TBI Flashcards
Open Injury
pierces the scalp and skull
Penetrates the meninges of the brain
Examples: gun shot or knife
Also called penetrating injuries
typically results in Focal Damage – limited to the area of injury
Damage is largely isolated to one area of the brain
Closed Injury
does not pierce the scalp and skull
Result of mechanical forces: acceleration-deceleration
Linear
Rotational
typically results in diffuse injury
Damage is widespread over areas of the brain
Primary injuries
are a direct result of trauma
In other words: Injuries that occur at the time of trauma
Result from combination of 2 forces:
impact (skull deformation/fracture/focal injury)
acceleration/deceleration (linear & rotational)
Open TBI primary injuries:
Skull fracture
Brain damage along path of foreign object
Closed TBI primary injuries:
Skull fracture
Contusion
Diffuse axonal injury
Contusion
– bruising
Axonal Injury
– widespread damage to axons
Coup
- initial point of impact
Contra coup
damage on opposite side of the initial impact
Coup/Contra-Coup
Primary Injury
Results in brain contusions
Base of skull boney with ridges- further damages brain
Areas vulnerable to damage: Lateral and ventral (underside) portions of frontal and temporal lobes Prefrontal region Limbic system Connections among brain areas
Rotational forces:
Primary Injury
Twist cortex around the brainstem
Can twist, stretch, and shear blood vessels and axons
Diffuse axonal injury (DAI)
Primary Injury
Twisting, stretching, and/or shearing of axons
Associated with coma
Reticular formation
Secondary injuries
Aftermath of primary injury
Neurochemical & metabolic changes
Bleeding of the brain (hemorrhage/hematomas)
Loss of oxygen to the brain (Hypoxia-ischemia/hypotension)
Infarction – damage due to loss of blood
Brain swelling (edema)
Increased cranial pressure (ICP)
Seizure
Glasgow Coma Scale (GCS)
TBIs are classified as mild, moderate, or severe
instrument used to classify injury severity
Assesses an individual’s level of consciousness
Scores on the GCS range from 3-15 (higher more conscious)
The lower the score; the more severe the injury
Majority of TBIs are mild
GCS of 13-15
Consequences of TBI
Consequences are VARIABLE
No two brains are the same
Injured brain regions may be similar but deficits can be different
Disability after TBI occurs on a continuum
Can impact ability to live independently
Can impact family
Individual with severe TBI may not be able to work or attend school and may be dependent on the care and support of family
Hallmark of TBI
Deficits in:
Orientation – person, place, time & circumstance
Attention (divided – multitasking; alternating – one task, then another)
Memory (Working memory – directly affects language)
Reasoning
Executive function – problem solving
Language deficits after TBI:
Aphasia (Aphasia tests may not capture language deficits after TBI)
Impaired auditory comprehension
Word finding
Naming errors
Confabulation
Confused language – empty, irrelevant speech that may contain circumlocutions, confabulations, and be tangential
Result of cognitive impairment NOT language abilities
Pragmatics
Pragmatics after TBI
difficulty effectively using language
“Talk better than they communicate”
Considered cognitive-communication deficit Discourse characterized as: Disorganized Inappropriate for social situation Difficulty with abstract language
Take away- language deficits mostly associated with use rather than form.
Dysarthria
motor speech disorder resulting from damage to the pyramidal or extrapyramidal tracts
Mutism
Speech d/o caused by Lesion to left basal ganglia nuclei or severe diffuse axonal injury
Better prognosis for those with basal ganglia nuclei lesions
Dysphagia
difficulty swallowing
Can resolve over time with treatment
Role of SLP in TBI
Collaborate with other professionals, patient, and family
Assess and mange all areas of communication
Receptive/expressive language
Written language (including reading)
Speech production
AAC
Hearing screening
Cognitive-communication deficits
Pragmatics
Assist with developing cognitive supports
Treatment varies based on stage of recovery
Early stages of recovery:
Patient is nonresponsive or response to stimuli is inconsistent
Unable to participate in standardized assessments
Monitor for ability follow commands
Treatment: Goals are to increase responses to verbal stimuli and establish communication
AAC may be introduced
AAC likely to be low-tech with yes/no responses
Intermediate stages of recovery:
Patient may be confused and agitated
Confused language
Informal assessments
Treatment Goals: May be in the form of group or individual therapy
Goal is to improve functioning in day-today environments
Restorative and compensatory approaches are used
Later stages of recovery:
Transition to purposeful and appropriate behaviors
May continue to have cognitive and communication deficits
Patient’s abilities vary based on injury severity and communication needs
Tests are selected based on the individual’s needs
Testing potential areas of deficit including: memory, attention, problem solving, executive function, language
Observation needed to determine functional abilities
Treatment Goal: carry over progress to everyday environments
Assessment
May perform well on standardized test but not do well in real life
Have to complete formal and informal testing
Discourse analysis:
Starts with an elicitation task- “tell me the story of…”
Audio or video recorded and transcribed
Utterances divided into T-units (dependent & independent clauses)
Analyzed for:
Story grammar components/summarization skills
Microlinguistic (grammar), microstructural (cohesiveness, use of pronouns match), and macrostructural (story grammar, sentenece structure) components
