TBI Flashcards
the result of abrupt external forces acting on the skull and the brain
TBI
It was noted a higher percentage of TBI is reported in the regions of ____ and _____
56% – Africa and Southeast Asia
in ______ countries experience nearly 3 times more TBI cases
lower middle income countries
the cause of the overall traumatic death or it’s considered the 3rd most common cause of overall death due to TBI
central nervous system
Etiologies of TBI
falls, vehicular accidents, violent assaults, being hit by or running into an object
Risk factors of TBI
Age
sex
substance abuse
School adjustments and social history
Socioeconomic status
Personality
Hx of TBI
High risk sports
young _____ adults are more likely to experiences head injuries
male
2 types of head injuries
penetrating head injuries (open TBI)
non-penetrating head injuries
Happens when an object pierces the skull and enters the brain tissue
penetrating head injuries (open TBI)
Typically damages only a part of a brain
penetrating head injuries (open TBI)
pathophysiology of penetrating head injuries (open TBI)
missiles, some by blunt object, and a few by falls
The degree and nature of damage caused by the missile are dependent on the ___________
velocity of the missile
how does penetrating brain injury happen
High-velocity missile perforates the skull and tunnel through the brain before exiting to the opposite side of the entry
High-velocity missiles create ____ that destroys the tissue on both sides of the projectile’s track and diffuses bleeding and tissue disruption throughout the brain and the brainstem
pressure wave
Almost always fatal within minutes to hours
penetrating head injuries (open TBI)
________ are less often fatal
Low velocity injuries
Perforates the skull and brain causing tissue damage adjacent to the missile’s track
Low velocity injuries
May fracture the skull
Damage to the brain may be mild
Low velocity injuries
High mortality for penetrating injury caused by a ________
handgun
threats after the first day of injury
Infection
Bleeding
Increased intracranial pressure
Another term for Closed Head Injury or Blunt TBI
NON-PENETRATING HEAD INJURIES
Caused by an external force or strong enough to move the brain within the skull
NON-PENETRATING HEAD INJURIES
type of TBI where there is NO VISIBLE WOUND
NON-PENETRATING HEAD INJURIES
trauma is damaging the brain because of the force affecting the intracranial contents
NON-PENETRATING HEAD INJURIES
Deformation of the skull at the point of impact
Non-acceleration injury
types of NON-PENETRATING HEAD INJURIES
Non-acceleration injury (fixed head trauma)
Acceleration injury (moving head trauma)
Traumatic hemorrhage
The primary consequences of non-acceleration injuries
related to the deformation of the skull by the impact of the object striking the skull
Localized damage to the meninges and the brain cortex at the point of impact
impression trauma
there’s damage in the meninges and it’s not really clear whether it’s caused by the impact of the depressed skull against the brain or by the negative pressure that develops when the skull snaps back
impression trauma
The skull is forced from oval shape to circular shape d/t a slow-moving object with a large surface
ellipsoidal deformation
true or false
Fractures at the base of the skull are more dangerous than fractures higher up
true
because basal skull fractures may damage cranial nerves or the carotid arteries and that could actually endanger the patients life
The movement is caused by inertial forces
acceleration injury
Refers to when a TBI is caused by a sudden acceleration or deceleration of the head the brain and brain stem often suffer diffuse damage caused by their movement inside the skull.
acceleration injury
this type of non-penetrating injury depends on the direction from which the head is struck.
acceleration injury
this occurs when the head is struck by a force aligned with the center axis of the head
Linear acceleration injuries
One is initially resting and there is a lag in the movement (does not move in the same time with the skull) so that might cause bruises or abrasions because of the compression of the brain against the skull
coup injuries
Associated with a moving object impacting a stationary head
coup injury
Moving head (brain) strikes a stationary object
countrecoup
Occurs more likely after blows to the front or back of the head than blows to the side of the head
translational trauma
Combination of coup and contrecoup injuries
translational trauma
Occurs only with linear acceleration and deceleration of the head
translational trauma
Caused by blows that strike the head off-center
Angular Acceleration Injuries
it can cause the brain to retate (rotate) and move it an angle away from the point of impact
Angular Acceleration Injuries
these are common with acceleration injuries to the brain.
cranial nerve injuries
true or false
Diffuse axonal injury → diffuse cognitive and behavioral impairments
true
This might result in the stretching of the nerve cell axons throughout the brain and the brainstem. This is what we call diffuse axonal injury, which can result to diffuse cognitive and behavioral impairments.
Cuts, bruises, twisting, and shearing forces in the brain cause bleeding (hemorrhages) and accumulations of blood (hematomas).
traumatic hemorrhage
most common (type?) of traumatic hemorrhage
Epidural hematomas
signs and symptoms of TBI
Physical Problems
Sensory Problems
Behavior Changes
Social Communication Issues
Swallowing Problems
Problems w/ Thinking Skills
speech and language problem
signs and symptoms
physical problems
Headache
Convulsions or seizures
Blurred or double vision
Unequal eye pupil size or dilation
Clear fluids draining from the nose or ears
Nausea and vomiting
New neurologic deficit (slurred speech; weakness of arms, legs, or face; loss of balance)
signs and symptoms
sensory problems
Light-headedness, dizziness, vertigo, or loss of balance or coordination
Blurred vision
Hearing problems, such as ringing in the ears
Bad taste in the mouth
Sensitivity to light or sound
Mood changes or swings, agitation, combativeness, or other unusual behavior
Feeling anxious or depressed
Fatigue or drowsiness
what type of signs and symptoms
Loss of or change in consciousness anywhere from a few seconds to a few hours
cognitive/behavioral changes
signs and symptoms
cognitive/behavioral changes
Decreased level of consciousness (e.g., hard to awaken)
Mild to profound confusion or disorientation
Problems remembering, concentrating, or making decisions
Changes in sleep patterns
frustration, irritability
may require only resting and over the counter pain relievers
mild TBI
2 types of severity
mild TBI and severe TBI
Treatment focuses on symptom relief and brain rest.
