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Bringman Neuro > TBI > Flashcards

TBI Flashcards

1
Q

Types of TBI- TAN

A
  • Traumatic (closed & Open)
  • Non-traumatic
  • Acquired
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2
Q

Traumatic TBI - closed

A
  • Coupe, contra coupe, shaking baby. Inside brain very sharp, blunt force will create injuries
  • DAI
  • Secondary- injury Inflammation, swelling of the brain –uncle herniation, hydrocephalus (within 24 hrs) bowel & bladder issues, Autonomic NS issues.
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3
Q

DAI-Diffused axonal injury

A

Small microscopic injuries that occurs, don’t show up on radiograph but BI still evident and changes in behavior occurs.

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4
Q

Traumatic TBI- Open

A
  • OH injury, GSW, baseball bat etc
  • Secondary issue infection
  • Herniation out of the opening
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5
Q

Non Traumatic BI- Anoxic

A

Loss of oxygen more common in pediatrics

Cause- suffocation due to near drowning, carbon monoxide, suffocation

Anoxic BI affects every cell in the brain due to lack of oxygen- every cells die

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6
Q

Observed changes in mental and functional status after a TBI

A
  • Confusion
  • Mood
  • Vomiting
  • Headaches etc. within the first 24hrs of injury
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7
Q

Differentiating TBI

A

Mild vs. Moderate & severe

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8
Q

Mild TBI= FL2AS2H MDFCWNVP

A

LOC < 30 min- Overlooked a lot

Issues -Referred to as -post concussive syndrome

  • Frustrations
  • Loss of sense of smell
  • Loss of appetite
  • Attention deficits
  • Slow thinking
  • Sleep disturbances
  • Headache
  • Memory problems
  • Moody/ irritable
  • Depression
  • Fatigue
  • Coupe counter coupe – balance, visual disturbances, attentiveness
  • Worst extreme- seizures
  • Nausea
  • Vomiting
  • Pt. gets lost

15% still have slight symptoms upwards to a year

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9
Q

Moderate & severe

A
  • LOC > 30-6h Mod
  • LOC 6 hrs or more – severe
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10
Q

Signs & Symptoms of moderate & severe TBI- Cognitive issues CoMP2ILE A

A

Similar symptoms to mild but magnified

  • Concentration
  • Memory
  • Processing speed
  • Perseveration
  • Impulsiveness
  • Language processing
  • Executive functions
  • Attention
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11
Q

Signs & Symptoms of moderate & severe TBI- Speech Impairments FIRES

A
  • Fast / slow speech
  • Inability to form words
  • Reading & writing
  • Expressive, receptive
  • Slurred speech
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12
Q

Signs & Symptoms of moderate & severe TBI- Foreign accent syndrome

A

Pt. acquires a foreign accent after the injury

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13
Q

Signs & Symptoms of moderate & severe TBI- Sensory & Vision

A

Sensory

All could be affected, gone fully, part etc depending on affected pathway

Vision

  • Complete loss
  • Diplopia- week muscles
  • Blurred vision
  • Distance vision affected
  • Nystagmus
  • Photophobia- light sensitivity
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14
Q

Signs & Symptoms of moderate & severe TBI- Hearing Smell &Taste

A

Hearing

Complete / increased sensitivity to sound

Tinnitus – wringing in ears

Smell- Loss or diminished

Taste- loss or diminished

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15
Q

Signs & Symptoms of moderate & severe TBI- Physical changes WFSCBAM

A
  • Weakness
  • Flacidity
  • Spasticity
  • Chronic pain
  • Bowel & bladder issues
  • ANS issues
  • Menstrual cycles
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16
Q

Signs & Symptoms of moderate & severe TBI- Social & emotional ID4EAL

A
  • Irritability
  • Dependent behaviors- child like
  • Depression
  • Disinhibition
  • Denial
  • Emotional ability to love, be sad, absence etc
  • Aggression
  • Lack of motivation
17
Q

Levels of consciousness- AOSMC

A
  • Awake & Alert x3 & x4- orientation to person, place, time event/situation
  • Obtunded- sleeps often when aroused decreased alertness and attentive
  • Stupor- unresponsive but can be aroused by noxious repeated stimuli
  • Minimal Conscious State- Some purposeful movements, open eyes, reaching but don’t know what to do with the object
  • Coma
18
Q

Coma- 2 states

A

Vegetative
Persistent vegetative

19
Q

Health care team

A
  • *Doctors -**Stabilize patient
  • *PT-** Prevent secondary complications- pneumonia, skin breakdown, contractures, DVT to get patient to interact with the outside environment

