercoup
All of the following are secondary damage to TBI except
a. hypoxic-ischemic damage
b. diffuse axonal injury
c. infection
d. seizure
diffuse axonal injury
This type of imaging is good for showing fractures in the skull
a. CT
b. MRI
c. x-ray
d. PET
x-ray
Which neurological imaging is good for nonresponsive patients in order to see brain activity?
a. CT
b. PET
c. EEG
d. fMRI
EEG
This type of imaging shows mass lesions and brain shifting from acute injury after TBI
a. CT
b. MRI
c. x-ray
d. PET
CT
_ is more sensitive than CT
MRI
This type of imaging shows disturbances in cerebral metabolism that may not show on other
a. CT
b. MRI
c. x-ray
d. PET
PET
This type of imaging shows cognitive dynamics and overall neuroplasticity
a. CT
b. MRI
c. fMRI
d. PET
fMRI
What autonomic nervous system changes are seen with TBI?
changes in pulse and respiratory rates temperature elevations blood pressure changes excessive sweating, salivation, tearing dilated pupils vomiting
All of the following include changes in the autonomic nervous system except
a. temperature elevations
b. constricted pupils
c. vomiting
d. changes in pulse
constricted pupils
All of the following include changes in the autonomic nervous system except
a. dilated pupils
b. changes in pulse and respiratory
c. temperature decreased
d. vomiting
temperature decreased
What are the neuromuscular changes that occur?
sensory impairments abnormal tone motor function impairments impaired balance loss of bowel or bladder control CN involvement locked-in syndrome
What sensory impairments can occur with TBI?
changes in primary sensation light touch, deep touch, position sense
What abnormal tone is seen with TBI?
a. low tone
b. high tone
c. normal tone
d. full spectrum
full spectrum possible
A patient’s LE is in extension and UE in flexion this describes
a. low tone
b. decorticate
c. rigidity
d. decerebrate
decorticate
All of the extremities are in an extension posture, this describes
a. low tone
b. decorticate
c. rigidity
d. decerebrate
decerebrate
All of the extremities are in an _ posture = decerebrate
extension
Decorticate position
a. LE in flexion and UE in flexion
b. LE in extension and UE in flexion
c. LE in extension and UE in extension
d. none of the above
LE in extension and UE in flexion
What are the motor function impairments possible with TBI?
motor control and learning impairments loss of selective motor control impairments in coordination, timing, sequencing paresis abnormal reflexes
TBI patients have a loss of bowel or bladder control (true/false)
true
What are the cognitive changes seen with TBI?
coma/altered level of consciousness memory loss altered orientation attentional deficits impaired insight and safety awareness problem-solving preservation impaired executive functioning
Learning is not affected with memory loss (true/false)
false
This is referred to as the time between injury and then the ability to remember ongoing events
PTA
Orientation includes
person
place
time
situation
This is defined as an inability to stay on task, concentrate or focus and inhibit distraction
a. impaired executive functioning
b. perservation
c. attentional deficit
d. problem-solving impairment
attentional deficit
This is usually when they are stuck on one idea and it is all they think about
a. impaired executive functioning
b. perservation
c. attentional deficit
d. problem-solving impairment
persevation
What visual changes occur with TBI?
cortical blindness
hemianopsia
Awareness of body parts, position of body in relationship to environment is defined as
a. body image
b. right left discrimination
c. spatial relations disorder
d. body scheme
body scheme
Dont recognize visual, auditory, or tactile
a. somatoagnosia
b. finger agnosia
c. unilateral neglect
d. agnosia
agnosia
Denial or lack of awareness of the problem on one side of the body
a. apraxia
b. agnosia
c. anosognisa
d. somatoagnosia
anosognisa
Impairment in scheme, inability to correctly identify or orient the parts of one’s body or the body of another
a. apraxia
b. agnosia
c. anosognisa
d. somatoagnosia
somatoagnosia
Ability to perceive self in relation to other objects
a. spatial relations disorder
b. figure-ground discrimination
c. form discrimination
d. body scheme
spatial relations disorder
Ability to distinguish foreground from background
a. spatial relations disorder
b. figure-ground discrimination
c. form discrimination
d. body scheme
figure ground discrimination
Ability to understand concepts like over, under, around, above and below
a. spatial relations disorder
b. position in space
c. body scheme
d. topographic disorientation
position in space
Ability to find ones way from one place to another
a. spatial relations disorder
b. position in space
c. body scheme
d. topographic disorientation
topographic disorientation
What are the behavioral deficits seen in TBI?
disinhibition impulsiveness physical and verbal aggressiveness apathy lability sexual inappropriateness irritability egocentricity
What are communication deficits seen in TBI?
