TBI Flashcards
definition: any injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma.
Acquired brain injury (ABI)
(true/false) TBI is not a type of ABI.
FALSE
Cerebral palsy is a ___ that occurs before birth.
TBI
(true/false) The number of people who sustain TBIs and do not seek treatment is UNKNOWN.
true
___% of persons discharged after acute TBI hospitalizations develop long-term disability
43%
What is the high risk population of TBI?
Males 0-4 y/o and 15-19 y/o
elderly 65-75 y/o
Alcohol is a factor in ___% of TBI incidents
50%
What is the leading cause of TBI?
falls
Secondary injury after a TBI causes (less/more) damage than the primary injury.
More
Contusions, lacerations, and hematomas cause (focal/diffused) damage.
focal damage
definition: scattered areas of hemorrhage or bruising usually along the undersurface of the frontal and temporal lobes due to the brain striking a ridge on the skull or dural fold. Seen with individuals with a serious head injury and often accompanied with SDH or EDH
contusions
definition:
TBI caused by:
Acceleration/Deceleration of the brain in the skull
Shearing and rotational forces
Axonal disruption in cerebrum, cerebellum and brainstem
Widespread/diffuse damage
Can now be found on imaging
Diffuse axonal injury
Anoxia/hypoxia is a (ABI/TBI)
ABI (not traumatic)
What has a worse prognosis… anoxia/hypoxia or TBI?
anoxia/hypoxia due to it having more diffusion
definition: injury that is a result of the brain’s reaction to trauma or other system failure.
secondary intracranial insults
Secondary intracranial insults occur primarily due to what?
lack of oxygen (can occur from minutes to days after)
definition: Collection of blood in between the skull and dura mater
Brief LOC
Lucid interval
Progressive neurological deterioration
epidermal hematoma (EDH)
What is more common… epidural hematoma or Subdural hemorrhage?
subdural hemorrhage
What is the key to survival for a person with an epidural hematoma?
early detection
definition: a collection of blood between dura mater and arachnoid space
subdural hemorrhage (SDH)
(acute/chronic) SDH is the most lethal of ALL head injuries.
acute SDH
You can possibly see chronic SDH in the elderly due to _____.
brain atrophy
definition: a collection of blood in the subarachnoid space (b/w arachnoid and pia mater)
subarachnoid hemorrhage (SAH)
SAH can potentially cause ______.
arterial vasospasm
What is the cognitive progression scale?
- coma
- vegetative state
- minimally conscious state
- low level/traditional
- high level
definition: “Represents a state of unarousable responsiveness in which the eyes remain continuously closed and there is no understandable response to environmental or intrinsic stimulation”
coma
definition: “A state with no sign of conscious awareness of self or environment but with preserved autonomic or ‘vegetative’ functions, typically including eye opening and sleep/wake cycles”
vegetative state
definition: “A condition of severely altered consciousness in which minimal, but definite behavioral evidence of self or environmental awareness is demonstrated”
minimally conscious state (MCS)
What are medical complications of TBI?
- hypermetabolism (catabolism
- Elevated rested energy expenditure
- electrolyte imbalance (hyponatremia)
- SIADH
- hypotension/ HTN
- tachycardia
- increased CO
- ANS dysfunction (PSH)
- DVT
- arrythmias
- ARDS
- apnea
- decreased O2 saturation
Hyponatremia is a deficit in ____ levels.
sodium
hydrocephalus is often due to what type of hemorrhage?
subarachnoid
What is the treatment for hydrocephalus?
ventriculoperitoneal shunt
A person with TBI is more susceptible to (early/late) seizures related to increased ICP
early
What are the risk factors for HO?
- multiple limb Fx
- immobility
- prolonged unconsciousness
- increased muscle tone
- high velocity accidents
What are clinical signs of HO?
- warmth
- redness
- decreased ROM
- pain
- swelling/edema
What are the functions of the frontal lobe?
Executive functions
emotions
attention
motor component of speech (Broca’s area)
Primary motor cortex
definition: bruising around the ear
battle’s sign
What are the functions of the temporal lobe?
primary auditory cortex
comprehension and expression of language
memory
learning
vestibular issues (Raccoon eyes and battle’s sign)
What does temporal lobe dysfunction cause?
petit mal seizures
poor short-term memory
explicit memory deficit
storage and retrieval loss
loss of auditory processing
wernicke’s aphasia
Receptive/fluent aphasia
wernicke’s aphasia
Expressive/non-fluent aphasia
broca’s aphasia
What are the functions of the parietal lobe?
primary sensory area
orientation of time and space
object recognition
processing of somatic and visual information
ability to process written information
What does parietal lobe dysfunction cause?
