TBI Flashcards
What is the definition of a TBI?
damage to the brain, which occurs after birth and it not related to a congenital or degenerative disease. Impairments may be temporary or permanent and cause partial or functional disability or psychosocial maladjustment.
What are the general deficits seen in TBI?
physical cognitive communicative neurobehavioral affects work, leisure, and social occupations
Within what time period is the extent of the disability typically identified with a TBI?
48 hours based on the length of amnesia and/or a coma
what is seen with a Mild TBI
clinically= loss of consciousness or amnesia for less than 10 min.
Glasgow Coma Scale 13-15
no skull fracture on physical examination
nonfocal neurological examination
80% of TBIS
what are the symptoms of a mild TBI
dizziness, headaches, fatigue, visual disturbance, and memory and executive-thinking difficulties during the first week.
What are characteristics of a Moderate TBI
hospitalization of at least 48 hours
initial Glasgow Coma Scale=9-12 or more
What are characteristics of a Severe TBI
loss of consciousness and/or post aquired amnesia more than 24 hours
Glasgow Coma Scale=1-8
What is a Focal Brain Injury?
caused by a direct blow to the head after collision with an external object or fall, a penetrating weapon injury, and collision of the brain with the inner tables of the skull.
What are common causes of a Focal Brain Injury?
falls, missile wounds and assults
What is a MultiFocal and Diffuse brain injuries
sudden deceleration of the body and head with variable forces transmitted to the surface deeps portions of the brain
What are common causes of a Multifocal or Diffuse brain injuries?
MVA, bicycle and skateboard crashes, falls from high surfaces or off horses/bulls.
what are three leading causes of a TBI
falls, Motor vehicle accidents and violence
what is the single leading cause of TBI?
Falls
What is the leading cause of severe TBI?
motor vehicle accidents
What is the etiology of a TBI?
results in promary(from impact) and secondary (after impact as a result of limited oxygenation) brain damage.
what is the most common neurological complication of TBI?
hydrocephalus
What dysfunction is most common with severe TBIs?
dysautonomia
What is dysautonomia
characterized by hypertension, tachycardia, increase body temp and BP, profuse sweating, decerebrate or decorticate posturing
What is DVT?
Deep Vein Thrombosis
What causes a DVT? and what can a DVT cause?
caused by prolonged immobilization
can cause a pulmonary emboli(most common cause of preventable hospital death in TBI
What motor deficits are seen in TBI?
decerebrate rigidity
decorticate rigidity
quadriparesis, hemiplegia, or monoplegia
spasticity
What is decerebrate rigidity?
brainstem damage
extensor posture of all limbs and/or trunk
What is decorticate rigidity?
cortical damage
flexion of the upper and extension of the lower limbs
abnormal reflexes
what are useful factors to determine prognosis after TBI?
trauma score GCS biomarkers presence or absence of hypoxia neuroimaging studies and electrodiagnostic findings length of coma levels of cognitive functioning
what is retrograde amnesia?
memory loss prior to the accident
may gradually, but incompletely improve
what is anterograde amnesia
inability to learn new long-term declarative info
typically last to improve
what are characteristics of Glasgow Coma Scale 1?
Pain: has no motor response to pinch, does not open eyes
Speech: makes no noise
what are characteristics of Glasgow Coma Scale 2?
Pain: opens yes when pinched
body become rigid in an extended position when examiner pinches victim(decerebrate posturing)
Speech:makes sound that examiner can’t understand
what are characteristics of Glasgow Coma Scale 3?
Speech: opens eyes when asked to in a loud voice
talks to examiner, can understand but makes no sense
Pain: flexes body away when pinched by examiner
what are characteristics of Glasgow Coma Scale 4?
Spontaneous: opens eyes on own
Pain: pulls a part of body away when pinched by examiner
Speech: Seems confused or disoriented
what are characteristics of Glasgow Coma Scale 5?
Pain: pulls examiner;s hand away when pinched
Speech: carries on a conversation correctly and tells examiner where and who he or she is and the month and year
what are characteristics of Glasgow Coma Scale 6?
command: follows simple commands
What are characteristics of a Rancho Level 1?
no response
total assistance
no response to pain, touch, sight or sound
What are characteristics of a Rancho Level 2?
generalized response
total assistance
generalized reflex response to stimuli
What are characteristics of a Rancho Level 3?
localized response
total assistance
demonstrates withdrawal or vocalization to painful stimuli
responds inconsistently to commands
What are characteristics of a Rancho Level 4?
confused agitated
max assist
agitated, alert, very active, aggressive or bizarre behaviors, performs motor activities, but behavior is non purposeful, extremely short attention span
What are characteristics of a Rancho Level 5?
confused, inappropriate, non-agitated
max assist
gross attention to environment, highly distractibly, requires continual redirection, difficulty learning new tasks, agitated by too much stimulation. may engage in social conversation, but with inappropriate verbalization
What are characteristics of a Rancho Level 6?
confused, appropriate
mod assist
inconsistent orientation to time and place. selective task attention, recent memory impaired, begins to recall past, consistently follows simple directions, goal-directed behavior with assistance
What are characteristics of a Rancho Level 7?
automatic appropriate
min assist
performs daily routine in highly familiar environment in nonconfused, but automatic robot-like manner, skills noticeably deteriorate in familiar and unfamiliar environment. lacks realistic planning for own future.