receptive aphasia expressive aphasia dysarthria auditory deficits impaired reading comprehension impaired writing expression impaired pragmatics
TBI patients can have dysphagia (true/false)
true
List the secondary impairments
contractures skin breakdown DVT heterotrophic ossification decreased bone density muscle atrophy decreased endurance infection pneumonia
The Glascow coma scale is used primarily to measure severity of TBI in which setting?
a. Outpatient rehab
b. Acute
c. ICU
d. Home health
Acute
Posttraumatic amnesia is defined as
a. Time between injury and ability to motor recovery
b. Time between injury and ability to come out of coma
c. Time between injury and ability to remember ongoing events
Time between injury and ability to remember ongoing events
A mild TBI is considered a concussion (true/false)
true
Which stage of severity of TBI considers physical, cognitive and behavioral impairments for months that could become permanent
a. Mild
b. Moderate
c. Severe
Moderate
Which clinical rating scales can be used to measure employability?
a. GCS and GOS
b. GOAT and GOS
c. DRS and FIM
d. DRS and FAM
DRS and FAM
Which category in the ICF table would FAM fit under?
a. Body function/impairment
b. Participation
c. Activity
d. Environment internal
Participation
Which category in the ICF table would DRS fit under?
a. Body function/impairment
b. Participation
c. Activity
d. Environment internal
Participation
Which clinical rating scale is used at discharge and then 6 months after injury?
a. GCS
b. GOAT
c. GOS
d. Rancho
GOS
Which clinical rating scale is used in the subacute stage measuring consciousness?
a. GCS
b. GOAT
c. GOS
d. Rancho
Rancho
The glascow coma scale measures what activities?
a. Cognitive status and postural control
b. Cognitive status, motor response and verbal response
c. Eye opening and vegetative state
d. Eye opening, best motor response and verbal response
Eye opening, best motor response and verbal response
The purpose of the GOS is to measure
a. Outcome
b. Prognosis
c. Current state of cognition
d. Motor response
Prognosis
If a patient is in a coma more than 2 weeks the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate to severe on GOS at 1 year
If a patient is in a coma less than 1 week, the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate to good recovery on GOS
If a patient is PTA is measured more than 12 weeks, the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate to severe on GOS
If a patient PTA is measured less than 4 weeks, the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate disability to good recovery
A patient scores a 14 on the GCS, their loss of consciousness was less than 30 minutes and PTA was 12 hours. What level of severity should they be categorized under?
a. moderate
b. severe
c. mild
mild
A patient scores 10 on the GCS, loss of consciousness for 10 hours and 4 days of PTA. What is their TBI severity level?
a. moderate
b. severe
c. mild
moderate
A patient scores a 4 on the GCS, loss of consciousness for 42 hours and has PTA for 14 days. What is their TBI severity level?
a. moderate
b. severe
c. mild
severe
GCS of 13-15
loss of consciousness <30 min
PTA 0-1 day
what is the severity level?
mild
GCS of 9-12
loss of consciousness 30 minutes-24 hours
>1 to <7 days
what is the severity level?
moderate
GCS of 3-8
loss of consciousness >24 hours
PTA > 7 days
what is the severity level?
severe
Blunt trauma or acceleration/deceleration with confusion, disorientation or impaired consciousness
a. moderate
b. severe
c. mild
mild
Confusion for days or weeks, physical, cognitive and behavioral impairments for months that could become permanent
a. moderate
b. severe
c. mild
moderate
Which clinical rating scale measures post-traumatic amnesia?
a. GOS
b. GCS
c. GOAT
d. DRS
GOAT
This clinical rating scale is used at discharge in acute care and then 6 months later
a. GOS
b. GCS
c. GOAT
d. DRS
GOS
What levels fall under GOS?
vegetative
severely disabled
moderately disabled
good recovery
The patient is persistently unresponsive, may have eye-opening, sucking, yawning, localized motor response. Which level of the GOS does this fit?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
vegetative
Patient is conscious but needs 24 hour care. Which level of the GOS does this fit?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
severely disabled
Patient is independent and can do self care skills, varying with other deficits. What level of the GOS?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
moderately disabled
Able to reintegrate into social and work life. Which level of the GOS?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
good recovery
This clinical rating scale starts with eye opening and has a wide range of scoring, gives measure of employability and overall disability scale.
a. Rancho
b. GOS
c. DRS
d. GCS
DRS
What are the highly recommended clinical rating scales?
