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Neuro management 2 > TBI > Flashcards

TBI Flashcards

1
Q

Why do we classify a brain injury

A

to determine prognosis for recovery for an individual who has experienced a TBI

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2
Q

How do we classify a brain injury (4)

A

chronicity
etiology of injury
level of arousal
cognitive function

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3
Q

regarding chronicity, the rate of recovery is greates during the first ___ years, b/c of the inpact of ___ ___ ___

A

2

spontaneous neural recovery

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4
Q

During the chronic timeframe (>2 yrs post-injurty), recovery is more related to

A

rehab and lifestyle choices

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5
Q

regarding etiology of injury, individuals with a more __ injury, usually have a better prognosis than individuals with a more ____ injury

A

focal

diffuse/global

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6
Q

Low velocity injuries have ___ outcomes than higher velocity injuries

A

better

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7
Q

____ level is measured at the time of injury and is predictive of ___ of injury. it is measured using the

A

arousal
severity
glasgow coma scale

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8
Q

a 15 pt scale based on the responsiveness of the individual according to 3 areas

A

glasgow coma scale

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9
Q

what are the 3 areas scored in the glasgow coma scale

A

motor response
verbal response
eye opening response

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10
Q

Scoring of glasgow coma scale

A

mild TBI > or equal to 13
Severe TBI < or equal to 8
Best score 15

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11
Q

How is cognitive function measured

A

Ranchos Los Amigos Scale of Cognitive Function

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12
Q

Rancho Level 1

A

No response

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13
Q

Rancho Level 2

A

Generalized response

a. decerebrate (everything extended)
b. decorticate (flexed)
c. chewing (vertical opening and closing)

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14
Q

decerebrate

A

everything extended Rancho 2

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15
Q

decorticate

A

everything flexed Rancho 2

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16
Q

Rancho Level 3

A

Localized response

a. visual tracking
b. withdrawal

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17
Q

Rancho Level 4

A

confused and agitated

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18
Q

Rancho Level 5

A

confused and inappropriate (non-agitated)

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19
Q

Rancho Level 6

A

confused and appropriate

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20
Q

Rancho Level 7

A

Automatic and appropriate

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21
Q

Rancho Level 8

A

purposeful

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22
Q

4 etiologies of TBI

A

Direct contact injuries
Ruptured cerebral aneurysms
Acceleration and deceleration injuries
Hypoxic injuries

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23
Q

Brain injuries involving an event where a stationary object or moving object forecfully contacts the head

A

direct contact injury

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24
Q

4 closed head injuries

A

concussion
cerebral contusion
epidural hemorrhage or hematoma
chronic subdural hematoma

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25
Q

rapid onset of neurological impairments following a minimal head injury which may or may not include loss of consciousness

A

concussion

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26
Q

areas of focal brain injury where there are multiple micro-hemorrhages into brain tissue. Damage frequently occurs from brain tissue moving against intracranial structures

A

cerebral contusion

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27
Q

damage to tissue on the side of the skull opposite to the impact

A

countrecoup cerebral contusion

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28
Q

management for crebral contusion

A

reducing intracranial pressure and maintaining cerebral perfusion pressure

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29
Q

impaired body functions with cerebral contusion

A

focal weakness, paresthesia, incoordination, aphasia, and difficulty with cognitive tasks

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30
Q

damage to major vessels including tearing of middle meningeal artery, middle meningeal veins or dural sinus resulting in blood accumulating in the epidural space

A

epidural hemorrhage or hematoma

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31
Q

_____ ____ neurological impairments are highly indicative of an ____ _____

A

progressively worse

intracranial hemorrhage

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32
Q

Hematomas are identified on

A

CT or MRI

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33
Q

management of epidural hemorrhage or hematoma

A

surgery (craniotomy and evacuation)

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34
Q

stretching of tiny veins in the subdural space, which ultimately tears the veins and blood accumulates. This occurs slowly over time (often several weeks) before symptoms become apparent

A

chronic subdural hematoma

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35
Q

Chronic subdural hematoma is most common in

A

older adults, where the veins are already stretched do to atrophy of brain tissue

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36
Q

management of chronic subdural hematoma

A

surgery (Burr hole craniostomy)

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37
Q

impairments include poor balance, hemiparesis, headache, slurred speech, dementia and lethargy

A

chronic subdural hematoma

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38
Q

open head injuries are called _____

A

penetrating injuries

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39
Q

Prognosis - recovery from direct contact injuries is usually ___ or ____, depending on the intensity or extent of the injury. Closed head injuries usually have ___ prognosis than penetrating injuries

