TBI Flashcards
Objectives
- Identify physical, cognitive and behavioral deficits common to Traumatic Brain Injured (TBI) patients.
- Explain the role of an interdisciplinary team for rehabilitation of the TBI patient.
- Discuss various clinical rating scales used with TBI patients.
fyi
Resistance of a muscle to passive elongation or stretch
Tone
Hypertonic motor disorder characterized by velocity-dependent resistance to passive stretch; often the result of an upper motor neuron lesion
Spasticity
Hypertonic state characterized by uniform resistance that persists the whole range of motion and is independent of the velocity of the movement; seen in disorders of the basal ganglia (leadpipe)
Rigidity
TBI
Patient care:
- Wide continuum of care; ICU, acute hospitalization, rehab center, community reentry, outpatient, schools, voc rehab, assisted living
- Need strong team concept
- Leading cause of death and disability in young adults
- 50,000 will die due to a TBI each year
- 230,000 will be hospitalized
- 80,000 to 90,0000 people will develop intellectual, behavioral and/or physical disabilities
- MVA: ½ of all TBI, ¼ falls, 15% assaults and violence, 10% sports and recreation
- Men more often than women
- Average: age 15-24
TBI-Epidemiology
- Can have a variety of mechanisms, as mentioned -external forces act on brain tissue
- Acceleration, deceleration and rotational forces of brain relative to bony skull
- Forces can be compression, strain, shearing and displacement
TBI- Pathophysiology
- Local injury to area of brain under site of impact
- Multiple types of injuries: hematoma, edema, contusion. Laceration
- Can have coup-countercoup injury: the brain “bounces”
- Common sites of focal brain injury: anterior-inferior temporal lobes and prefrontal lobes
TBI- Focal injury
- caused by acceleration, deceleration and rotational forces
- Results in shearing and retraction of damaged axons
- Diffuse axonal injury can cause coma
Diffuse axonal injury
- Result from lack of oxygenated blood flow to brain tissue
- Caused by systemic hypotension, anoxia or damage to specific vascular areas of the brain
- Can see global damage
- Associated with poor cognitive function
Hypoxal-Ischemic injuries
If brain swells or fluids increase; what happens to the brain?
- Increased intracranial pressure
- Hematoma
- Mild increase in ICP can cause increased morbidity
- Can see secondary cell death: when there is tissue damage there can be cellular events that follow that create cell death
- MRI and CT
- Also, PET (positron emission tomography) SPECT (single photon emission computerized tomograpy) and fMRI (functional MRI)
- MRI better than CT in terms of soft tissue injuries
- PET, SPECT, fMRI: detect regional blood flow
TBI- Diagnosis
Wide range of neuromuscular, cognitive and behavioral impairments: lead to functional limitations and disability
Sequelae of TBI
- Can present with abnormal tone
- Primitive postures: decorticate and decerebrate rigidity
- Decorticate: UE flexed, LE extended: upper brainstem injury
- Decerebrate: UE and LE extended: lesion in brainstem between vestibular nucleus and superior colliculus
- Will see spasticity
TBI-Neuromuscular Impairments
UE flexed, LE extended: upper brainstem injury
DECORTICATE OR DECEREBRATE
DECORTICATE
UE and LE extended: lesion in brainstem between vestibular nucleus and superior colliculus
DECORTICATE OR DECEREBRATE
Decerebrate
Change in light touch, pain, deep pressure, temperature
Proprioception and kinesthesia may be impaired
Alteration in sensations from Neuromuscular Impairments
- Altered level of consciousness: occurs with acceleration-deceleration injuries and some focal injuries
- COMA: can’t obey commands, can’t utter words, can’t open eyes
- Glasgow Coma Scale: help to identify coma
- Scores < 8 is severe brain injury
- 9-12 moderate brain injury
- 13-15 mild brain injury
- Rancho Los Amigos Levels of Cognitive Functioning
Cognitive impairments of Neuromuscular Impairments
I am able to respond to your simple commands. When my mother walked in the room, I was easily distracted and then began to ramble about something that appeared off subject. I could not remember what you had just instructed me to do.
what level of RLA
Rancho Los Amigos
5
confused- inappropriate
I am responsive to speech; I follow most motor commands and I attempt to talk though my speech is confusing and not well put together. My score = ??
Glasgow coma scale - you’ll need to look up
take a look
- Severely altered consciousness
- Minimal self or environmental awareness
- Will localize noxious stimuli
- Will reach for objects
- Altered LOC
Minimally conscious state of TBI
unresponsive state: pt can be aroused for brief periods of time
Stupor
sleeps often, when aroused exhibits decreased alertness and interest in environment with delayed reactions
Obtunded
- Retrograde amnesia
- Anterograde amnesia
- Posttraumatic amnesia:
TBI Memory
time between injury and time when pt is able to remember ongoing events
Posttraumatic amnesia
recall facts and previous events
Used to explicitly learn
Declarative memory
- How to do motor tasks
- Implicit learning
Procedural memory
- Habits
- Don’t require a lot of conscious thought
- Learn by lots of practice
Implicit learning OF TBI
- Problems with hyperactivity, impulsiveness
- Unable to focus, easy to distract
- Difficult for pt to attain functional skills
- Poor safety awareness
- Executive function cognitive skills may be impaired: volition, planning, purposive action, effective performance
Patient with TBI- Difficulty with attention
- Can be most socially debilitating
- Sexual disinhibition, low frustration tolerance, emotional disinhibition, apathy, aggressive tendencies, depression
- Neuropsychologists treat behavioral disorders
Behavioral Impairments
Can have multiple deficits: reading, writing, aphasia, language skills, dysarthria
Communication Impairments