Rancho
FIM
What are pre-injury characteristics that influence outcomes?
cognitive
behavioral
social
physical
What are the post injury chacteristics?
static
dynamic
What are the static post injury factors?
trauma
cognitive
physical
What are the dynamic postinjury factors?
trauma cognitive behavioral social physical environmental
What does the DRS measure?
arousability, awareness, and responsivity
the cognitive ability for self-care
dependence on others
psychosocial adaptability
PT management is based on physical deficits which is influenced by _ function
cognitive
cognitive function is not relevant to PT management (true/false)
false
A history and complete chart review should be completed for which levels?
all levels
systems review should be completed for which levels?
all levels
Cognitive status should be completed for which levels?
all levels
What is the clinical rating scale that should be used for cognitive status?
Moss Attention Rating Scale
This scale measures their ability to pay attention
Moss Attention Rating
ROM should be examined for which levels?
all levels
Sensation testing should be done at what levels?
formal testing I-IV
modified V-VI
Skin integrity should be examined at what levels?
all levels
Motor examination should be tested at what levels?
all but may be modified in levels I-VI depending on cognition
What do you need to test with the motor examination?
spasticity
reflexes
What reflexes should be tested?
superficial cutaneous reflex
primitive and tonic reflexes
What are the primitive and tonic reflexes that should be tested?
flexor withdrawl tonic neck crossed extension grasp associated reactions
An absent reflex would be scored _
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
0
A reflex of tone change, slight, transient with no movement of extremities would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
1+
A visible movement of extremities (normal) would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
2+
An exaggerated, full movement of extremities (brisk) would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
3+
An obligatory and sustained movement, lasting for more than 30 seconds would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
4+
What motor components need to be examined?
quality of movement
variability
movement patterns
balance
Quality of movement can be examined at what levels?
up to levels 5 and 6 cannot do formalized
What levels are appropriate to measure balance?
level 7 or higher
Posture and alignment should be measured at what levels
all levels
coordination should be measured at what levels
observation 3-4
formal 7 or higher
What level can you measure diadokokinesia?
any level
What level can you measure fatigability?
level 4 or higher
Functional status can be measured at what levels?
level 4 observation
modify levels 5 and 6
When can you use outcome measures for functional tasks?
level 5 and 6
At what level can you expect to do a full set of Core Measures?
level VII at the lowest, maybe not until level VIII
What neuromuscular movement system diagnoses are possible for a TBI patient?
all
The FAM is designed to be applicable in which setting?
inpatient rehab
increase in intracranial pressure is a (primary/secondary) effect
secondary
Which is the most common primary deficit after TBI?
a. cognitive
b. perceptual
c. behavioral
d. visual
visual
Which is the most common primary deficit after TBI?
a. cognitive
b. perceptual
c. behavioral
d. visual
visual
Unilateral neglect is commonly caused by damage to the _ lobe
a. frontal
b. parietal
c. temporal
d. occipital
parietal
somatoagnosia is a (body scheme/body image) disorder
body scheme
inability to recognize objects
visual agnosia
inability to recognize objects
visual agnosia
inability to identify objects through touch
tactile agnosia
What is the determinant that a pt is no longer in a coma?
spontaneous eye-opening
What are the four main acute care goals?
maintain pulmonary hygiene
maintain/improve motor skills and ROM for function
functional mobility
cognitive reorientation
How can you treat to improve motor skills and ROM in acute care?
ROM
casting
positioning
facilitation of normal movement patterns
What should be included for treatment in functional mobility in acute care?
mobility training wt bearing trunk rotation proximal stability with distal mobility WC upright
How do you treat cognitive reorientation in acute care?
stimulation
structured environment
family/team involvement
Goals of LOCF I-III should include:
increase alertness and function reduce risk of secondary impairmetns improve postural and motor control manage tone increase tolerance and endurance
These goals are appropriate for which LOCF level (level 1-3, 4, 5-6, 7-up) increase alertness and function reduce risk of secondary impairments improve postural and motor control manage tone increase tolerance and endurance
LOCF I-III
What does management of LOCF I-III look like?
decrease abnormal posturing and primitive reflexes
position upright and transition to sitting/standing
sensory stimulation
management of tone
facilitation of movement
managing which level of LOCF
decrease abnormal posturing and primitive reflexes
position upright and transition to sitting/standing
sensory stimulation
management of tone
facilitation of movement
LOCF I-III
What stage focuses on positioning, and posturing the most?
LOCF I-III
Examination is (passive/active/structured/observational) at level IV
observational
Exam for LOCF IV should include
cognitive status functional mobility/balance ROM motor function sensation tone reflexes skin integrity
Goals for LOCF IV should include
increase endurance
prevent secondary impairments
increase activity tolerance
prevent outbursts, assist to control behavior
these goals are indicated for which level
increase endurance
prevent secondary impairments
increase activity tolerance
prevent outbursts, assist to control behavior
level IV
What does a structured program look like?
consistency expect no carry over model calm behavior flexibility safety family education
A concussion is a _ type of TBI
a. direct blow without fracture
b. penetrating
c. direct fracture
d. diffuse axonal injury
diffuse axonal injury
sports injuries are the most common cause of a concussion (true/false)
false
falls are!!!
