TBI

Question 1

what does the frontal lobe do

Answer 1

commonly injured
judgement
reasoning
executive function

Question 2

what occurs in the temporal lobe

Answer 2

ability to think
memory

Question 3

what occurs in the occipital lobe

Answer 3

ability to see
visual functions

Question 4

what function does the central sulcus provide

Answer 4

helps movement and initiation of movement

Question 5

what is in the subcortical layer and what functions are provided

Answer 5

basal ganglia and cerebellum
help modify movement
allows smoother movement

Question 6

What occurs in a brain injury?

Answer 6

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

Question 7

What are secondary effects after impact on TBI

Answer 7

excitatory amino acids release
these may lead to cell death

Question 8

what is involved in TBI recovery

Answer 8

decreased swelling
reduction of excitatory amino acids
not much recovery of dead cells
damaged areas can somewhat compensate for others

Question 9

What is a TBI

Answer 9

Alteration in brain function caused by an external force to the head

Question 10

What are the most common causes of TBI?

Answer 10

Falls and RTAs

Question 11

What are the two types of head injuries?

Answer 11

Closed head injuries which do not penetrate the skull
Open head injuries which do penetrate the skull

Question 12

What is a typical clinical presentation for TBI?

Answer 12

Spasticity,
confusion,
concentration problems,
dizziness,
loss of balance

Question 13

What age group are at most risk of being hospitalised due to TBI?

Answer 13

Adults aged >65
are at greatest risk of
being hospitalised and dying from TBI.

Question 14

What assessments can be done for TBI

Answer 14

Clock test for cognition
ROM for spasticity
Timed up and go for gait
2 minute walk test

Question 15

How is timed up and go performed

Answer 15

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)

Question 16

How is the clock drawing test performed?

Answer 16

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

Question 17

How is the 2 minute walk test performed

Answer 17

• Walk as far as possible in 2 minutes
• Can use walking aids
• Should be independently mobile
  ~ 15m course

Question 18

What are predicted distances for populations in the 2-minute walk test?

Answer 18

Women 260 - (0.7 x age) - (1.7 x BMI)
Men 280 - (0.9 x age) - (1.4 x BMI)

Question 19

What are possible mobility exercises for TBI?

Answer 19

Co-ordination: throwing and catching, reaching forwards
Dressing / putting sock on - functional
Passive ROM for affected limbs

Question 20

What are possible strengthening exercises for TBI?

Answer 20

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

Question 21

what education can be provided to TBI patients?

Answer 21

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

Question 22

What cognitive advice can be provided to TBI patients?

Answer 22

Minimise distractions

Question 23

What home exercise can be provided to TBI patients?

Answer 23

Muscle strengthening- leg lifts, squats, bicep curls.
Balance- tandem stands, stand eyes closed, stand on one leg.

Question 24

What should TBI patients be encouraged to do?

Answer 24

Encourage participation in community events e.g. volunteering, hobbies
Talk to family about receiving help where possible.

Question 25

What warm up exercises can be provided for TBI patients.

Answer 25

Seated marching
Head circles.
Across body arm stretch

Question 26

what cool down exercises can be provided for TBI patients?

Answer 26

Seated leg stretch
Side trunk flexion stretch
Arm circles

Question 27

What safety considerations need to be considered for TBI patients?

Answer 27

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

Question 28

How is spasticity assessed?

Answer 28

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

Question 29

What are contraindications / cautions in spasticity assessments?

Answer 29

Haemophilia
Osteoporosis
Fracture joint instability
Severe pain
Osteomyelitis
Acute joint infection
DVT
Flaccidity

Question 30

What are ways of moving when there is spasticity?

Answer 30

Bend hip to bend knees
this helps to reduce spasm
Should ensure feet are on foot plates on wheelchairs