Visual-spacial deficits (inattention)
Difficulty recognizing objects (agnosia)
touch, proprioception, and pressure sensory loss
loss of ability to read and write
loss of right/left discrimination
definition: difficulty recognizing objects
agnosia
definition: loss of ability to read
alexia
What are the occipital lobe functions?
vision
What does occipital lobe dysfunction cause?
visual agnosia
field cuts
nystagmus
cortical blindness
What are the functions of the cerebellum?
Coordination
postural control
balance
Vestibulo-ocular function
unconscious proprioception
What does cerebellar dysfunction cause?
hypotonia
incoordination/ataxia
decomposition of movements
intention tremor
dysmetria
Wide BOS
scissoring gait
Vestibulo-ocular deficits
balance disorders
proprioceptive/kinesthetic loss
What is one of the cardinal signs of cerebellar damage?
ataxia
Hypotonicity occurs on the (ipsilateral/contralateral/both) side(s) of the cerebellar lesion if it is NOT central
ipsilateral side
Hypotonicity occurs on the (ipsilateral/contralateral/both) side(s) of the cerebellar lesion if it is central
both sides
What are the functions of the brainstem?
CVP control
reflexes
postural tone
autonomic function
swallow/gag reflex
What does brainstem dysfunction cause?
apnea
arrythmias
rigidity
diplopia
dysarthria
dysphagia
CN disorder
Disorder of conscious state
locked-in syndrome
What is the first thing to do when experiencing a person with a TBI in emergent situations?
ABC’s (airway, breathing, circulation)
What should the ICP be in an adult lying in supine?
0-10 mmHg
What should the CPP be in an adult?
80-100 mmHg
What MAP range is needed to maintain cerebral blood flow?
50-100 mmHg
What are s/s of elevated or increasing ICP?
Change in arousal
Disorientation, confusion, combativeness
Change in cranial nerve exam
Pupil changes
Altered RR
Altered HR, rhythm
Altered BP
Increased posturing, tone
Decreased motor response
Increased temperature
HA/N/V
How should you as a PT help prevent secondary complications of TBI?
- maintain ROM
- optimize positioning
- integumentary care
What signs show positive prognosis for a person when emerging from unresponsiveness?
- young age
- reactive pupils and conjugate eye movements
- decorticate posturing
- early spontaneous eye opening
- absence of ventilator and/or hydrocephalus
- shorter time period between injury and rehab
- higher DRS score
- early rapid functional improvement
definition: Traumatically induced physiological disruption of brain function with at least one of the following:
- Any period of loss of consciousness
- Any loss of memory for events immediately before or after the trauma
- Any alteration in mental status at the time of the trauma
- Focal neurological deficits that may or may not be transient
mild TBI
definition: When the severity of the injury exceeds the following:
LOC > 30 min
After 30 min, initial GCS of < 12
Post-traumatic amnesia > 24 hours
Cognitive/behavioral problems = major long-term source of disability
moderate/severe TBI
(true/false) Those with a moderate /severe TBI usually do not physically recover.
FALSE (they usually physically recover well)
What is another name for a mild TBI?
concussion
Pharmacology:
MOA: not entirely known.
- Facilitates dopamine release.
- Glutamate antagonist.
Used to reduce agitation in severe TBI
Also used as a psychostimulant for those in the VS/MCS
Side effects: Orthostasis, peripheral edema, livedo reticularis, lowers seizure threshold, hallucinations
amantadine (symmetrel)
Pharmacology:
MOA: enhances dopaminergic transmission
Uses:
- Attention
- Mood
- Alertness
- Arousal
- information processing
Side effects: tachycardia, insomnia, decreased appetite, GI upset, headaches, dizziness, motor tics, irritability, anxiousness, tearfulness
Methylphenidate (Ritalin)
pharmacology:
MOA: dopamine agonist
Uses:
- Parkinson’s disease for autonomic regulation, motor control, and arousal
Side effects: orthostatic hypotension, nausea/vomiting, vertigo, edema, headaches, dyskinesias, dystonia, sleep disturbance, hypersexuality
bromocriptine (Parlodel)
