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Physical Rehabilitation > TBI > Flashcards

TBI Flashcards

1
Q

What is a traumatic brain injury?

A

Alteration in brain function, or other evidence of brain pathology

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2
Q

What is the leading cause of TBI?

A

TBI is leading cause of injury-related death
Falls (32%)
MVA (19%) are second

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3
Q

Who is most at risk for a TBI?

A

Children and young adults

most common in children 0-4 years old

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4
Q

What is the mechanism of injury for primary injury?

A

Brain tissue contacts object (bony skull or external object , bullet)
Rapid acceleration/deceleration

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5
Q

What are the 2 was rapid acceleration/deceleration create a primary brain injury?

A

Cause sheer, tensile, and compression forces

Causes diffuse axonal injury (DAI), tissue tearing, hemorrhages

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6
Q

Where do you see TBI related blast injury?

A

Military conflicts, explosive devices produce shock waves

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7
Q

What is the mechanism of injury during a secondary injury part of a TBI?

A

Results of chain of cellular events that follow tissue damage
Hypoxemia, hypotension, ischemia, edema, elevated ICP, hematomas
Develop over hours and days

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8
Q

What are some common impairments seen with TBI (7)?

A

WIDE spectrum
Neuromuscular - paresis, abnormal tone, motor function
Cognitive - arousal, attention, concentration, memory
Neurobehavioral - Agitation, aggression, disinibition, apathy, impulsivity
Communication
Swallowing
Dysautonomia
Seizures

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9
Q

Are cognitive and behavioral or physical limitations more disabling?

A

Cognitive and behavioral

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10
Q

What are the 3 categories in the Glasgow Coma Scale?

A 
Eye opening (1-4)
Best Motor Response (1-6)
Verbal Response (1-5)
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11
Q

How does the scoring system of the Glasgow Coma Scale work?

A

Scored 3-15
Score 8 or less = severe
9-12 moderate
13-15 mild

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12
Q

What are some other ways you can determine the severity of a TBI?

A

Measure loss of consciousness
Alteration of consciousness
Post traumatic Amnesia

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13
Q

What is post-traumatice amnesia and how can it be used as a predictor for recovery?

A

Length of time between injury and time at which the patient is able to consistently remember ongoing events
0-1 day mild
>1 and 7 days Moderate
>7 Days Severe

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14
Q

What needs to be done at the scene of the accident after a TBI?

A

Stabilize cardiovascular and respiratory systems to maintain sufficient blood flow and O2 to the brain

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15
Q

What happens early on at the hospital after a TBI?

A

Minimize secondary brain injury by optimizing cerebral blood flow, stabilize vitals, perform complete exam, identify and treat non neurological injures
May need intubation
Imaging and possible surgeries for hematomas

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16
Q

What is normal ICP per NIH?

A

1-20 mmHg

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17
Q

How can you treat elevated ICP (5)?

A 
Sedating medications
Moderate head-up positioning
Hypothermia
Surgical decompression (bone flap removal)
Induced coma may be necessary
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18
Q

Where’s the best place to monitor ICP?

A

External ventricular drain with subdural bolt or fiberoptic catheter

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19
Q

Name 2 things you want to do before seeing the patient with a TBI in the acute phase.

A

Complete medical record review

Get an update on status from nursing

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20
Q

What are some things your going to want to look at with a patient with a TBI?

A 
Arousal, attention, cognition
Integument integrity
Sensory integrity
Motor function
ROM
Reflex integrity
Ventilation and respiration
21
Q

What are some scales you can use to measure arousal, attension, and cognition and what’s the most important one?

A

Coma recovery scale-Revised (CRS-R) - (23 item measures auditory, visual, motor, oromotor, communcaion and arousal)
Disorders of Consciousness scale (DOCS) - 23 items assess social knowledge, taste/swallowing, olfactory, proprioception, tactile sensation, auditory function, and visual function
Rancho Los Amigos Levels of Cognitive Functioning (LOCF) best one

22
Q

What are the 8 stages of the Rango Los Amigos Level of Cognitive Functioning?

A 
1 - No response
2 - Generalized response
3 - Localized Response
4 - Confused-Agitated
5 - Confused-Inappropriate
6 - Confused-Appropriate
7 - Automatic-Appropriate
8 - Purposeful-Appropirate
23
Q

What are some goals in the acute phase after a TBI? (8)

A

Increase physical function and level of alertness
Reduce risk of secondary impairments
Manage the effects of tone
Improve postural control
Increase tolerance of activities and positions
Improve or maintain joint mobility and integrity
Educate family and caregivers
Coordinate with team members to provide care

24
Q

What are some interventions for preventing secondary impairments in the acute phase?

