TBI

Question 1

Type of damage that occurs when an OBJECT hits a stationary head

Answer 1

contusion

Question 2

type of damage that occurs with rapid acceleration and deceleration ?

Answer 2

defuse axonal injury

Question 3

which type of injury tends to be more severe ?

Answer 3

defused axonal injury has more extensive and widespread damage (also more unpredictable and involve more body parts) vs contusion is more localized impairments

Question 4

type of damage that occurs when the HEAD hits a stationary object

Answer 4

Coup contrecoup

Question 5

injury by sharp object

Answer 5

penetration

• open type of injury = higher chance of infection
• deficits depends on size and location

Question 6

secondary effects of TBI

Answer 6

• increased ICP
• hypoxia ischemia
• edema
• infection
• post traumatic epilepsy
• hydrocephalus

Question 7

what is normal ICP? What is considered increased ICP?

Answer 7

Normal: 0 -10 mmHg
Increased: > 20 mmHg

Question 8

what are signs of increased ICP?

Answer 8

nausea
visual disturbances due to papilledema
drowsiness 
Altered consciousness
vomiting

Question 9

What can increased ICP result in? (what damage occurs)

Answer 9

• displacement in brain tissue
• ischemia
• hydrocephalus

Question 10

what are secondary effects of TBI

Answer 10

• increased ICP
• hypoxia ischemia
• edema
• infection
• post traumatic epilepsy
• hydrocephalus

Question 11

what is cerebral perfusion pressure? normal vs abnormal levels?

Answer 11

• the amount of pressure needed to maintain blood flow to the brain
• Difference between mean arterial pressure (MAP) and intracranial pressure (ICP)
• normal CPP: ≥ 70 mmHg
• CPP levels that cause ischemia: ≤ 40 -50

Question 12

Glasgow Coma Scale

Answer 12

• rates the severity of coma/TBI
• three categories: eye response, verbal response, and motor response
• scores range: 3-15
• severe: 3-8
• moderate: 9 -12
• mild: 13- 15

Question 13

coma

Answer 13

• Unconscious and unarousable

- No periods of wakefulness or eye opening in response to stimulation

Question 14

vegetative state

Answer 14

• Lack of awareness / consciousness of themselves and environment
• Are arousable- either spontaneously or stimulus induced BUT responses are NOT sustained, reproducible, purposeful, or voluntary.
• no evidence of language compression or expression
• intermittent wakefulness with presence of sleep wake cycles

Question 15

retrograde vs anterograde amnesia

Answer 15

• retrograde: unable to recall memories prior to injury

- anterograde: unable to recall memories post injury

Question 16

minimally conscious state

Answer 16

clear demonstration of awareness of self and environment by one or more of the following:

• simple command follow
• gestural or verbal yes/no (does have to be accurate)
• intelligible verbalization
• purposeful behaviors

Question 17

Westmead post traumatic amnesia scale

Answer 17

• Measures duration of post traumatic amnesia
• PTA is over when person can form new memories
• Mild: 5 - 60 mins
• moderate: 1 - 24 hours
• Severe: 1 -7 days
• very severe: 1- 4 weeks
• extremely severe: > 4 weeks

Question 18

Leading cause of TBI? other causes?

Answer 18

falls 40.5%
other/unknown 19%
stuck by/against 15.5%
MVA 14.3%
assault 10.7 %

Question 19

TBI deaths

Answer 19

• deaths male to female ratio: 3:1

- highest incident of death is ≥ 65 yo

Question 20

most common location of intracerebral hematoma

Answer 20

frontal and temporal

Question 21

stages for ranchos los amigos cognitive function

Answer 21

1: no response
2: general response
3: localized response
4: confused agitated
5: confused, non agitated, inappropriate
6: confused, appropriate
7: automatic, appropriate
8: purposeful, appropriate

Question 22

what stage of the ranchos los amigos cognitive function would you use a behavioral plan?

Answer 22

level 4: confused, aggressive, inappropriate