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

TBI - 2a Mod-Severe TBI Flashcards

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

A

awake, attentive, interactive

24
Q

characteristics of lethargic level of arousal

A

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

25
Q

characteristics of delirium level of arousal

A

confused
hallucinating

26
Q

characteristics of obtunded level of arousal

A

difficult to arouse (aggressive stim)
confused when alert

27
Q

characteristics of stupor/semicoma level of arousal

A

not self alerting
responds to vigorous/noxious stim
- ie sternal rub, nail bed

28
Q

what is a comatose state (DOC)

A

state of unarousable unresponsiveness in which there is no evidence of self-awareness or environmental awareness

29
Q

what behavior is seen in a comatose state and what is this indicative of

A

behavior limited to reflexive activity

failure of reticular activating system (RAS) and integrated cortical activity

30
Q

what is there no evidence of in a comatose state (6)

A

awake/aware
sleep wake cycles
spontaneous eye opening
purposeful response to environmental stim
discrete localized responses
evidence of language comprehension/expression

31
Q

what is a vegetative state (DOC)

A

awake but not aware

32
Q

what is the dx criteria for vegetative state of consciousness

A

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
Q

what is the main difference between veg and comatose states of consciousness

A

veg - recovery of eye opening w continued absence of observable signs of cog mediated behavior signals

34
Q

what behaviors seen in veg state can be construed as arising from partial consciousness

A

grinding teeth
swallowing
smiling
shedding tears
grunting
moaning
screaming

all w/o apparent external stim or orienting behavior

35
Q

what is a minimally conscious state (MCS)

A

minimal but definitive behavioral evidence of self-awareness or environmental awareness

36
Q

what are characteristics of conscious behaviors exhibited in a MCS

A

subtle and inconsistent
must be differentiated from random or reflexive

37
Q

what are 4 ex of dx MCS behaviors

A
  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
Q

what is the differential between MCS and someone who is emerging

A

more consistent awareness in emergences
- reliable demonstration of either interactive communcation or functional object use

39
Q

what are the 3 categories assessed in the GCS

A

eye opening
motor response
verbal response

40
Q

mTBI: GCS, LOC length, imaging

A

GCS >/= 13 (“conscious”)
brief or no LOC
imaging normal

41
Q

mod TBI: GCS, LOC length, imaging

A

GCS 9-12
LOC 30min-24hr
imaging prob abnormal

42
Q

notable characteristic of a GCS >/=9

A

follows commands

43
Q

severe TBI: GCS, LOC length, imaging

A

GCS </= 8
LOC > 24hrs
imaging likely abnormal

44
Q

what is the purpose of the coma recovery scale (CRS-R)

A

assist w differential dx, px, assessment and treatment planning in pts w DOC

45
Q

what are 6 subscale functions scored in the CRS-R

A

auditory
visual
motor
oromotor
communication
arousal

46
Q

how are subscales of the CRS-R arranged and the correlating anatomical structures assessed

A

hierarchically arranged items ranging from reflexive activity (brainstem) to cog-mediated behaviors (cortical processes)

47
Q

what is CRS-R scoring based on

A

presence or absence of defined behavioral responses

48
Q

RLA level 1: response, assistance needed, and main presentation

A

no response
total assist

comatose

49
Q

RLA level 2: response, assistance needed, and main presentation

A

generalized response
total assist

limited, inconsistent, delayed, and identical responses to any stimuli

50
Q

RLA level 3: response, assistance needed, and main presentation

A

localized response
total assist

inconsistent but specific responses depending on stim
may follow simple commands

51
Q

RLA level 4: response, assistance needed, and main presentation

A

confused-agitated
max assist

active and bizarre behavior w purposeful attempts but not appropriate relative to environment
incoherent, inappropriate verbalizations

52
Q

RLA level 5: response, assistance needed, and main presentation

A

confused-inappropriate non-agitated
max assist

consistent follow simple commands
gross attention to environment
w structure, may converse on social/automatic level briefly

53
Q

RLA level 6: response, assistance needed, and main presentation

A

confused-appropriate
mod assist

inconsistent orientation
goal-directed behavior
shows carryover to relearned tasks
*memory book - use w max assist

54
Q

RLA level 7: response, assistance needed, and main presentation

A

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
Q

RLA level 8: response, assistance needed, and main presentation

A

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
Q

RLA level 9: response, assistance needed, and main presentation

A

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
Q

RLA level 10: response, assistance needed, and main presentation

A

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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