What are characteristics of a Rancho Level 8?
purposeful and appropriate
stand by assist
consistently oriented to person place and time. initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with min assist.
What are characteristics of a Rancho Level 9?
purposeful appropriate
stand by assist on request
able to think of consequence of decision or actions with assistance when requested. Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines independently and unfamiliar personal household, work, and leisure tasks with assistance when requested
What are characteristics of a Rancho Level 10?
purposeful appropriate
modified independence
able to think about consequences of decision or actions with assistance when requested
what is the modified ashworth scale used for?
used to manually rate spasticity
what is a 0 on the Modified Ashworth Scale?
no increase in tone
what is a 1 on the Modified Ashworth Scale?
slight increase in muscle tone, manifested by a catch and release or min resistance at the end of the ROM when the affected part(s) is/are moved in flexion or extension
what is a 1+ on the Modified Ashworth Scale?
slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder(less than half) of ROM
what is a 2 on the Modified Ashworth Scale?
more marked increase in muscle tone through most of the ROM, but affected part(s) easily moved
what is a 3 on the Modified Ashworth Scale?
considerable increase in muscle tone, passive movement difficult
what is a 4 on the Modified Ashworth Scale?
affected part(s) rigid in flexion or extension
what are some difficulties ad symptoms for patients with TBI?
memory, difficulty adapting. difficulty with motor learning, depression, PTSD, substance abuse, aggressive behavior
What is the clinical picture of TBI?
decorticate, decerebrate, and motor rigidity abnormal muscle tone and spasticity primitive reflexes muscle weakness decrease functional endurance ataxia postural defects/deficits dysphagia cognitive deficits limitation in joint motion visual and perceptual deficits behavioral and pyschosocial challenges
what is ataxia?
movement abnormality characterized by incoordination, impaired sitting and standing balance, or both
what are the postural defects seen in TBI?
Pelvis=posterior pelvic tilt
Trunk=kyphosis, scoliosis, and lordosis, and lateral trunk flexion
Head and Neck=forward flexion or hyperextension of the neck and lateral flexion of the head(follows trunk)
what are the postural deficits seen in TBI?
scapula=depressed, protracted or retracted, downwardly rotated, or all due to imbalance in scapular muscle tone
UE’s= bilaterally or unilaterally involved
LE’s=severe extension patterns in both LE’s also hip ADD, internal rotation, knee flexion, plantar flexion, and inversion of the feet.
what can cause the limitation in joint motion for TBI pts
increase muscle tone volitional resistance contractures heterotopic ossication fractures or dislocations pain
What are some of the areas of cognitive deficits seen in pts with TBI
attention and concentration memory initiation and termination of activities safety and awareness and judgement processing info executive functions and abstract thought generalization
what are some of the pyschosocial challenges for pt’s with TBI?
self-concept social roles independent living status dealing with loss affect changes
what are the driving rehabilitation and the unique contributions by OT?
understands medical conditions and disease process analyze ADLs and IADLS knowledge of adaptive devices occupation-based interventions social impact roles
What does the OT driving Assessment cover?
sensory, cognitive, and motor performance
performance patterns
safety concerns
contextual and environmental barriers and supports
influence of community mobility and driving on the client’s ability to participate in daily life
address mental health issues when community mobility/driving is comprised
Loss of consciousness or amnesia for less than 10 min is characteristic of what type of TBI? What would be the Glasglow coma scale
Mild TBI Glasgow Coma Scale 13-15 no skull fracture on physical examination nonfocal neurological examination 80% of TBIS
hospitalization of at least 48 hours is characteristic of what type of TBI? What would be the Glasglow coma scale
Moderate TBI
initial Glasgow Coma Scale=9-12 or more
loss of consciousness and/or post acquired amnesia more than 24 hours characteristic of what type of TBI? What would be the Glasglow coma scale
Severe TBI
Glasgow Coma Scale=1-8
Glasgow Coma Scale=1-8 is charcheristic of what type of TBI
Severe
Glasgow Coma Scale 13-15is charcheristic of what type of TBI
Mild
Glasgow Coma Scale=9-12 or more is charcheristic of what type of TBI
Moderate
