TBI

Question 1

Risk factors for TBI

Answer 1

Ages 15-24 & 64+, men >women, ETOH, drug abuse, prior brain injury, SES/education, unemployment, divorce, LD/ADHD, psych illness, heart disease & HTN

Question 2

Glasgow Coma Scale (GCS)

Answer 2

Assesses degree of impaired consciousness via responsiveness level in eye opening, motor mvmt, & verbal communication

Question 3

What are the advantages of using GCS score for measuring TBI severity?

Answer 3

scores can be determined with 1st 24 hours, predictive of early important outcomes & later functional outcomes

Question 4

What are the disadvantages of using GCS score for measuring TBI severity?

Answer 4

which GCS score to use (post-resuscitation, ER admission, etc.), can be affected by early management (intubation, sedating meds), limited in pts w/ aphasia or facial injuries

Question 5

What are factors that complicate the use of initial GCS as a prognostic indicator?

Answer 5

Drugs/ETOH, sedation, intubation, facial injuries, echymosis, delayed deterioration (e.g., slow bleeding SDH)

Question 6

Time to follow commands following TBI is predictive of

Answer 6

Global outcomes, NP functioning, personal independence, employment

Question 7

What are the advantages to using time to return to conscious state as a marker for TBI severity?

Answer 7

takes into account early complications, can be obtained during early stages of recovery

Question 8

What are the disadvantages to using time to return to conscious state as a marker for TBI severity?

Answer 8

interval can affected by sedation, difficult to interpret behaviors & fluctuations in MS, not immediately available for early prediction of outcome, no commonly agreed upon classification scheme, often not available to later-treating physicians

Question 9

Posttraumatic amnesia

Answer 9

Phase of recovery from TBI during which the patient is responsive, but acutely confused, disoriented, & unable to form & retain new memories

Question 10

PTA is predictive of

Answer 10

NP outcome, independent living states, return to work

Question 11

Using duration of unconsciousness, what is a mild, mod, sev TBI?

Answer 11

Mild: 24 hrs

Question 12

Using GCS scores, what is a mild/mod/sev TBI?

Answer 12

Mild: 13-15
Mod: 9-12
Sev: 3-8

Question 13

Using duration of PTA, what is a mild/mod/sev TBI?

Answer 13

Mild: 7 days

Question 14

Areas of the brain that are most vulnerable to diffuse axonal injury

Answer 14

Frontal & temporal lobes, BG, perinventricular zones, CC, brainstem fiber tracts, superior cerebellar peduncles

Question 15

Glasgow Outcome Scale

Answer 15

Death
Vegetative state
Severe disability (requires assistance to meet basic needs)
Moderate disability (unable to return to non-sheltered work or resume other major roles)
Good recovery

Question 16

Factors predictive of functional outcome after TBI

Answer 16

Pre-injury employment status, demographic variables, injury severity, CC atrophy, physical impairments, early cognitive status, post-injury depression, impaired self-awareness, early fx status, family support, post-acute brain injury rehab

Question 17

Risk factors for substance abuse following TBI

Answer 17

pre-injury history, onset of depression since injury, better physical functioning, male gender, young age, uninsured, single

Question 18

Negative predictors of return-to-work following TBI

Answer 18

severity of injury, age >40, low education, greater physical or cognitive impairment, personality change, substance abuse

Question 19

Positive predictors of return-to-work following TBI

Answer 19

multidisciplinary team approach during acute rehab, socially inclusive work environment, environmental modifications, focus position on strengths of the individual

Question 20

ACRM mild TBI definition

Answer 20

A traumatically induced physiological disruption of brain fx: any LOC, any loss of memory for events before/after accident, any alteration in MS at time of accident, focal neuro deficits that may/may not be transient

Severity of injury does not exceed: LOC of 30 mins or less, initial GCS of 13-15 after 30 mins, PTA not >24 hrs

Question 21

Psychological causes of chronic postconcussion syndrome

Answer 21

Attributions/misattributions
Diagnosis threat
Expectation as etiology
"Good old days" bias
Iatrogenesis
Nocebo affect

Question 22

Tetany

Answer 22

Repetitive muscle stimulation by electricity that prolongs contact during electrocution

Question 23

Second Impact Syndrome

Answer 23

When a 2nd TBI is sustained before the physiological reactions to the prior injury have resolved; diffuse swelling within hours of even mild injury that is likely the result of compromised cerebral autoregulation

Question 24

What constitutes primary, secondary, tertiary, & quaternary damage secondary to blast injuries?

Answer 24

Primary - blast wave
Secondary - flying debris
Tertiary - blast winds throw individuals into other things
Quaternary - anything else, like burns, toxic inhalations, crush injuries

Question 25

The younger the child at the time of TBI, the more likely to display

Answer 25

Brain swelling, hypoxic-ischemic insult, diffuse rather than focal injuries

Question 26

Academic performance in older children following TBI

Answer 26

Academic decline in behavioral terms with increased risk of retention, special ed placement, etc.

Achievement tests tend to be insensitive to their academic changes

Question 27

Academic performance following TBI in younger children

Answer 27

More likely to demonstrate deficits on standardized achievement tests than older children

Question 28

Academic performance following TBI in children is predicted by

Answer 28

Premorbid academic fx, postinjury NP fx, postinjury bx adjustment, family environment, age at injury (preschool injury assoc. w/ school failure & slower acquisition of academic skills)

Question 29

Factors related to pediatric TBI outcome

Answer 29

Severity, pre- & post-injury family status, treatment received, premorbid fx

Question 30

Social functioning following pediatric TBI

Answer 30

Rated as less socially competent & lonelier than peers, poor social outcomes persist over time, relationship b/t injury & social outcome moderated by poor family fx, lower SES, lack of family resoources

Children w/ frontal lobe injury more likely to have problems

Question 31

There is empirical support for what treatments following pediatric TBI?

Answer 31

Operant conditioning in decreasing aggressive behaviors, school-based social interventions, cognitive remediation for attention skills, involvement of family member as member of treatment team

Question 32

Galveston Orientation & Amnesia Test (GOAT)

Answer 32

Test of orientation; starts at 100 & failing items of orientation result in subtractions

Question 33

Contusions are seen most in what areas?

Answer 33

Orbitofrontal cortex, anterior temporal lobe, posterior portion of superior temporal gyrus & adjacent parietal opercular area

Question 34

Diffuse axonal injury (DAI)

Answer 34

Breaking/shearing/stretching of myelinated axons due to acceleration/deceleration & rotational injuries

Question 35

Excitatory amino acids that are produced after DAI have an affinity for receptors that are especially prevalent in the _____ & ______.

Answer 35

Hippocampus & thalamus

Question 36

Increase in risk in dementia with aging after history of severe TBI

Answer 36

4-5x higher

Question 37

Risk of 2nd TBI following 1st

Answer 37

8x

Question 38

Low velocity GSW injuries create contusions at

Answer 38

Entry & contrecoup points

Question 39

High velocity GSW injuries are more likely to create

Answer 39

Diffuse injury secondary to shock waves & pressure effects

Question 40

Pathway of electrical current most likely to result in CNS disturbance

Answer 40

Head to foot

Question 41

Most damage caused by primary blast wave injuries occurs in

Answer 41

Organs that contain air (ears), fluid (stomach/intestines), tissue/air, tissue/fluid interface