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Neuro Rehab 2 > TBI - 2a Mod-Severe TBI > Flashcards

TBI - 2a Mod-Severe TBI Flashcards

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1
Q

what is an acquired brain injury

A

any type of brain damage occurring after birth that isn’t hereditary, congenital, degenerative, or induced by birth trauma

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2
Q

what are the top 4 causes for acquired brain injuries

A

falls
MVA
struck by/against
assault

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3
Q

what age range is the incidence of acquired brain injury highest in

A

15-24yo

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4
Q

what is the leading cause of TBI in people >65yo

A

falls

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5
Q

what are 5 risk factors for TBIs

A

SDOH
- education
- socio-economic
- healthcare access
- resource access
male
age (<4yo, 15-24, >65yo)
substance abuse
previous TBI
- behavior, insight, judgment

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6
Q

what are primary injuries from a TBI (6)

A

skull fx
contusions
lacerations
hematomas
DAIs
hypoxia

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7
Q

why does having a TBI inc risk for seizures

A

metabolic and electrical signaling imbalance

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8
Q

what are secondary injuries from a TBI (7)

A

ischemia
infection
neurochem alterations
sz
edema
inc ICP
brain/brainstem herniation

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9
Q

what are the 3 main types of intracranial hematomas from a TBI

A

intracerebral
epidural
subdural

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10
Q

what is a common cause of intracerebral hematoma

A

caused by lacerations - blood flow in brain

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11
Q

what is a common cause of epidural hematoma

A

tearing of meningeal vessels results in blood collecting b/w skull and dura

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12
Q

what is a common cause of subdural hematoma

A

accel-decel injuries when bridging veins to superior sagittal sinus are torn and blood accumulates in subdural space

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13
Q

what is the pathophys of a DAI

A

brain tissues differing in structure and wt experience unequal acceleration, deceleration, or rotation during rapid head movement or impact
- tissue tears and shears

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14
Q

white vs gray matter in a DAI

A

white matter heavier than gray matter
- gray matter = cell bodies
- white matter = axons

-> see axonal twisting/crushing as white matter accels/decels

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15
Q

what is the location of tissue sheared in a DAI

A

b/w coup and contrecoup

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16
Q

what is a common MOI for DAIs

A

high-speed MVA

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17
Q

what specific brain tissues/structures are more susceptible to DAIs (3)

A
  1. parasagittal white matter of cerebral cortex
  2. pontine-mesencephalic junction
  3. corpus callosum
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18
Q

