TBI Flashcards
1
Q
What is the GCS for mild TBI
A
13-15
2
Q
what is the GCS for moderate TBI
A
9-12
3
Q
What is the GCS for severe TBI
A
less then 9
4
Q
what is the time of post traumatic amnesia (PTA) /memory loss in mild concussion
A
less then one day
5
Q
what is the time of post traumatic amnesia (PTA) /memory loss in moderate concussion
A
1 day to 1 week
6
Q
what is the time of post traumatic amnesia (PTA) /memory loss in severe
A
more then 1 week
7
Q
decerebate positioning
A
extension
8
Q
decoreticate positioning
A
flexion
9
Q
LOC in mild TBI
A
less then 30 minutes
10
Q
LOC in moderate TBI
A
30 minutes to 24 hours
11
Q
LOC in severe TBI
A
more then 24 hours
12
Q
what are the red flags that would indicate taking a concussion patient to the ER because they might indicate a brain bleed
A
- worsening dizziness or vertigo
- worsening disequilibrium
- worsening headache
- double vision
- loss of coordination
- N/V
13
Q
Imaging for Mild TBI
A
normal imaging - but not normal “function” due to secondary chemical changes in the brain
14
Q
if concussion S/S remain for longer then (blank) weeks then seek medical attention
A
3 weeks
15
Q
what are the four major events that lead to the secondary complications of TBI
A
1) Axonal damage (shearing)
2) Neuroinflammation
3) ionic dysfunction leading to an increased in glutamine (excitotoxicity)
4) decreased metabolic function leading to an energy crisis
16
Q
increased metabolic function/hypermetabolism in the brain leads to
A
- inability to process information efficiently
- reduction in processing duel task
- reduced attention
- fatigue
- leads to susceptibility for repeat injury
17
Q
what are the vestibular inputs
A
1) head rotation
2) head linear acceleration
18
Q
what are the outputs of the vestibular system
A
1) Eyes (CN3 and CN6)
2) cerebellum for coordination
3) lateral vest tract for LE extensor tone
4) medial vest for C/S, T/S and UE orientation
19
Q
what are S/S of damage to the vestibular system in a concussion
A
dizziness and vertigo; disruption in timing
20
Q
Post concussion syndrome
A
concussion S/S lasting longer then 6 weeks problems with motor, behavior, and cognitive
21
Q
what does neuroinflammation lead to
A
- brain changes
- low hippocampal volume (memory)
- increased risk for cell death
- smaller thalamus (decreased processing speed)
- risk of limbic suppy
22
Q
migrane headache
A
bilateral presents as throbbing or pulsing
23
Q
tention headache
A
one side
24
Q
what are the S/S of WAS
A
headaches, neck pain, memory, concentration, tinnitus
25
what are the 6 areas of common S/S for concussion
1) vestibular
2) oculomotor
3) postural control
4) autonomic NS changes
5) behavioral and cognitive
6) environmental
26
what are the oculomotor deficits in concussion
- decreased initiation of saccads
- slower speed of voluntary gaze
- loss of visual motor symmetry
27
what are the deficits in postural control post concussion
- unable to react or change to things in environment in a timely manner
28
what are the autonomic NS changes in concussion
losss of autoregulation of BP leads to vaso-restriction of blood flow and ex tolerance/headaches thus creating anxiety/depression/ irritability/ sleep loss/ memory and confussion
29
what are the factors that contribute to behavioral and cognitive changes in concussion
loss of prefusion, hypometabolim in energy crisis, neuroinflammation, and axonal loss
30
what are the 3 areas that have to be evaluated for RTS
1) vestibulo-ocular
2) autonomic dysfunction
3) C/S issues
31
steps to rule out C/S involvement
1) ex and rot exam of the C/S for cervogenic headache
2) palpate over the facts for musculature tenderness
3) cervical dysfunction giving glides over C2 and C7
4) laser pointed headlamp to test C/S proprioception (4.5 error is considered WAS)
32
tests to use to evaluate vestibular involvement
- VOMS (gold standard)
- VOR
- VOR cancellation
- dixhallpike and head thrust test
- dynamic visual acuity
33
tests to evaluate behavioral involvement
- questionaries
- rivermead (assesses physcial, cognitive and behavoral)
- King Devick
34
Tests to evaluate autonomic involvement
- graded exertional tolerance exam
- buffalo concussion treadmill test (gold standard)
35
graded exertional tolerance exam
- do not preform if patient has S/S at rest
can do on the bike or the treadmill and assess for blunted HR and increase in RPE
36
buffalo concussion treadmill test
start at 3.3 mph
at first min. increase incline to 2% and 1% each additional minute
stop test if: VAS increases by 3, RPE over 17, or if pt stops communicating
37
tests to examine balance
- BESS (atheltes)
- modified CTSIB
- computerized posturography
- DGI and FGA (more appropriate for non sport related injury
38
test for coordination and reaction time
ruler drop test.