mild TBI
type of severity wherein Surgery, Medications, Rehabilitation and Over the counter drugs are usually prescribed
severe TBI
OTC medicine for severe TBI
anticonvulsant drugs that are used to treat ____
seizures
OTC medicine for severe TBI
anticoagulants to prevent ________
blood clots
OTC medicine for severe TBI
_______ to increase the awareness
stimulants
OTC medicine for severe TBI
________ to reduce fluid build up and reduce pressure in the brain
diuretics
OTC medicine for severe TBI
__________ and _________ to treat the feelings of fear and nervousness
antidepressants and anti-anxiety medications
levels of consciousness
coma
vegetative state
minimally conscious state
pathologic unconsciousness in which the patient’s eyes are continuously closed and in which the patient cannot be aroused.
coma
a condition in which the patient’s awareness of self and his or her environment are presumed absent.
vegetative state
a condition in which the patient makes minimal but unmistakable evidence of consciousness.
minimally conscious state
Typically resolves within 3 to 4 weeks of injury
coma
TBI diagnostic imaging
Computed tomography (CT)
Magnetic resonance imaging (MRI)
immediate assessment
head injuries and the neurological exam
this exam will judge motor and sensory skills testing speech, coordination and balance, mental status, changes in mood or behavior, and other abilities
Neuropsychological tests
Glasgow Coma Scale
This would involve looking into the cognitive behavioral aspects as well as the symptoms.
Prognosticating Factors for TBI
Duration of Coma
Patient-Related Variables
Duration of Posttraumatic Amnesia
duration of coma indicates that ___
Longer durations of coma are associated with poorer eventual recovery
Good recovery is expected the sooner the patient recovers from the coma
patient-related variable is defined in terms of ___
how old the patient is (because older patients with TBI had higher mortality rates than due younger patients)
If the patient has a good score and GOAT, that would actually correlate to a ________
better prognosis
duration of post-traumatic amnesia can be assessed using ____
Glasgow coma scale or GOAT
type of assessment test wherein it is usually used to track the recovery of orientation and memory for patients with TBIs from coma
GOAT, or the Galveston Orientation & Amnesia Test
5 Managements given to TBI px
Sensory stimulation and orientation
Behavior management
Pharmacologic intervention
Cognitive-communication rehabilitation
Community integration
the goal/purpose of this management is to increase the patient’s alertness, arousal, and responsiveness to the environment and prevent sensory deprivation
sensory stimulation
On early intervention _______ (type of collaboration) is important to maximize the recovery and they have a better prognosis for the patient
interdisciplinary
this is an intervention for comatose or semi-comatose patients
sensory stimulation (coma stimulation or coma arousal therapy; repeated exposure to auditory, visual, tactile, olfactory and taste stimulation)
Complements orientation training and environmental control by incorporating procedures to increase adaptive behavior or decrease maladaptive behavior
behavior management
General Principles of Sensory Stimulation
- Control the environment to eliminate distraction
- Ensure that the patient is comfortable before beginning stimulation
- Stimulate one modality at a time
- Stimulate acoustic, tactile, olfactory, and kinesthetic senses
- Select meaningful stimuli
- Alternate intervals of no stimulation with intervals of stimulation prevent habituation and support the patient’s sense of the passage of time
- Keep objective observational records of the nature and patient’s response to each stimulation interval
true or false
Patients with TBI who are in the early stages of recovery usually are NOT affected by intangible consequences or information feedback
true
They are more responsive to the tangible / incentive feedback
true or false
incorporating procedures to increase adaptive behavior or decrease maladaptive behavior, you can also provide information feedback
true
Providing the patient with information about the appropriateness or correctness of his response to the stimuli
2 types of feedback
incentive and information feedback
Denotes a class of response-contingent stimuli that can maintain (or eliminate) behaviors whose only function is to elicit (or avoid) the stimuli
incentive feedback
Denotes a class of stimuli that provides information about the appropriateness, correctness, or accuracy of the responses that elicit the stimuli
information feedback
It provides restorative intervention to repair compromised cognitive-communication processes
cognitive-communication rehabilitation
true or false
if restorative approaches alone doesn’t work, you might try compensatory interventions or the adaptive interventions
true
For example, for disoriented patients you might use the visual aids for those who are suffering from attention, visual stimuli might also be used depending on how the patient responds to the external aids.
type of cog-com rehab
mental muscle building
restorative intervention (remedial)
type of cog-com rehab
focus on adaptive behaviors rather than cognitive processes compared to the restorative which seeks to promote the patient’s independence by treating the specific cognitive processes
Compensatory interventions
To stimulate and reactivate cognitive and linguistic processes
component training
You treat them to restore the impaired process (linguistic & cognitive)
component training
FINAL STAGE of rehabilitation for patients with TBI to be able to access the opportunity to participate in family, vocational, and community settings
COMMUNITY INTEGRATION
Participants spend part of their day working on their specific strategies that would make them practice their daily living skills, working on groups— they will discuss problems and potential solution, and provide emotional support to each other
COMMUNITY INTEGRATION