A 
Proper positioning in bed/wheelchair
Passive ROM
Special boots or splints
Turning to prevent skin breakdown (every 2 hours)
Socialized air mattress
Serial casting (contracture)
25
Q

True/False It is important to move into a sitting position as soon as medically stable.

A

TRUE

Use tilt table for early weight-bearing

26
Q

During an examination of a patient with a TBI what is important for the physical therapists to be?

A

Be creative and Observant

-Standardized tests and measures may be difficult or inaccurate due to cognitive and behavioral impairments

27
Q

What are some things the PT should know?

A

Patient able to follow commands? (1-step, mutli-step)
Is the patient oriented to person, place, and time?
Does the patient recognize family members?
Does the patient demonstrate any insight into what has happened?

28
Q

Name some outcome measures for TBI Attention and Cognition.

A

The Moss Attention Rating Scale (MARS)
Test of Everyday Attention and Trail Making Test Part B (used by neuropsychology)
Galveston Orientation and Amnesia Test (GOAT), often used b SLP

29
Q

Name some outcome measures for TBI Balance

A

BERG Balance Scale (when used with FIM may prdict length of stay, falls and functional gains)
Community Balance and Mobility Scale (CB&M) - reliable and valid (specific to TBI)
High-Level Mobility Assessment Tool (HiMAT) - measures higher level of performance patients with TBI

30
Q

What is a good outcome measure for global function after a TBI?

A

FIM

  • functional mobility, ADL function, cognition, and communication
  • Designed to measure level of disability and burden of care during inpatient rehab
  • Useful for monitoring patient progress
  • Valid and Reliable after TBI
31
Q

Describe the FIM

A

Has 18 items
-13 motor
-5 cognitive
Scores range from 18-126 (each task has a 7 point scale)

32
Q

How does the scoring system work for the FIM?

A

No Helper - 7 or 6 (6 uses an assistive device
Helper Modified Dependence - 5-3 (5 just needs supervision, 4 min assist, 3 mod assist)
Helper Complete Dependence - 1-2 (2 max assist, 1 total assist)

33
Q

Name some functional and outcome measures for locomotor skills after TBI?

A 
Observational gait (stance and swing phase)
Gait speed (10 meter walk test)
Endurance (6 MWT)
Dual Task Performance
Functional Gait Assessment (FGA)
Dynamic Gait Index (DGI)
34
Q

Name some motor re-learning strategies after TBI.

A

Plan sessions ahead of time
Practice should be distributed with frequent rest periods
Explicit or augmented feedback may be better then intrinsic
FOCUS on FUNCTION and work toward Active Movement as soon as able

35
Q

Do you want to use restorative or compensatory interventions with TBI injuries?

A

Probably both
Restorative rehab will result in greater functional independence
Compensatory will ensure safety

36
Q

What type of interventions with large amounts of practice can induce neuroplastic changes and restore function?

A

Task Specific Interventions

37
Q

What 3 things about interventions make them the most beneficial?

A

Specific to function/task
Meaningful to patient
Challenging to systems

38
Q

Name some strategies for treating confused or agitated patients (6)?

A

Consistency - All team members be consistent, establish routine
Expect No Carryover - Teaching new skills unrealistic (use charts, graphs, memory aids)
Model Calm Behavior
Expect egocentricity - patient may not see others points of view
Flexibility/Options
Safety

39
Q

What type of TBI is a concussion known as?

A

mTBI

Mild TBI

40
Q

What characteristics be in a person with a concussion? (GCS score, etc)

A

13-15 GCS score
Varying degrees of loss of consciousness (0-30 min)
PTA
Altered mental state for up to 24 hours

41
Q

What are some symptoms of a mild TBI?

A 
Blurred vision and nausea are the 2 biggest ones
Cognitive deficits
Postural control and balance impairments
Light Sensitivity
Sleep Disturbance
Ringing in the ears
42
Q

How long does it take for most people to recover from a mild TBI?

A

Fully recover in 3 months

43
Q

What percentage of people may experience postconcussive syndrome?

A

10-20%

44
Q

How do you want to return to activity after mild TBI?

A

1: No activity - (cognitive & physical rest until symptoms resolve)
2: Light aerobic exercise
3: Sport-specific exercise
4: Noncontact training drills
5: Full-contact practice
6: Return to play

45
Q

How long does each step of recovery take after mTBI?

A 
24 hours
(1 week to return to full active duty or sport activity)
46
Q

What needs to be done if symptoms of mTBI return during a stage of recovery?

A

Wait 24 hours (rest)

Go back to previous stage

47
Q

Name some interventions for mTBI.

A

Vestibular - BPPV & Gaze stabilization exercises
High-level task oriented balance and gait training
Patient Education

48
Q

What is one of the most important thing to educate a patient about for a mTBI?

A

Dangers of Second Impact Syndrome

Physical Rehabilitation (18 decks)

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