39
Anoxic brain injury (ABI)
complete loss of 02 (stroke) LOC for 15 seconds to 4 minutes
40
hypoxic brain injury
no sufficient 02 sat
41
most common cause of TBI to least common
1) falls
2) unknown
3) struck in the head
4) motor vehicle
5) assult
42
high risk sports
- girls: soccer and basketball
- Boys: football and hockey
43
what are the 3 primary types of TBI injuries
1) DAI
2) Dural hematoma
3) penetrating objects
44
DAI
widespread shearing of the while matter of the midbrain. most common type of primary damage secondary to unequal deceleration, acceleration or rotational injuries
45
mild DAI
microscopic changes to any white matter area of the brain
46
Moderate DAI
damage to the corpus callosum
47
Severe DAI
lesions in the brainstem
48
epidural hematoma
damage to the menigial artery between the dura and the skull faster to occur
49
subdural hematoma
- tears in the sagittal sinus (venous blood)
- between the dura and the arachnoid
- increases pressure on the brain leading to a more severe midline shift
- S/s take longer to develop
50
protein aggrivation in mild repeativite TBI / CTE leads to
neurofibrillary tangles (dementia)
51
protein aggrivation in mild repeatitive TBI/ CTE leads to
amyloid - b protein build up (alzhimers)
52
damage to the cerebellum in TBI will lead to
decreased balance and corrdination
53
damage to the BG in TBI will lead to
decreased initiation, motor planning, and decision making
54
damage to the premotor cortex in TBI leads to
decreased working memory, self control and decision making
55
damage to the amydala in TBI leads to
increased fear responce and emotional regulation
56
damage to the hippocampus in TBI leads to
decreased in learning and memory
57
Damage to the reticular activating system in the brain stem leads to
decrease in sleep wake cycle
58
motor outcomes of TBI
hemiparesis, ataxia cerebellar, synergistic movement, hypertonia, clonus, spasticity, rigidity and contractures, tremors
59
3 functions of the RAS reticular activating system
1) waking: increase thalamic input for arousal and alertness
2) sleeping
3) fight or flight (ANS): hypothalamus
60
Reticular formation function
integration, relay and coordination center for vital functions
61
CN that respond to reticular formation for respiration
5,7,9,10,12
62
memory in the prefrontal cortex
working memory (short term)
63
memory in the amydala
emotional memory
64
memory in the hippocampus
episodic memory (spatial information, non-spatial and actions) - long term memory
65
memory in the cerebellum
procedural memory
66
that connects the amydala and the hippocampus to the prefrontal cortex
the unicinate fasciculus
67
what does exercise increase in the brain
BDNF and Orexin A
68
what do increased BDNF and Orexin A lead to
increased long term potentiation, increased synapic plasticity, and increased neurogensis
69
exercises impact on cytokines
- decreases proinflammatory cytokines leading to a decrease in neurotoxic microglia
- increase antiinflammatory cytokines leading to increase in neuroprotective microglia
70
what increases ICP
edema, hemorrhage or hematoma
71
acute hydrocephalus
blood in the ventricals requiring EVD
72
EVD
external ventricular drain
73
what does the brain bolt monitor
brain 02 levels
74
what does the ventricular catheter monitor
ICP levels
75
what is a normal ICP
7-15 ( do not move if over 20)
76
S/S of abdnormal ICP
puillary changes and headache
77
decompressive craniectomy
removal of the skull to relieve pressure
78
mobilization with EVD
- bed position must not be changes while drain is open
- clamp drain before moving
- monitor CPP (make sure it is over 60)
- keep at level of tragus
79
coma definition
