TBI Flashcards
Risk factors for TBI
Ages 15-24 & 64+, men >women, ETOH, drug abuse, prior brain injury, SES/education, unemployment, divorce, LD/ADHD, psych illness, heart disease & HTN
Glasgow Coma Scale (GCS)
Assesses degree of impaired consciousness via responsiveness level in eye opening, motor mvmt, & verbal communication
What are the advantages of using GCS score for measuring TBI severity?
scores can be determined with 1st 24 hours, predictive of early important outcomes & later functional outcomes
What are the disadvantages of using GCS score for measuring TBI severity?
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
What are factors that complicate the use of initial GCS as a prognostic indicator?
Drugs/ETOH, sedation, intubation, facial injuries, echymosis, delayed deterioration (e.g., slow bleeding SDH)
Time to follow commands following TBI is predictive of
Global outcomes, NP functioning, personal independence, employment
What are the advantages to using time to return to conscious state as a marker for TBI severity?
takes into account early complications, can be obtained during early stages of recovery
What are the disadvantages to using time to return to conscious state as a marker for TBI severity?
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
Posttraumatic amnesia
Phase of recovery from TBI during which the patient is responsive, but acutely confused, disoriented, & unable to form & retain new memories
PTA is predictive of
NP outcome, independent living states, return to work
Using duration of unconsciousness, what is a mild, mod, sev TBI?
Mild: 24 hrs
Using GCS scores, what is a mild/mod/sev TBI?
Mild: 13-15
Mod: 9-12
Sev: 3-8
Using duration of PTA, what is a mild/mod/sev TBI?
Mild: 7 days
Areas of the brain that are most vulnerable to diffuse axonal injury
Frontal & temporal lobes, BG, perinventricular zones, CC, brainstem fiber tracts, superior cerebellar peduncles
Glasgow Outcome Scale
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
Factors predictive of functional outcome after TBI
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
Risk factors for substance abuse following TBI
pre-injury history, onset of depression since injury, better physical functioning, male gender, young age, uninsured, single
Negative predictors of return-to-work following TBI
severity of injury, age >40, low education, greater physical or cognitive impairment, personality change, substance abuse
Positive predictors of return-to-work following TBI
multidisciplinary team approach during acute rehab, socially inclusive work environment, environmental modifications, focus position on strengths of the individual
ACRM mild TBI definition
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
Psychological causes of chronic postconcussion syndrome
Attributions/misattributions Diagnosis threat Expectation as etiology "Good old days" bias Iatrogenesis Nocebo affect
Tetany
Repetitive muscle stimulation by electricity that prolongs contact during electrocution
Second Impact Syndrome
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
What constitutes primary, secondary, tertiary, & quaternary damage secondary to blast injuries?
Primary - blast wave
Secondary - flying debris
Tertiary - blast winds throw individuals into other things
Quaternary - anything else, like burns, toxic inhalations, crush injuries
The younger the child at the time of TBI, the more likely to display
Brain swelling, hypoxic-ischemic insult, diffuse rather than focal injuries
Academic performance in older children following TBI
Academic decline in behavioral terms with increased risk of retention, special ed placement, etc.
Achievement tests tend to be insensitive to their academic changes
Academic performance following TBI in younger children
More likely to demonstrate deficits on standardized achievement tests than older children
Academic performance following TBI in children is predicted by
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)
Factors related to pediatric TBI outcome
Severity, pre- & post-injury family status, treatment received, premorbid fx
Social functioning following pediatric TBI
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
There is empirical support for what treatments following pediatric TBI?
Operant conditioning in decreasing aggressive behaviors, school-based social interventions, cognitive remediation for attention skills, involvement of family member as member of treatment team
Galveston Orientation & Amnesia Test (GOAT)
Test of orientation; starts at 100 & failing items of orientation result in subtractions
Contusions are seen most in what areas?
Orbitofrontal cortex, anterior temporal lobe, posterior portion of superior temporal gyrus & adjacent parietal opercular area
Diffuse axonal injury (DAI)
Breaking/shearing/stretching of myelinated axons due to acceleration/deceleration & rotational injuries
Excitatory amino acids that are produced after DAI have an affinity for receptors that are especially prevalent in the _____ & ______.
Hippocampus & thalamus
Increase in risk in dementia with aging after history of severe TBI
4-5x higher
Risk of 2nd TBI following 1st
8x
Low velocity GSW injuries create contusions at
Entry & contrecoup points
High velocity GSW injuries are more likely to create
Diffuse injury secondary to shock waves & pressure effects
Pathway of electrical current most likely to result in CNS disturbance
Head to foot
Most damage caused by primary blast wave injuries occurs in
Organs that contain air (ears), fluid (stomach/intestines), tissue/air, tissue/fluid interface
