TBI Flashcards
2 types of TBI?
traumatic: from ext force/ open or closed
Non-traumatic: not ext, called aquired brain injury
in more severe injuries, what happens? as oppose to contusion from coup
what are the types of bleeding?
Diffuse axonal injury
Sheering
Tensile stress
epidural, subdural,subarachnoid,intraparenchymal
these are primary mechanisms of brain injury
2ndary mechanisms of TBI?
Ischemia Hypoxia Hypotension Edema ICP inc Hypercapnia (inc CO2) Excitotoxicity from inc chem/NT
What are the non traumatic Brain injury mechanisms?
hemorrhage stroke hydrocephalus Tumor Anoxia Infection Encephalopathies (from toxic or metabolic --fluid levels)
What are signs and symptoms of increasing ICP?
Dec level of consciousness *** Cushings Triad (^SBP/bradycardia/abn. respiration)**** headache vomit ocular palsy Papilledema dilated pupil abducens palsy
Awareness of injury mechanism assists with what?
Tx planning
and prognosis
DVTs in TBI are common because
what do we look for?
lack of mobility
Warmth
Redness
Swelling
patient may not be able to notice cuz TBI .
Where is seizure more common?
What are their nature?
more common in open Fx
can be general or focal
Therapist usually notice focal ones.
Heterotpic ossification?
laying of bone on jt.. MO is on muscle.
usually have dec ROM
given drugs and PROM
Anterograde vs Retrograde Amnesia?
A: cant form new memories
R: can’t recall old memories
this can help classify severity of brain injury
What to Assess for TBI?
ROM Strength Sensation Edema Qual tone: observe Quan tone: MAS
want to be observant of spontaneous movement of limbs
What to assess for Brain stem/Cranial nerve
Pupil alignment/motility Visual startle Localization to sound Fixate Pursuit
What to do to assess cog/arousal/attention?
If disorder of consciousness use CRS
Vegetative: no purposeful response
Minimal: respond but inconsistent
Emerged:normal conscious but Fx may not be.
What is orientation log?
10 questions scored out of 30 used when pt minimally conscious every day at diff times of day.
3: spontaneous answer
2: require cue
1: multiple choice
0: cant answer
What to note for assessing executive Fx and memory?
cant have one without other so test both.
via: GOAT/MOCA/Cog-log
test broad to capture deficits
Level 1 classification of Cognitive Fx?
Coma: no sleep/wake/response
usually in ICU/stepdown
PT: PROM/position/casting or spasticity
want to examinee BS reflex/resp/patho reflex (UMN)
Level 2 classification of Cognitive Fx?
Vegetative State: general but not purposeful response
acute rehab
PT: PROM/mobilizstion
Casting/use coma recovery Scale
Level 3 classification of Cognitive Fx?
Minimally Conscious: purposeful response inconsistent.
PT:mobilize/PROM
can use more traditional PT like gait.
Level 4 classification of Cognitive Fx?
confuse/agitated: weird non purposeful behavior STM loss
can be restless/agressive
PT: behavior management Gait training give choices and reward quiet environment DONT PROMISe
Rehab considerations for level 4?
Reorient (But can trigger them)
dec Amt of interaction
mitts to prevent harming.
Level 5 classification of Cognitive Fx?
Confused/inappropriate
less agitate than 4
PT: build tolerance to external stimuli
Provide a schedule
encourage automatics: brushing teeth and stiff
Level 6 classification of Cognitive Fx?
Confused but appropriate:
not consistently oriented
PT: encourage external cues, recall, schedule to reorient them
Level 7+8 classification of Cognitive Fx?
7: can do things from before, but judgement is impaired so need supervision
8: oriented and responds appropriately
PT:use remediation manage stress, emphasize self-awareness.
What are some assessment tools for TBI?
Himat: high-level function asses running, jumping.
Management of Spasticity?
is a 2ndary complication
oral meds (baclofen)
inject/intrathecal
stretch
cast
most common synergy is extension.
What is favorable prognosis?
young (not too young) high IQ good home life fam support no substance abuse.
unfavorable prognosis?
prolong coma >1wk
long amnesia >2wk
coexisting injury
no trauma
TBI in older adults?
usually from falls
less brain density cuz old
mortality higher
