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Neuro Exam 2 > TBI > Flashcards

TBI Flashcards

1
Q

Name the 2 categories of TBI

A
  1. penetrating head injury (skull is fractured and meninges are torn) aka open head injury
  2. non-penetrating head injury (skull and meninges stay intact) aka closed head injury
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2
Q

What is the most common cause of a TBI?

A
  • falls (28%)
  • other (21%)
  • MVA (20%)
  • struck by… (19%)
  • assault (11%)
  • suicide (1%)
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3
Q

T/F 90% of OHIs are caused by falls, MVAs, and assaults

A

false, 90% of CHI

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4
Q

T/F TBI is leading cause of neurologic disability in persons under age 50

A

true

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5
Q

Risk factors of TBI

A
  • intoxication
  • poor academic performance
  • SES
  • type A personalities
  • participation in high-risk sports
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6
Q

2 categories of penetrating brain injuries

A
  • high and low velocity
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7
Q

Adults who survive penetrating head injuries are almost always left with…

A

physical, cognitive and linguistic impairments

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8
Q

High velocity

A

rifle bullets, military projectiles

- perforates the skiull and tunnels through the brain before exiting through the skull opposite the point of entry

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9
Q

Low velocity

A

bullets from handguns, shrapnel

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10
Q

T/F low velocity injuries are often less fatal than high velocity injuries

A

true

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11
Q

2 categories of non-penetrating injuries

A

acceleration and non-acceleration injuries

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12
Q

Acceleration injuries are…

A

moving-head trauma
- caused by sudden acceleration or deceleration of the head, brain, and brainstem causing diffuse damage due to movement inside the skull

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13
Q

What are the 2 forms of acceleration injury

A
  1. linear acceleration injuries (coup and countercoup)

2. angular acceleration injuries

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14
Q

Linear acceleration injuries occur when…

A

the head is struck by a force aligned with the center axis of the head

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15
Q

Provide circumstances in which linear acceleration injuries could occur

A
  • shaken baby syndrome

- whiplash injuries in MVAs

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16
Q

T/F linear acceleration injuries cause diffuse damage to meninges and brain tissue

A

false; focal damage

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17
Q

Angular acceleration injuries are caused by…

A

blows that strike the head off-center, causing it to rotate and move at an angle away from the point of impact

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18
Q

Non-acceleration injuries aka?

A

fixed-head trauma

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19
Q

T/F Non-acceleration injuries usually cause less severe BI than acceleration injuries

A

true

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20
Q

Blows to a moveable head are up to ____ times more devastating than blows to a fixed head

A

20

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21
Q

Consequence of non-acc injuries is…?

A

deformation of the skull by the impact of the object striking the skull

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22
Q

T/F Acc BIs may stretch nerve-cell axons throughout the brain and brainstem– “diffuse axonal injury” and is common in acc injuries

A

true

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23
Q

Severe diffuse axonal injury may lead to vegetative state and is sign of severe damage to…

A

cortical and subcortical tissues

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24
Q

Cuts, bruises, twisting, and shearing forces in the brain cause ______ (bleeding) and _______ (accumulations of blood)

A

Hemorrhages and hematomas

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25
Q

What is the most common cause of a traumatic hemorrhage?

A

auto accidents followed by falls, and sports injuries

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26
Q

Magnitude of symptoms depends on…

A

extent on the location of the hemorrhage

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27
Q

Most common tx for traumatic hemorrhage?

A

surgical removal

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28
Q

T/F subdural hematomas are twice as common and twice as deadly as epidural hematomas

A

true

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29
Q

What is the most common cause of SDH?

A

MVA

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30
Q

Increasing pressure and displacement of brain tissue by expanding hematoma may lead to…

A

coma and death within a few hours

31
Q

T/F A patient may go for years without overt symptoms of a subarachnoid hematoma

A

true

32
Q

Secondary consequences of TBI (5)

A
  • cerebral edema
  • traumatic hydrocephalus
  • elevated intracranial pressure
  • ischemic brain damage
  • alteration in blood-brain barrier
33
Q

T/F primary consequences of TBI are often more devastating than secondary consequences

A

false; secondary consequences are often more devastating than primary consequences

34
Q

Cerebral edema is caused by…

A

accumulation of fluid due to trauma, anoxia, infection, inflammation

35
Q

Where does the fluid accumulate for cerebral edema?

A

between brain & skull, ventricles, brain tissues

36
Q

Cerebral edema is a common consequence of what type of injury?

A

diffuse injuries

37
Q

How does elevated intracranial pressure differ from other types of intracranial pressures?

A

it is the most dramatic and deadly consequence of TBI and is the most frequent cause of death from TBI

38
Q

T/F Most BI pts sustain ischemic brain damage

A

true

39
Q

How does a BI disrupt the regulation of the blood-brain barrier?