How much can they do- walking, dressing, eating, reading etc
How much can we help with- what equipment needed, discharge plan,

Mental & behavioral issues have an impact on therapy careful not to trigger negative emotions

Investigate premorbid behavior
Effects of the injury- accident, abuse etc.
Nature of environment used for therapy- does it promote good or bad behavior

20
Q

Glasgow coma scale rating

A

Mild TBI- 13-15

Moderate 9-12

Severe 3- 8

21
Q

Ranchos Los Amigos Level 1-

A

No response- pt. appears to be in a deep sleep, no response to stimuli- therapy to prevent sensory deprivation as soon as possible. Keep sensory info going in. Early in therapy- brain still trying to heal, tactile, auditory, olfactory stimulation, ROM teach family, splinting, serial casting - e.g place in DF if in too much PF. 5-15min each session 2-3 times per day.

22
Q

Ranchos Los Amigos Leve 2

A

Generalized response- inconsistent non purposeful responses that do not change regardless of stimuli- same response with any stimulus.-still try to prevent sensory deprivation, is the response consistent? at this stage this shows a pattern of their brain waking up- put pt. in different position, lying, sitting, upright. Pre-feeding (swabs with flavor) pt. will typically reflex- decorate room with things they like, pics, music, TV shows. Goals, if 1/4 stimulus goal could b pt. will have 3/4 stimulus to show improvement.

23
Q

Ranchos Los Amigos Level 3

A

Localized Response- Vague awareness of themselves- how many responses can we get- decrease the time of response to the stimulus- should be grabbing things by now, throw non-threatening things to them, can they throw back, open/close. Lots of one step tasks, cards with red and blue choose between them. Bathing & showering positive response

24
Q

Ranchos Los Amigos Level 4

A

Confused & Agitated- heightened state of activity still have a decreased ability to process info- will try to punch you. Don’t demand participation, simple gross motor, more ball throwing lots of praises do not bring up the negatives. End therapy on a positive note say something they know to do well. More explanation= less agaitation.

25
Q

Ranchos Los Amigos Level 5

A

Confused, inappropriate , non agitated- Alert and responds to simple commands, highly distractible bring family and friends into the therapy more, self-care, feeding, ADLs, establish a morning routine. OTs will do Crafts, games and stuff that needs more attention span. Work on weaknesses, strengthening exercises. Group activities with other non-agitated BI patients. Disinhibition occurs here- inappropriate behaviors.

26
Q

Ranchos Los Amigos Level 6

A

Confused but appropriate- Pt can do tasks but dependent on external input to be told what to do. Short term memory still very affected. Goals increased complexity of task, memory tasks, try to get them to do things on their own. Increase group activities, try to make them independent, daily log of their daily tasks and hold them responsible.

27
Q

Ranchos Los Amigos Level 7

A

Automatic appropriate appears appropriate & oriented in a safe normal/ known environment. Do things automatically, don’t need as much cuing to get things done, Increased awareness but lack reality into future planning and judgement. Work on abstract thinking, reasoning skills, What are the patients goal at this time? How do patients interact in the environment, grocery store, movies, assessment of emergency skills and safety awareness. See how they act in unknown environments. Get VOC assessment and rehab.

28
Q

Ranchos Los Amigos Level 8

A

Purposeful appropriate- pt. is independent at home and in community may still not be back to the point they were before. What is cognitively and physically still affected? What skills could we help them learn?* Usually work as grocery store baggers.

29
Q

Vegetative state

A

person utters no words, does not follow commands, does not make any meaningful physiologic response but has intact eye opening and sleep/wake cycles no other interactions our job is to get them to emerge and interact with the outside environment

30
Q

Persistent vegetative state

A

No meaningful motor or cognitive state, no awareness of self or awareness. lasts for 1 year, less for someone with an anoxic brain injury 3 months

31
Q

CTE- Chronic traumatic encephalopathy

A

repetitive trauma to the head- boxing & football

32
Q

Acquired brain injury

A

Cord wrapped around baby neck during birth so increased cell death.

Lack of oxygen producing cell death
Cell mediators kill brain tissue

Excess of 4-6 minutes w/o oxygen causes accelerated cell death. • labelled acquired BI - happened during birth

33
Q

Signs & Symptoms- Social & emotional Issues

A
  • Dependent behavior
  • Child like behavior- latching on
  • Ability to love increased or decreased
  • Lack of motivation
  • Irratability
  • Aggression
  • Depression

Bringman Neuro (7 decks)

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