TBI Flashcards
TBI - defintion
- damage to the brain due to a forceful external event
- caused by falls, vehicle accidents, struck, sports accident, or violent assault
TBI - at risk
- adolescent males (sports/risk-takers)
- children under 4 (falls/shaken baby)
- adults over 75 (falls/why?)
closed head injury
- doesn’t break the skull open or penetrate cerebral meninges
- acceleration/deceleration injuries
acceleration/deceleration injuries
brain is accelerating and comes to a sudden stop (whiplash)
- coup contre-coup injury (front = C and back of head = CC)
diffuse axonal shearing
- g-force - angular movement
- twisting and shearing of structures (shaken baby - they have no control)
- more damage than open head
open head TBI
- penetrates the skull into the brain
- specific in location
secondary mechanisms of damage
- increased intracranial pressure (cerebral edema - cut off square of skull to reduce swelling)
- traumatic hydrocephalus (fluid)
- traumatic hemorrhage (bleeding)
- hematoma (pooling of blood)
- post traumatic epilepsy
shaken baby syndrome
- most common cause of TBI and death in children
- damage is due to rotational and accel-decel forces on the child’s brain
military TBI
- improvised explosive devices (IED) creates multiple levels of trauma
- polytrauma - describes various types of trauma following IED blast
types of polytrauma
- primary: over/underpressurization of air b/c of detonation device/weapons
- secondary: result from flying debris
- tertiary: result from being thrown by blast wind (seeing brain differences)
- quaternary: catch all
PTSD
- symptoms overlap
- headache, dizziness, irritability, decreased concentration
- body is reacting to an event in order to process it
- causes physical changes in the body
sports-related TBI
- closed head TBI experienced by athletes
- chronic trauma encephalopathy: brain looks like dementia
- concussion: 2nd hit is multiple times worse if not healed from 1st hit
motor deficits
- gross and fine motor movement deficits, bilateral paresis/paralysis, or contralateral hemiplegia
- isn’t always the brain
- abnormal muscle tone
- swallowing/motor speech disorder
cognitive deficits
- affect level of orientation, attention, memory
- display impulsivity, emotional lability (can’t control), lack of motivation
- coma: not responsive for more than 6 hours
- vegetative state: minimal response, lack consciousness or cognition
- persistent VS: more than 4 years
- post-traumatic amnesia: memory loss after coma/VS
personality changes
- agitation, combativeness (argumentative)
- depression and anxiety
- low frustration tolerance
- impulsivity (don’t think things through)
- insensitivity to societal rules/values (who cares?)
language deficits
- depends on location/extent of damage
- anomia (word-finding), aphasia, decreased arousal
TBI assessment
varies on age, education level, and severity of deficits
assessment of memory
long term, visual, immediate/short-term recall
assessment of arousal
glasgow coma scale or rachos los amigos levels of cognitive functioning for adults
assessment of orientation
person, place, time
assessment of communication, language, cognition
- aphasia (naming), right hemi disorder (conversation, problem-solving), and dementia
- effects must be kept in mind
therapy for TBI
- decreased arousal (awake/alertness)
- attention, problem-solving, working memory deficits
- 2 categories: restorative and compensatory
restorative approach
- rehabilitate lost abilities
- spaced retrieval training (presentation of information over increasingly greater amounts of time)
compensatory approach
- rehearsal training with imaging and visual association
- low tech material device: sticky notes, write on hand
- high tech material device: app, phone calendar
changes affecting academic performance
- difficulty learning and remembering new things
- trouble paying attention/staying focused
- difficulty planning/following through with tasks
