TBI Flashcards
Types of TBI- TAN
- Traumatic (closed & Open)
- Non-traumatic
- Acquired
Traumatic TBI - closed
- 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.
DAI-Diffused axonal injury
Small microscopic injuries that occurs, don’t show up on radiograph but BI still evident and changes in behavior occurs.
Traumatic TBI- Open
- OH injury, GSW, baseball bat etc
- Secondary issue infection
- Herniation out of the opening
Non Traumatic BI- Anoxic
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
Observed changes in mental and functional status after a TBI
- Confusion
- Mood
- Vomiting
- Headaches etc. within the first 24hrs of injury
Differentiating TBI
Mild vs. Moderate & severe
Mild TBI= FL2AS2H MDFCWNVP
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
Moderate & severe
- LOC > 30-6h Mod
- LOC 6 hrs or more – severe
Signs & Symptoms of moderate & severe TBI- Cognitive issues CoMP2ILE A
Similar symptoms to mild but magnified
- Concentration
- Memory
- Processing speed
- Perseveration
- Impulsiveness
- Language processing
- Executive functions
- Attention
Signs & Symptoms of moderate & severe TBI- Speech Impairments FIRES
- Fast / slow speech
- Inability to form words
- Reading & writing
- Expressive, receptive
- Slurred speech
Signs & Symptoms of moderate & severe TBI- Foreign accent syndrome
Pt. acquires a foreign accent after the injury
Signs & Symptoms of moderate & severe TBI- Sensory & Vision
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
Signs & Symptoms of moderate & severe TBI- Hearing Smell &Taste
Hearing
Complete / increased sensitivity to sound
Tinnitus – wringing in ears
Smell- Loss or diminished
Taste- loss or diminished
Signs & Symptoms of moderate & severe TBI- Physical changes WFSCBAM
- Weakness
- Flacidity
- Spasticity
- Chronic pain
- Bowel & bladder issues
- ANS issues
- Menstrual cycles
Signs & Symptoms of moderate & severe TBI- Social & emotional ID4EAL
- Irritability
- Dependent behaviors- child like
- Depression
- Disinhibition
- Denial
- Emotional ability to love, be sad, absence etc
- Aggression
- Lack of motivation
Levels of consciousness- AOSMC
- 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
Coma- 2 states
Vegetative
Persistent vegetative
Health care team
- *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
Glasgow coma scale rating
Mild TBI- 13-15
Moderate 9-12
Severe 3- 8
Ranchos Los Amigos Level 1-
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.
Ranchos Los Amigos Leve 2
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.
Ranchos Los Amigos Level 3
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
Ranchos Los Amigos Level 4
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.
Ranchos Los Amigos Level 5
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.
Ranchos Los Amigos Level 6
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.
Ranchos Los Amigos Level 7
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.
Ranchos Los Amigos Level 8
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.
Vegetative state
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
Persistent vegetative state
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
CTE- Chronic traumatic encephalopathy
repetitive trauma to the head- boxing & football
Acquired brain injury
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
Signs & Symptoms- Social & emotional Issues
- Dependent behavior
- Child like behavior- latching on
- Ability to love increased or decreased
- Lack of motivation
- Irratability
- Aggression
- Depression