what is the prognosis for a DAI

A

worse outcomes

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19
Q

what are the 3 main characteristics to describe a TBI

A

open vs closed
focal vs diffuse
level of arousal

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20
Q

what are 3 measures to assess status of TBI

A

CRS-R ->DOC
glasgow coma scale
RLA

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21
Q

what are ex of focal vs diffuse TBIs

A

focal:
- coup
- coup & contre-coup
- hematoma

diffuse:
- DAI
- anoxic brain injury

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22
Q

what are 5 main definitions for level of arousal

A

alert
lethargic
delirium
obtunded
stupor/semicoma

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23
Q

characteristics of alert level of arousal

Study These Flashcards
A

awake, attentive, interactive

24
Q

characteristics of lethargic level of arousal

Study These Flashcards
A

drowsy
drifts to sleep when not stim
brief response to stim
poor attention

25
characteristics of delirium level of arousal
confused hallucinating
26
characteristics of obtunded level of arousal
difficult to arouse (aggressive stim) confused when alert
27
characteristics of stupor/semicoma level of arousal
not self alerting responds to vigorous/noxious stim - ie sternal rub, nail bed
28
what is a comatose state (DOC)
state of unarousable unresponsiveness in which there is no evidence of self-awareness or environmental awareness
29
what behavior is seen in a comatose state and what is this indicative of
behavior limited to reflexive activity failure of reticular activating system (RAS) and integrated cortical activity
30
what is there no evidence of in a comatose state (6)
awake/aware sleep wake cycles spontaneous eye opening purposeful response to environmental stim discrete localized responses evidence of language comprehension/expression
31
what is a vegetative state (DOC)
awake but not aware
32
what is the dx criteria for vegetative state of consciousness
must meet all three: 1. no evidence of sustained, reproducible purposeful or voluntary behavioral responses to visual, auditory, tactile, or noxious stim 2. no evidence of language comprehension or expression 3. intermittent wakefulness manifested by presence of sleep/wake cycles (ie periodic eye opening)
33
what is the main difference between veg and comatose states of consciousness
veg - recovery of eye opening w continued absence of observable signs of cog mediated behavior signals
34
what behaviors seen in veg state can be construed as arising from partial consciousness
grinding teeth swallowing smiling shedding tears grunting moaning screaming all w/o apparent external stim or orienting behavior
35
what is a minimally conscious state (MCS)
minimal but definitive behavioral evidence of self-awareness or environmental awareness
36
what are characteristics of conscious behaviors exhibited in a MCS
subtle and inconsistent must be differentiated from random or reflexive
37
what are 4 ex of dx MCS behaviors
1. follow simple commands 2. gestures/verbalizes yes/no regardless of accuracy 3. intelligible verbalization 4. movement/affective behavior occurs in response to environmental stim that are not reflexive
38
what is the differential between MCS and someone who is emerging
more consistent awareness in emergences - reliable demonstration of either interactive communcation or functional object use
39
what are the 3 categories assessed in the GCS
eye opening motor response verbal response
40
mTBI: GCS, LOC length, imaging
GCS >/= 13 ("conscious") brief or no LOC imaging normal
41
mod TBI: GCS, LOC length, imaging
GCS 9-12 LOC 30min-24hr imaging prob abnormal
42
notable characteristic of a GCS >/=9
follows commands
43
severe TBI: GCS, LOC length, imaging
GCS 24hrs imaging likely abnormal
44
what is the purpose of the coma recovery scale (CRS-R)
assist w differential dx, px, assessment and treatment planning in pts w DOC
45
what are 6 subscale functions scored in the CRS-R
auditory visual motor oromotor communication arousal
46
how are subscales of the CRS-R arranged and the correlating anatomical structures assessed
hierarchically arranged items ranging from reflexive activity (brainstem) to cog-mediated behaviors (cortical processes)
47
what is CRS-R scoring based on
presence or absence of defined behavioral responses
48
RLA level 1: response, assistance needed, and main presentation
no response total assist comatose
49
RLA level 2: response, assistance needed, and main presentation
generalized response total assist limited, inconsistent, delayed, and identical responses to any stimuli
50
RLA level 3: response, assistance needed, and main presentation
localized response total assist inconsistent but specific responses depending on stim may follow simple commands
51
RLA level 4: response, assistance needed, and main presentation
confused-agitated max assist active and bizarre behavior w purposeful attempts but not appropriate relative to environment incoherent, inappropriate verbalizations
52
RLA level 5: response, assistance needed, and main presentation
confused-inappropriate non-agitated max assist consistent follow simple commands gross attention to environment w structure, may converse on social/automatic level briefly
53
RLA level 6: response, assistance needed, and main presentation
confused-appropriate mod assist inconsistent orientation goal-directed behavior shows carryover to relearned tasks *memory book - use w max assist
54
RLA level 7: response, assistance needed, and main presentation
automatic-appropriate min assist for ADLs appropriate/oriented in home/hospital setting min to no confusion carryover new learning at dec rate judgment impaired rec/social activities w structure - poor social skills
55
RLA level 8: response, assistance needed, and main presentation
purposeful-appropriate stand-by assist carryover for new learning and no supervision once activities learned need supervision for new activities recall/integrate past and recent events aware of environment
56
RLA level 9: response, assistance needed, and main presentation
purposeful, appropriate stand-by assist on request independence shifts back and forth still might need supervision might still be more irritable than before injury *assistive memory device accurately estimate abilities acknowledge others feelings/needs self-monitor appropriateness of social interaction
57
RLA level 10: response, assistance needed, and main presentation
purposeful, appropriate modified independent better in tune w limitations better bandwidth to be more tolerable w social interactions and emotions

Neuro Rehab 2 (48 decks)

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