A

good, fair, better

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40
Q

brain injuries usually associated with a minor direct contact injury, along with a cerebral aneurysm (weakness in the wall of the arteries usually in the ___ __ ___)

A

ruptured cerebral aneurysms

circle of willis

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41
Q

most common cause of a subarachnoid hemmorrhage

A

ruptured cerebral aneurysm

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42
Q

bleeding into the CSF (the subarachnoid space) from small vessels, usually resulting from a ruptured aneurysm

A

subarachnoid hemorrhage

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43
Q

diagnosis of subarachnoid hemorrhage

A

identified on CT scan following an acute, severe headache, comfirmed with lumbar puncture (presence of RBCs in CSF)

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44
Q

management of subarachnoid hemorrhage

A

maintain cerebral perfusion and reduce likelihood of rebleeding from the aneurysm via surgery (clipping of aneurysm)

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45
Q

causes of ruptured cerebral aneurysms

A

direct contact injuries (fall, MVA, etc)

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46
Q

prognosis of ruptured cerebral aneurysms

A

recovery of this type of injury depends on the size and location of the aneurysm. Aneurysms with larger size and those located in more POSTERIOR circulation have worse prognosis

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47
Q

indirec brain injuries where the etiology of injury involves a high velocity incident

A

acceleration and deceleration injuries

48
Q

most common cause of acceleration/deceleration injury is

A

MVA

49
Q

other causes of acceleration/deceleration injuries

A

shaken baby (usually acute subdural hematoma) syndrome, and blast injuries which are most common to occur during combat

50
Q

3 resulting health conditions from an acceleration/deceleration injury

A

complex concussion
diffuse axonal injury
acute subdural hematoma

51
Q

occur when rotational forces cause unequal sheering of long axons within the brain

A

diffuse axonal injury

52
Q

Because brain tissues differ in weight and density, tissues that are less ___ (ie. axonal pathways made primarily of white matter) are more likely to be stretched and damaged

A

dense

53
Q

diffuse axonal injury is NOT ____, but rather associated with deformation of particualr areas: ___ __, ___ ___, ____ and ___ ___

A 
diffuse
corpus callosum
internal capsule
brainstem
cerebellar peduncles
54
Q

Diagnosis for diffuse axonal injury

A

sometimes identifiable on MRI (not on CT)

55
Q

prognosis for diffuse axonal injury

A

poor

56
Q

veins in the superior sagittal sinus are torn and blood accumulates in the subdural space.

A

acute subdural hematoma (acceleration/deceleration)

57
Q

Regarding acute subdural hematoma, individuals who have a rapid onset of symptoms have a ___ prognosis of survival due to rapid increase in ____.

A

poor

ICF

58
Q

diagnosis of acute subdural hematoma

A

CT

59
Q

management of acute subdural hematoma

A

surgery (craniotomy and evacuation)

60
Q

prognosis of acceleration/deceleration injuries

A

poor

61
Q

indirect brain injuries where the etiology of injury involves lack of oxygen to the brain

A

hypoxic injuries

62
Q

most common cause of hyposxic injuries are ___ and ___

A

near drowning incidents and myocardial infarction

63
Q

prognosis for hypoxic injuries

A

very poor

64
Q

after a hypoxic injury most individuals do non survive and if they do, they remain in a stage of

A

impaired consciousness (coma, persistent vegetative state, or minimally conscious state)

65
Q

Regarding ICP, we want this to be less than ____. what position is bad for patients with elevated ICP?

A

20 mmHg

laying flat

66
Q

prognosis for TBI decreases after

A

65

67
Q

in a systems review, what is important to consider regarding MSK

A

flexibility in places for heteroptopic ossification

68
Q

difficulty w/lip closure (drooling)

A

cranial nerve VII (facial)

69
Q

difficulty chewing

A

CN V (trigeminal)

70
Q

Difficulty moving bolus posteriorly

A 
CN VII (facial-retention of food between cheeks and gums)
CN XII (hypoglossal-retention of food in mouth)
71
Q

Difficulty initiating swallowing

A 
CN IX (glossopharyngeal) 
CN X (vagus)
72
Q

cognitive impairments (6)

A 
info processing speed
executive fxn
problem solving
attention
memory
communication
73
Q

rate of activity is slowed, result is delayed reaction time or increased tak completion time

A

information processing speed impairment

74
Q

difficulty engaging in independent, purposeful, self-serving behavior, result is difficulty initiating, planning, monitoring performance, anticipating consequences and responding flexibility (refer out to neuropsych)

A

executive functioning impairment

75
Q

difficulty brainstorming, comparing ideas, prioritizing ideas and drawing inferences

