TBI Flashcards
Open injury
direct penetration through the skull to the brain
Examples: gunshot, knife or sharp object, skull fragments, and direct trauma.
Closed injury
without penetration to the skill.
Examples: concussion, contusion, hematoma, injury to extracranial blood vessels, hypoxia, drug overdose, near drowning, acceleration and deceleration injuries.
Primary injury
initial injury to brain sustained by impact.
Examples: skill penetration, skull fractures, contusions to gray and white matter.
Coup lesion
direct lesion of the brain under the point of impact. Local brain damage
Contrecoup lesion
opposite side of brain because of rebound effect after impact
Secondary injury
as a response to initial injury.
Examples: hematoma, hypoxia, ischemia, increased intracranial pressure and post-traumatic epilepsy.
Epidural hematoma
between skull and dura
Subdural hematoma
between dura and arachnoid
Obtundity
state of consciousness characterized by state of sleep, reduced alertness to arousal, and delayed responses to stimuli
Clouding of consciousness
state of consciousness characterized by quiet behavior, confusion, poor attention, and delayed responses.
Concussion grades:
Grade 1
no loss of consciousness.
Symptoms typically resolve within 15 minutes of event.
Athlete should be removed and return only if symptom free for 1 week.
Concussion grades:
Grade 2
moderate head injury with transient confusion that will last longer than 15 minutes.
Receive medical evaluation. CT scan is indicated if symptoms worsen and return to play should be deferred until athlete is asymptomatic for 2 weeks with rest and exertion.
Concussion grades:
Grade 3
loss of consciousness
ER
hospitalization warranted if altered consciousness or mental status persists.
Athlete withheld from competition once symptom free for 1 month. Secondary to diffuse axonal injury and if severe can result in coma.
Rancho Los Amigos Level of Cognitive Functioning:
I. No response
deep sleep and unresponsive
Rancho Los Amigos Level of Cognitive Functioning:
II. Generalized response
reacts inconsistently and non-purposefully to stimuli in a nonspecific manner.
Rancho Los Amigos Level of Cognitive Functioning:
III. Localized response
reacts specifically but inconsistently to stimuli.
may follow simple commands but they are inconsistent and delayed.
Rancho Los Amigos Level of Cognitive Functioning:
IV. Confused-Agitated
heightened state of activity.
Behavior is non-purposeful.
Unable to cooperate directly with treatment.
Verbalizations frequently are incoherent and/or inappropriate to envrionment.
Rancho Los Amigos Level of Cognitive Functioning:
V. Confused-inappropriate
able to respond to simple commands fairly consistently.
Responses are non-purposeful, random or fragmented.
Highly distractable and lacks ability to focus attention.
Verbalization is often inappropriate
Memory is severely impaired
Rancho Los Amigos Level of Cognitive Functioning:
VI. Confused-appropriate
shows goal-directed behavior, but is dependent on external input or direction.
follows simple directions consistently and shows carryover for relearned tasks such as self-care.
Responses may be incorrect due to memory problems, but they are appropriate to the situation.
Rancho Los Amigos Level of Cognitive Functioning:
VII. Automatic-Appropriate
Appropriate and oriented within the hospital and home setting.
Goes through daily routine automatically but frequently robotic like.
Shows minimal to no confusion.
Has shallow recall of activities
Shows carryover for new learning but at a decreased rate.
With structure can initiate social or recreational activities; judgment remains impaired.
Rancho Los Amigos Level of Cognitive Functioning:
VIII. Purposeful-Appropriate
Basically normal but may still show decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress and judgment in emergencies or unusual circumstances.
Additional levels of VIII.
standby assistance upon request
modified indep
Glasgow coma scale scoring
8 or less=
9-12
13-15
severe brain injury or coma
moderate brain injury
mild brain injury
Anterograde amnesia
inability to create new memory.
Usually last to recover after comatose state
Post-traumatic amnesia
Does not recall the injury or events leading up to recovery.
Used as an indicator of extent of damage.
Retrograde amnesia
inability to remember events prior to injury.
May progressively decrease with recovery.
