TBI Flashcards by Colleen Caribardi

definition: any injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma.

Acquired brain injury (ABI)

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(true/false) TBI is not a type of ABI.

FALSE

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Cerebral palsy is a ___ that occurs before birth.

TBI

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(true/false) The number of people who sustain TBIs and do not seek treatment is UNKNOWN.

true

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___% of persons discharged after acute TBI hospitalizations develop long-term disability

43%

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What is the high risk population of TBI?

Males 0-4 y/o and 15-19 y/o

elderly 65-75 y/o

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Alcohol is a factor in ___% of TBI incidents

50%

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What is the leading cause of TBI?

falls

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Secondary injury after a TBI causes (less/more) damage than the primary injury.

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Contusions, lacerations, and hematomas cause (focal/diffused) damage.

focal damage

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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

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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

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Anoxia/hypoxia is a (ABI/TBI)

ABI (not traumatic)

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What has a worse prognosis… anoxia/hypoxia or TBI?

anoxia/hypoxia due to it having more diffusion

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definition: injury that is a result of the brain’s reaction to trauma or other system failure.

secondary intracranial insults

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Secondary intracranial insults occur primarily due to what?

lack of oxygen (can occur from minutes to days after)

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definition: Collection of blood in between the skull and dura mater

Brief LOC
Lucid interval
Progressive neurological deterioration

epidermal hematoma (EDH)

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What is more common… epidural hematoma or Subdural hemorrhage?

subdural hemorrhage

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What is the key to survival for a person with an epidural hematoma?

early detection

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definition: a collection of blood between dura mater and arachnoid space

subdural hemorrhage (SDH)

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(acute/chronic) SDH is the most lethal of ALL head injuries.

acute SDH

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You can possibly see chronic SDH in the elderly due to _____.

brain atrophy

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definition: a collection of blood in the subarachnoid space (b/w arachnoid and pia mater)

subarachnoid hemorrhage (SAH)

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SAH can potentially cause ______.

arterial vasospasm

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What is the cognitive progression scale?

1. coma 2. vegetative state 3. minimally conscious state 4. low level/traditional 5. 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)