A

problem solving impairment

76
Q

difficulty receiving and beginning to process stimuli, difficulty maintaining focus, ignoring distractions and simultaneously attending to more than 1 thing (dual-task: motor and cognitive)

A

attention impairment

77
Q

difficulty encoding, storing and retrieving explicit or implicit info (refer out to neuropsych)

A

memory impairment

78
Q

difficulty understanding or expressing language (refer to SLP)

A

communication impairment

79
Q

T/F subdural hemorrhage has poorer prognosis than subarachnoid or epidural hemorrhage

A

T

80
Q

Longer duration of coma ___ has poorer prognosis

A

> 24 hrs

81
Q

longer duration of uncontrolled ____ disorder has poorer prognosis

A

seizure

82
Q

longer duration of post-traumatic ____ has poorer prognosis

A

amnesia

83
Q

Considering concussions, people should not get worse. worsening symptoms, pronounced amnesia, progressive balance dysfuction suggest

A

intracranial pathology and required imaging

84
Q

cognitive rehab- alter demands on the patient

A

simplify or eliminate task
work in short segments with frequent breaks
reduce stimuli

85
Q

cognitive rehab-provide salient cues for initiation

A

provide external cue

86
Q

cognitive rehab–provide external guides for sequencing behavior

A

use metacognitive strategies

training specific behavioral sequence for repetitious activities

87
Q

metacognition

A

thinking about thinking

88
Q

cognitive rehab-employ behavioral interventions

A

DO NOT ignore abusive, disruptive behavior, address it and have a natural consequence for their behavior

89
Q

cognitive rehab–reduce aggressive, disruptive, or intrusive behaviors

A

because they impair adaptive social functioning

90
Q

impaired processing speed management

A

tasks require decoding of info to perform and reaction time

91
Q

examples of management for impaired processing speed

A

stepping to a target while matching footstep to an auditory or visual cue, standing while catching scarves of a particular color, path finding (reading and making a decision regarding a sign)

92
Q

impaired executive functioning management

A

Tasks require initiation, planning, monitoring performance, anticipating consequences, and responding and responding flexibly

93
Q

examples of management of impaired executive functioning

A

getting dressed, house cleaning activities, taking transportation to a destination

94
Q

interventions for impaired executive function

A

task-specific metacognitive strategies

95
Q

impaired problem solving

A

tasks require brainstorming, comparing ideas, prioritizing ideas, and drawing inferences

96
Q

interventions for impaired problem solving

A

generalized metacognitive strategies

97
Q

examples of management of impaired problem solving

A

novel tasks for the individual where decision making must be made, such as planning and implementing a dinner or going on a recreational trip (hiking)

98
Q

impaired divided attention

A

tasks require the ability to respond to multiple stimuli simultaneously

99
Q

examples of management of impaired divided attention

A

walking in a figure 8 while carrying different size grocery bags, tandem walking while adding numbers

100
Q

Regarding the Coma stimulation program, what does the hierarchial level of cueing mean

A

force them to be successful: “squeeze my hand” WAIT for them and then manually make them squeeze you hand “you are squeezing my hand”

101
Q

progression of interventions- arousal

A

increase the complexity of the response (amplitude or require a decision) or request a different response (motor or verbal rather than visual)

102
Q

progression of interventions- info processing speed

A

increase the speed of the response or increase the complexity of the info

103
Q

progression of interventions- executive function

A

decrease the number of external cues and increase reliance on internalized procedures

104
Q

progression of interventions- problem solving

A

increase the complexity of the problem

105
Q

progression of interventions- attention

A

increase time for sustained attention, increase distraction for selective attention, increase choices to select for alternating attention, and increase number of variables for divided attention

106
Q

progression of interventions- vestibular spinal

A

decrease alternative sensory systems (vision and proprio), then add conflicting sensory stimuli from other systems

107
Q

progression of interventions- vestibular ocular reflex

A

increase speed of head movement without excessive blurring

108
Q

progression of interventions- dizziness

A

decrease the reliance on alternative sensory systems (vision and proprio) while encouraging re-orientation and anxiety management

109
Q

progression of interventions- timing

A

improve reaction time

110
Q

progression of interventions- sequencing

A

increase the amount of sequencing

111
Q

progression of interventions- activation

A

increase the size of the response

112
Q

progression of interventions- perceptions

A

decreased the amount of sensory stimuli to achieve same response

113
Q

progression of interventions- proprioception

A

decrease the amount of sensory stimuli to achieve same response

114
Q

progression of interventions- cutaneous sensation

A

decrease the reliance on other systems, particularly vision

115
Q

progression of interventions- power

A

increase the resistance or decrease the time to complete activity

Neuro management 2 (9 decks)

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