complete paralysis of cerebral function/unresponsiveness
80
Persistive vegetative state definition
chronic condition with no possiblity in change or improvement
81
minimally responsive state
only responds to stimulus
82
rancho level 1
no responce, person appears to be asleep
83
rancho level 2
generalized responce, person reacts inconsitantly, not directly to stimulus
84
rancho level 3
localized responce, reacts inconsitantly directly to stimulus
85
rancho level 4
confused, agitated
86
rancho level 5
confused-inappropriate/ non-agitated, person is confused and inaccurately to commands
87
rancho level 6
confused- appropriate
88
rancho level 7
automatic-appropriate; person gets through daily routine with minimal confusion
89
rancho level 8
purposeful-appropriate; person has functioning memory, responsive to environment and may display depression
90
rancho level 9
purposeful appropriate, goes through daily life routine aware of need for SBA, depression may continue
91
rancho level 10
purposeful-appropriate/ modified independent, does through daily life by may require more time or compensatory strategies, periodic depression may occur
92
what is the time frame is the greatest risk for getting another concussion
first 10 days
93
what does the VSR assist in
postural stability
94
in VOR the head and the eyes move in (blank) direction
opposite
95
what do the otoiths detect
linear movement
96
what do the semicircular canals detect
angular movement
97
what are the vestibular and ocular defictis in concussion
VOR, Ocular movements, gaze stability, and postural control
98
what system do you start with in treatment
the ocular system
99
occular system training progression
1) saccade
2) smooth pursuit
3) target ocular exercises
100
VOR training progression
1) VOR
2) VOR cancellation
3) walking with visual activity
4) walking with head turns
5) changing speeds while walking
101
what is brock string used for
convergance and vergence
102
s/s of ANS not working properly
blunted HR and BP
103
s/s of increased ICP
dizziness and headache
104
what intervention to start with for improving executive function
visual spatial
105
posterior cortex
sends sensory information to the frontal cortex. area of planned movement
106
prefrontal cortex
plans movements
107
premotor cortex
organizes movement sequences
108
motor cortex
produces specific movements
109
priorities for handeling neurological clients (NDT)
1) core, head, and trunk alignment
2) LE alignment and connection to the trunk
3) motor learning with task
4) duel tasking
110
what does the superior colliculus in the brain do
- automatic responce to external stimulus
- structure generates motor responce to turn toward visual stimulus
- mediates conscious awareness
- decision making
111
visual injury with DAI
- difficulty scanning scene
- impaired ability to quickly react to stimuli
- spatial orientation to head and eyes
112
order of things to work on in TBI
1) superior colliculus in brainstem (automatic movements then planned)
2) add posterior parietal cortex
3) prefrontal cortex and planned movement
4) premotor cortex
113
how to engage the posterior parietal cortex
have pt start to plan what they would do. work on the ability to be able to pay attention to a stimuli while inhibiting other stimuli (ex coffee in a mug or glass cup)
114
how to engage the prefrontal cortex
not automatic movemet
- STS transfer and reaching
115
how to engage the premotor cortex
mirror neurons
116
supplemental motor area
- connected to the primary motor cortex, thalamus, cerebellum and BG (complex sequence of movement)
117
primary motor cortex
activates 5-100 ms before initiation to encode force, direction, and speed of movement
