TBI

Question 1

Signs of localized lesion to:

Frontal: primary motor cortex

Answer 1

fxn: discrete volintional mvmt
lesion: CL paralysis and paresis (most pronounced in distal parts of limbs and lower part of face)

Question 2

Signs of localized lesion to:

Frontal: premotor area

Answer 2

fxn: motor planning or praxis
lesion: apraxia or motor planning difficulties

Question 3

Signs of localized lesion to:

Frontal: prefrontal area

Answer 3

fxn: motor association area
lesion: loss of specific motor plans

Question 4

Signs of localized lesion to:

Frontal: supplementary motor

Answer 4

fxn: B control of posture
lesion: loss of B control of posture

Question 5

Signs of localized lesion to:

Frontal: middle frontal gyrus

Answer 5

fxn: conjugate eye mvmt
lesion: transitory paralysis of conjugate eye mvmts to CL side

Question 6

Signs of localized lesion to:

Frontal area: motor speech area (Boca)

Answer 6

fxn: language production
lesion: nonfluent aphasia

Question 7

Signs of localized lesion to:

Prefrontal area: dorsolateral

Answer 7

fxn: motivation, problem solving
lesion: B lesions: imparied ability to concentrate

Question 8

Signs of localized lesion to:

Prefrontal area: orbitofrontal

Answer 8

fxn: emotions, behavior
lesion: unstable emotions, unpredictable behavior

Question 9

Signs of localized lesion to:

Prefrontal area: orbitall gyri (posteriolateral)

Answer 9

fxn: olfaction
lesion: inability to distcriminate odors

Question 10

Signs of localized lesion to:

Parietal: postcentral gyrus / primary somatosentory area

Answer 10

fxn: somesthetic sensations
lesion: loss of CL stimulus location, intensity

Question 11

Signs of localized lesion to:

Parietal: secondary somatosensary area

Answer 11

fxn: sensory interpretation
lesion: tactile agnosia: asterognosis, agraphesthesia, loss of 2-point discrimination, extinction

Question 12

Signs of localized lesion to:

Parietal: gustatory cortex

Answer 12

fxn: taste
lesion: impairment of taste in CL tongue

Question 13

Signs of localized lesion to:

Parietal: parietal lobe (R hemisphere)

Answer 13

fxn: perceptual fxn
lesion: visual-spatial disorders, body scheme disorders, aprasias, tactile and auditory perceptual disorders

Question 14

Signs of localized lesion to:

Temporal: primary auditory cortex

Answer 14

fxn: hearing
lesion: subtle decrease in hearing and ability to localize sounds, both CL

Question 15

Signs of localized lesion to:

Temporal: Wernicke’s speech area

Answer 15

fxn: lanaguage understanding and formulation; storage of auditorially presented info
lesion: fluent aphasia

Question 16

Signs of localized lesion to:
Temporal: superior temporal gyrus (L hemisphere)
Temporal: temporal cortex (nondominant side)
Temporal: parahippocampal region

*confusing in table in book

Answer 16

fxn: storage of visually presented info
fxn: recent memory
lesion: impairment of learning and memory
lesion: profound memory loss of recent events; no new learning

Question 17

Signs of localized lesion to:

Occipital: primary visual cortex

Answer 17

fxn: vision
lesion: CL homonymous hemianopsia

Question 18

Signs of localized lesion to:

Occipital: visual association cortex

Answer 18

fxn: visual understanding
lesion: visual agnosia

Question 19

Signs of localized lesion to:

Occipital: posterior multimodal area (parietal, temporal, occipital)

Answer 19

fxn: integrates sensory info (somatosensory, visual, auditory)
lesion: perceptual impairment

Question 20

TBI: etiology

Answer 20

contact forces to skull; rotational acceleration forces

Question 21

TBI: pathophysiology

Answer 21

Primary brain damage

• diffuse axonal injury: disruption and tearing of axons and small blood vessels from shear-strain of angular acceleration; results in neuronal death and petechial hemorrhages
• focal injury: contusions, lacerations, mass effect from hemorrhage, and edema (hematoma)
• coup-contracoup injury: injury at point of impact and opposite point of impact
• closed or open injury (with fx of the skull)

Secondary brain damage

• hypoxic-ischemic: results from symptomatic problems (resp or cardiovasc) that compromise cerebral circulation
• swelling/edema: can result in mass effect with increased ICP, brain herniation (uncal, central or tonsillar), and death
• electrolyte imbalance and mass release of damaging neurotransmittors

Concussion: loss of consciousness, either temp or permanent, resulting from injury or blow to head, with impaired fxning of the BS reticular activating system (RAS); may see changes in HR, BP, RR

Question 22

Characteristics of mild TBI

Answer 22

LoC: 0-30min
Alteration of consciousness: brief; >24hrs
Posttraumatic amnesia: <1 day
GCS: 13-15
Imaging: normal

Question 23

Characteristic of moderate TBI

Answer 23

LoC: 30min < x < 24 hrs
Alteration of consciousness: >24 hrs
Posttraumatic amnesia: 1 day < x < 7 days
GCS: 9-12
Imaging: normal; abnormal

Question 24

Characteristics of severe TBI

Answer 24

LoC: >24 hrs
Alteration of consciousness: >24 hrs
Posttraumatic amnesia: >7 days
GCS: <9
Imaging: normal; abnormal

Question 25

TBI: Outcome measures

Answer 25

GCS: Glasgow Coma Scale
LOCF: Rancho Levels of Cognitive Fuctioning
Rappaport’s Disability Rating Scale (DRS)
Glasgow Outcome Scale (GOS)
Hi-MAT
FIM/FAM
Neurological Outcome Scale for TBI (NOS-TBI)
Assessment of Life Habits (Life-H)
Coma Recovery Scale
Motor Attention Rating Scale

Question 26

Diffuse axonal injury: recovery stages

Answer 26

Coma: no response
Unresponsive vigilance/vegetative state
Mute responsiveness/min responsiveness
Confusional state
Emerging independence
Intellectual/social comptence