TBI Flashcards
closed injuries
rapid acceleration/deceleration movement of head, brain strikes skull (blunt external force)
open injuries
object enters brain
primary TBI
at moment of impact
secondary TBI
several days to many weeks after injury
focal injury
- direct blow to head/contact
- collision with external object, fall, penetrating injury
- scalp injury, skull fx, surface contusions
multifocal/diffuse injury
- Includes diffuse axonal injury (DAI), hypoxic-ischemic damage, meningitis, and vascular injury
- caused by acceleration-deceleration forces
- can be due to MVA, bike, skateboard accident, high fall
what score on the GCS is decerebrate rigidity?
2
what score on the GCS is decorticate rigidity?
3
at what RLA level is inpatient rehabilitation phase?
V (confused, inappropriate, nonagitated)
how is apraxia treated?
hand-over-hand activities to repair damaged neural paths, following steps in pics or written on card
what approach to recovery is used during early recovery stages?
remediation/biomechanical
what approach to recovery is used during later recovery stages?
compensatory/rehabilitative
when does the greatest improvement occur for TBI
in the first 5 months
L hemisphere TBI
- language (speech, reading, writing) deficits
- logic deficits
- depression & anxiety
- insight of deficits (anosognosia)
- slow cautious behavior
- easily distractible
- perseveration
R hemisphere TBI
- spatial temporal deficits
- visual-spatial deficits
- poor body scheme/neglect
- lack of insight/poor judgement
- increased safety risk
- difficulty with abstract reasoning
- euphoria
- difficulty perceiving emotions
- impulsive
bilateral TBI
- impaired vision
- confusion
- emotion abnormalities
- short attention span
- memory loss
- poor EF
brain stem TBI
- swallowing & speech difficulties
- unstable vitals
- potential organ failure
frontal brain TBI
- personality changes
- body scheme deficits
- poor problem solving
parietal TBI
- attention deficits
- contralateral neglect
temporal TBI
- agnosia
- prospopagnosia
occipital TBI
- vision impairments
cerebellum TBI
- dysmetria
- delayed reaction time
- ataxia
- tremor
perseveration
repetitive and continuous behavior, speech or thought that occurs due to changes in cognitive skills
dysmetria
can’t control distance, speed & ROM necessary to perform smoothly coordinated movements
ataxia
lack of coordination of involuntary movements
prospopagnosia
face blindness
agnosia
can’t recognize familiar objects via the senses
focus of acute phase of TBI rehab
PHASE 1: in intensive care unit & acute care units of hospitals
- IMPORTANT: wc positioning, inhibit primitive reflexes, increase sitting tolerance, improve respiration/swallowing, interact with environment
- bed positioning
- splinting/casting
- sensory stimulation
- agitation
focus of inpatient rehabilitation phase of TBI rehab
PHASE 2: stimulus specific responses (RLA Level V)
- INITIAL: optimize motor function, motor learning, skill acquisition, exercise (GM)
- ataxia
- apraxia
- visual abilities
- visual-perceptual abilities
- cognitive function
- voice & speech
- competence in self management (dysphagia/self-feeding, bed mobility, wc management, functional emulation, community mobility, transfers, home management, community reintegration)
- mediate problem behaviors (environmental/interactive interventions)
- caregiver support
focus of postacute rehab phase of TBI rehab
PHASE 3 (last): home based therapy, residential program, day tx program, outpatient community re-entry program)
- cognitive function
- visual & visual perceptual
- self-maintainence
- leisure/social participation
- work
- behavioral/emotional adaptation
- caregiver support
TBI splinting
- resting/functional splint: not active/functional
- cone splint: keep fingers from digging into palm
- antispasticity splint: position hand/wrist in functional position, abduct fingers to decrease spasticity
- elbow cast for loss of PROM in elbow flexors
how to manage agitation
- common in acute phase
- behavior management strategies
- track arousal/alertness
- yes/no system with eye blinks, head nods, thumbs up
bed positioning during acute phase of TBI
abnormal tone: lie on side/semi prone
- sensory input
- pillows, foam wedges, splinting
how to treat ataxia
- compensatory strategies for control (weighting body parts, weighted utensil/cup)
how to treat apraxia
- hand over hand exercises
- following steps in pics or written on card
how to optimize vision
- environmental adaptation
- vision correction
- compensatory strategies: contrasting colors, textured tapes, sunglasses
how to optimize visual perceptual abilities
compensatory & rehabilitative
- neglect: encourage use of affected side
- environmental adaptation: moving meal tray to that side
- COMPENSATORY: place all objects in that field of vision for success
how to treat expressive aphasia
- conversation exercises with OT recognizing client errors
- ask client to verbalize what they meant to say
- compensatory: communication devices, pictures, charts
how should dysphagia be treated?
begin feeding instruction in isolated, quiet area to prevent distraction & grade to include social situations
- rocker knife, plate guard, non spill mug
- place fork down between bites to ensure full chew/swallow
how to train in bed mobility
from scooting up/down to rolling, bridging, moving from/to supine, sitting & standing
compensatory devices for functional empulation
walker with bags/baskets, canes, reachers
community mobility AD
scooters, wheelchairs
transfers in PHASE 2 of rehab
difficult due to memory issues
- train caregivers
how are clients in PHASE 2 reintegrated back into community?
community trips to practice IADLs in natural environment
how to decrease/mediate problem behaviors
isolated, quiet room without roommate
- AT: wander guards (wandering)
- environmental cues to orient to place/time
- calm, concise, deliberate speech
- behavioral management programs
how to encourage leisure/social participation in PHASE 3 of TBI rehab
- social skills training groups
- behavior contracts
- role play
- self reflection through video feedback, role modeling
how to restore competence in work in PHASE 3 of TBI rehab
- punctuality/feedback response, follow work schedule
- vocational rehabilitation
what cognitive issues remain in PHASE 3 of TBI rehab?
memory problems, EF
- provide stable/consistent environment
- self awareness
coup
tissue at point of impact
contrecoup
opposite pole
pharmacologic interventions for TBI
antibiotics, anticonvulsants, sedatives, antidepressants
postconcussion syndrome
symptoms continuing for weeks, months, year+ after a concussion
- symptoms usually subside in a few weeks
- symptoms: concussion with/without LOC
- headache, fatigue, cog impairment, dizzy, depressed, impaired balance, irritable, apathy
how is postconcussion syndrome dx?
- exercise testing (treadmill)
- neuropsych eval, vestibular testing
interventions for postconcussion syndrome
- cognitive/physical rest
- CBT
- antidepressants