Who has the highest death rate due to concussions?
a. 0-4 year old
b. 15-25 year old males
c. 65+ year old females
65+ year old females
What level is focused on impairment and strategy pillars?
level V and VI
What level is this performance of functional mobility and ADL improved gait, mobility, balance increased postural and motor control prevent secondary problems increased strength and endurance improve safety in ADL's and mobility improve tolerance mobility
level V and VI
What does intervention in level V and VI look like
structured distributed practice restorative constraint-induced work directly on impairments and motor function compensatory strategies
Which type of practice should be used in levels V and VI?
a. random
b. blocked
c. distributed
d. any type of practice
structured distributed
At what level can restorative training begin?
a. level 3
b. level 1-8
c. level 4
d. level 5-6
level 5-6
What does restorative training include?
task oriented training
aerobic training
gait training
What gait training should be used for TBI level 5 and 6?
a. BW support
b. non BW support
c. treadmill or overgound
d. a and d
BW support
treadmill or overground
At what level can constraint-induced therapy begin?
a. level 3
b. level 1-8
c. level 4
d. level 5-6
level 5 and 6
At what level can all pillars be addressed?
level 7 and up
What level is this
safety improved
improved ADL, community and re-integration
improved functional mobility
motor control, motor learning and postural control improved
self-management of symptoms increased
level 7 and up
At what level can you give responsibility to the patient?
a. level 4
b. level 5
c. level 6
d. level 7 and up
level 7 and up
At what level do you expect a patient to be able to reenter the community?
level 7 and up
males are at a higher risk for a sports related concussion (true/false)
false
this is a head injury that is usually sufficient enough to result in a loss of consciousness after which 3-8 symptoms arise within 4 weeks
a. post-concussive syndrome
b. persistent post-concussive syndrome
c. diffuse axonal injury
d. head fracture with a concussion
post-concussive syndrome
Somatic, cognitive, behavioral, and or emotional symptoms that last longer than ones peers
a. post-concussive syndrome
b. persistent post-concussive syndrome
c. diffuse axonal injury
d. head fracture with a concussion
persistent post-concussion syndrome
Meds should be limited to the first - days post concussion and stopped by _ weeks post
2-10 days
2 weeks
Who makes the final determination to return back to life?
physician
Return to work/school/life is based on
symptoms
routine activity
graduated exertion
Why is relative rest important in the acute phase?
demand of brain energy exceeds supply
When an individual (typically athlete) sustains a second or subsequent before first head injury has been cleared
second impact syndrome
Compromised metabolic state can persist for weeks or months (true/false)
true
Symptoms of cervicogenic headache are not the same as concussion symptoms (true/false)
false
What can be the source of head pain related to cervicogenic components of concussion?
occipital nerve roots
joint complexes
cervical spine symptoms are (unilateral/bilateral)
unilateral
What tests are used for serious neck pathology
Vertebral Artery Test
Alar ligament
Transverse ligament
deconjugate horizontal eye movements that allow binocular fixation and stereopsis of visual targets at different viewing distances is defined as
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
vergence
eyes moving symmetrically in the same direction is defined as
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
version
adjustment of the optics of the eye to keep an object in focus on the retina as the distance from the eye varies
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
accomdation
rapid ballistic movement of eye that abruptly change point of fixation is defined as
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
saccades
What can cause a post concussion headache?
occulomotor dysfunction
seizures can cause additional damage due to high _ and _ requirements
oxygen
glucose
This hematoma is a tearing of meningeal vessels results in blood collecting between skull and dura
a. subdural
b. intracerebral
c. epidural
epidural
This hematoma is blood accumulating in the subdural space
a. subdural
b. intracerebral
c. epidural
subdural
This hematoma causes hypoxia to tissues fed by hemorrhaging blood vessels and adds pressure and distortion to brain tissue
a. subdural
b. intracerebral
c. epidural
intracerebral
What are the functional outcome measures you would use?
DRS
FIM/FAM
Hypoxic ischmeia can be (primary/secondary/both) and affects (cognitive/physical/both) function
both - secondary more common
both
Which imaging is looking for a mass lesion and brain shifting?
CT
Which imaging shows differences in metabolism?
PET or SPECT
Which imaging shows cognitive dynamics and overall neuroplasticity?
fMRI
cortical blindness can be due to
coup-countercoup
