TBI Flashcards
what does the frontal lobe do
commonly injured
judgement
reasoning
executive function
what occurs in the temporal lobe
ability to think
memory
what occurs in the occipital lobe
ability to see
visual functions
what function does the central sulcus provide
helps movement and initiation of movement
what is in the subcortical layer and what functions are provided
basal ganglia and cerebellum
help modify movement
allows smoother movement
What occurs in a brain injury?
cerebrum on a stalk
impact to areas (usually frontal then temporal most common)
hit causes bruising and contusions
- may have tearing or lesions
- fusaxonal injury = widespread
may also occur where brainstem connects to cerebellum due to twisting injury
What are secondary effects after impact on TBI
excitatory amino acids release
these may lead to cell death
what is involved in TBI recovery
decreased swelling
reduction of excitatory amino acids
not much recovery of dead cells
damaged areas can somewhat compensate for others
What is a TBI
Alteration in brain function caused by an external force to the head
What are the most common causes of TBI?
Falls and RTAs
What are the two types of head injuries?
Closed head injuries which do not penetrate the skull
Open head injuries which do penetrate the skull
What is a typical clinical presentation for TBI?
Spasticity,
confusion,
concentration problems,
dizziness,
loss of balance
What age group are at most risk of being hospitalised due to TBI?
Adults aged >65
are at greatest risk of
being hospitalised and dying from TBI.
What assessments can be done for TBI
Clock test for cognition
ROM for spasticity
Timed up and go for gait
2 minute walk test
How is timed up and go performed
Pt in chair with back on back of chair
- Command go
- Walk 3 meters at comfortable pace, turns and walks back to chair and sits down
- Should have a practice trial
- Can use assistive device
For 65+
Has excellent test-retest reliability in stroke according to Flasnbjer et al 2005)
How is the clock drawing test performed?
Ask to drawer clock face
Place numbers on clock
Draw hand to given time
Can be given pre-drawn circle
No one scoring test main aspects are
- correct spacing with even spaces between numbers
- correct placement of 3,6,9,12
- correct in between numbers
- placement of clock hands correct
How is the 2 minute walk test performed
- Walk as far as possible in 2 minutes
- Can use walking aids
- Should be independently mobile
~ 15m course
What are predicted distances for populations in the 2-minute walk test?
Women 260 - (0.7 x age) - (1.7 x BMI)
Men 280 - (0.9 x age) - (1.4 x BMI)
What are possible mobility exercises for TBI?
Co-ordination: throwing and catching, reaching forwards
Dressing / putting sock on - functional
Passive ROM for affected limbs
What are possible strengthening exercises for TBI?
Functional exercises such as sit to stand
Moving can on and off shelf
Squats
Lungs
Leg lifts
Bicep curls
Sit to stand
Tandem stance
Leg abductions
what education can be provided to TBI patients?
Symptoms
Precautions to avoid further injury e.g. bike helmet and seat belt
Remove potential hazards and install hand rails
Potential challenges faced
- Neurological deficits may lead to loss of independence, strain on relationships, ADLs become difficult, stairs at home potential challenge
What cognitive advice can be provided to TBI patients?
Minimise distractions
What home exercise can be provided to TBI patients?
Muscle strengthening- leg lifts, squats, bicep curls.
Balance- tandem stands, stand eyes closed, stand on one leg.
What should TBI patients be encouraged to do?
Encourage participation in community events e.g. volunteering, hobbies
Talk to family about receiving help where possible.
What warm up exercises can be provided for TBI patients.
Seated marching
Head circles.
Across body arm stretch
what cool down exercises can be provided for TBI patients?
Seated leg stretch
Side trunk flexion stretch
Arm circles
What safety considerations need to be considered for TBI patients?
Should be done at 40%-70% of peak oxygen uptake
13/20 RPE
Consider cognitive impairments when doing exercise that may cause them to take greater risks
How is spasticity assessed?
Place hands and wait
Move limb slowly to assess available PROM from inner to outer range
Limb moved through available range at different speeds- assess presence or absence of a catch and how this catch varies in speeds
Change in direction of motion of joint at various speeds and assess resistance
What are contraindications / cautions in spasticity assessments?
Haemophilia
Osteoporosis
Fracture joint instability
Severe pain
Osteomyelitis
Acute joint infection
DVT
Flaccidity
What are ways of moving when there is spasticity?
Bend hip to bend knees
this helps to reduce spasm
Should ensure feet are on foot plates on wheelchairs