A

allows normally excluded substances (e.g. proteins, neurotransmitter chemicals) to enter brain tissue

40
Q

Passage of normally excluded substances into the BBB may contribute to…

A

accumulation of fluid and swelling of brain tissues (cerebral edema)

41
Q

Rating severity of concussions: Grade 1

A

1:Transient confusion, no loss of consciousness; concussion symptoms or mental status abnormalities resolve in less than 15 minutes

42
Q

Rating severity of concussions: Grade 2

A

Transient confusion, no loss of consciousness; concussion symptoms or mental status abnormalities last more than 15 minutes

43
Q

Rating severity of concussions: Grade 3

A

Any loss of consciousness, whether brief (seconds) or prolonged (minutes)

44
Q

What is post concussive syndrome? (PCS)

A

physical, psychological, and cognitive effects of BI that persist for weeks or months after what appears at onset to be a typical concussion

45
Q

What are the symptoms of a concussion?

A

headache, nausea, vomiting, memory loss, dizziness, double vision, blurred vision, emotional lability, sleep disturbances

46
Q

Relatively good physiologic recovery usually occurs due to _____

A

neuroplasticity

47
Q

Moderate TBI is…

A

diffuse axonal damage spread throughout the brain and brainstem

48
Q

Examples of moderate TBI

A

lacerations/contusions on surface of the brain destroy brain tissue, creating focal lesions

49
Q

Severe TBI is…

A

extensive axonal damage through brain/brainstem

50
Q

Duration of posttraumatic amnesia is defined as…

A

the time following a coma during which the pt is unable to store new info and experiences in memory

51
Q

T/F Duration of posttraumatic amnesia is directly related to a pt’s eventual level of recovery from TBI

A

false; it is inversely related

52
Q

Review Rancho Los Amigos (RLAS) Levels of Cognitive Functioning

A

see page 467-470 in text

53
Q

T/F Most pts do progress through RLAS levels

A

true

54
Q

T/F Five lowest RLAS levels are more sensitive to language impairments than the five highest levels

A

false; 5 highest are more sensitive than 5 lowest

55
Q

Risk factors for hemorrhages

A
  • age
  • substance abuse
  • education
  • intelligence
  • SES
  • premorbid personality
56
Q

How is the pattern of recovery for TBI different from CVA?

A

TBI follows a fairly predictable stair-step pattern

57
Q

Treating cognition at Rancho levels: 1-3

A
  • interdisciplinary collaboration among staff

- sensory stimulation to increase responsiveness to environment and encourage return to consciousness (aka “coma stim”)

58
Q

Treating cognition at Rancho levels: What are the different types of stimulation?

A
  • acoustic, visual, tactile, olfactory, kinesthetic, intense
59
Q

Treating cognition at Rancho levels: How do you track responses from stimulation?

A

with rating scale (i.e. Rappaport)

60
Q

Treating cognition at Rancho levels: 4-5

A

environmental controls- consistent, predictable routines to decrease confusion

61
Q

Treating cognition at Rancho levels: orientation training

A
  • use of environmental prompts in the form of visual cues
  • verbal orientation cues, drills
  • passive orientation vs. active orientation
  • behavior management vs. impact of positive or negative setting events
62
Q

Approaches to tx of cognition RLAS 5 and above (2)

A
  • restorative or remedial interventions

- compensatory interventions (adaptive)

63
Q

Approaches to tx of cognition RLAS 5 and above: Restorative/remedial interventions

A

process specific drills (aka ‘mental muscle building’)

- consistent with medical model or impairment based approach

64
Q

Approaches to tx of cognition RLAS 5 and above: Compensatory interventions

A
  • train practical skills for adaptive behavior
65
Q

Approaches to tx of cognition RLAS 5 and above: What is best practice?

A

a combination of restorative and compensatory interventions

66
Q

Improvement of attentional skills: Attention process training is a…

A

structured program targeting each aspect of attention

67
Q

Improvements of memory skills

A

‘muscle building’ approach with repetitive drills

68
Q

Improvements of memory skills: Compensatory approaches

A

internal vs. external strategies like day planner

69
Q

Improvement of reasoning: paper pencil activities

A

done as homework vs. in session

70
Q

Improvement of problem solving

A

paper pencil vs. individual’s actual issues for life

  • hypothetical situations
  • real situations
71
Q

Role of SLP: concussion

A
  • ID and monitor students with concussions who are demonstrating difficulty with communicating/interacting with others
  • administer assessments
  • determine and provide classroom strategies/modifications
  • direct services to a particular student
72
Q

School-based SLPs: medical model treats ____ deficits

A

mild

73
Q

educational model works with students who are…

A

not successful in general ed

Neuro Exam 2 (4 decks)

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