TBI

Question 1

TBI Overview

Answer 1

Insult to brain caused by external physical force 
Results in the following impairments: 
-Cognitive 
-Physical 
-Behavioral 
-Emotional

Question 2

TBI Occurence

Answer 2

1.7 million sustain a TBI annually
-75% are concussions or mild TBI
-52,000 deaths
-275,000 hospitalizations
-1,365,000 ED visits (80%)
M>F
Age 16-35

Question 3

Injury Source

Answer 3

MVA - 50%
Falls - 20%
Recreation - 20%
Violence - 10%

Question 4

Injury Types : Closed

Answer 4

Intact scalp & mucus membranes. 
Results in diffuse brain damage w/o outward signs (i.e. contusions or traumatic injury to blood vessels due to contact w/ boney prominences. 
-Skull FX
-Laceration 
-Contusion 
-Hematoma 
-Diffuse axonal injury

Question 5

Injury Types : Open

Answer 5

Disruption of scalp and mucus membranes. Intacranial cavity is open w/ environment.
Increased infection risk

Question 6

Mechanisms of Injury

Answer 6

Coup/Coutercoup
Acceleration/Deceleration
Projectile (Bullet) 
Concussive (blast) 
Direct Blow

Question 7

Secondary Injuries

Answer 7

Cranial N. Injury 
Hematoma 
Skull FX 
Hypoxia 
Concussion
Increased ICP

Question 8

Hematomas : Epidural

Answer 8

Trauma to temple
Middle meningeal
Bleeding outside dura

Question 9

Hematomas : Subdural

Answer 9

Injury to veins to brain

Slow leak below dura

Question 10

Hematomas : Intaccerebral

Answer 10

Within brain tissue

>BP, aneurysm leak, rupture

Question 11

Glasgow Coma Scale

Answer 11

Used in ED & Acute Care 
Assess level of consciousness 
Rates severity of injury 
Predicts outcomes 
-Best Motor Response (M) 1-6 points 
-Verbal Responses (V) 1-5 points 
-Eye Opening (E) 1-4 points

Question 12

GCS Scoring : Mild Head Injury

Answer 12

13-15 points

Question 13

GCS Scoring : Moderate

Answer 13

9 - 12

Question 14

GCS Scoring : Severe

Answer 14

3-8

Question 15

GCS Scoring : Vegitative State

Answer 15

< 3

Question 16

Ranchos Los Amigos Cognitive Scale

Answer 16

Behavioral observations categorize cognitive level 
Used to develop rehab TX plan 
Communicates pt. status 
Levels I-VIII
Addition of levels IX - X (1998)

Question 17

COMA

Answer 17

Absence of definitive sleep/wake cycles on EEG

Loss of capacity for environmental interaction

Question 18

COMA Criteria

Answer 18

Eyes do no open 
Cannot follow commands 
Does not mouth or utter words 
Lack of intentional movement 
Cannot sustain visual pursuit

Question 19

Vegetative State

Answer 19

COMA usually lasts <4 weeks

No signs of consciousness s/p eyes open = vegetative state

Question 20

Persistent Vegetative State

Answer 20

Chronic Condition
Basic arousal & life sustaining fxn are intact
Absence of meaningful environmental interactions
Poor prognosis : 3 months r > s/p non-traumatic injury, 12 months s/p trauma

Question 21

Minimally Responsive

Answer 21

No longer comatose or vegetative
Remain severely disabled
Responses are inconsistent but indictative of meaningful interaction with environment

Question 22

Treatment for Comatose Patients

Answer 22

Eval form 
Coma Stimulation 
Positioning 
PROM 
Splinting 
Manage Agitation-level IV 
Family Education

Question 23

Inpatient Rehabilitation

Answer 23

Usually level V (may be IV in some settings) 
Vision-perception 
Cognition 
Behavior 
Motor Skills 
Transfers 
Mobility 
B & I ADL tasks 
Community Re-entry

Question 24

Teaching Learning Principles for TBI

Answer 24

Begin TX at level of breakdown
Activities should match pt. processing ability
Provide organized, systematic presentation of info
Teach self-monitoring strategies
Feedback enhances learning

Question 25

Teaching Learning Principles Continued

Answer 25

Structure TX environment 
Use movement 
Positioning 
Body Alignment 
Active Movement patterns 
Consider difficulty of cog/percept & motor skills in activities

Question 26

JFK Coma Recovery Scale

Answer 26

Based of stimulation (it is a specialty)

Scales: Auditory, visual, motor, verbal communication, arousal

Question 27

JFK Stim Guidelines

Answer 27

All positive senses (i.e. nice fragriences)
Use 1-2 Senses per modality
Can follow through w/ AAROM
Mantain conversation the whole time (i.e. whats on TV, time of years, seasons)
Look for visual, auditory/tone reflexes, responses on telemetry unit for vital signs increasing)