TBI Flashcards
what is the leading cause of TBI
falls (40%)
how can you classify head injuries using the GCS
scaled on a 3-15 scale
8 or less = coma
9-12 = moderate head injury
13-15 mild head injury
headache, confusion, lightheadedness, and blurred vision are characteristics of what level of TBI
mild head injury
changes in memory, concentration, and attention are characteristics of what level of TBI
mild head injury
fatigue and changes in sleep patterns are characteristics of what level of TBI
mild head injury
nausea and vomiting are characteristics of what level of TBI
moderate to severe
dilation of one or both pupils, coordination loss, and extremity weakness/numbness are characteristics of what level of TBI
moderate to severe
slurred speech, confusion, restlessness, agitation are characteristics of what level of TBI
moderate to severe
symptoms of concussion
dizziness, diorientation, burred vision, concentration difficulty, sleep alterations, nausea, headache, balance deficits
what is a contusion in the context of TBI
brain surface hemorrhage of small vessels
which areas of the brain are most susceptible to diffusion axonal injury
corpus callosum, basal ganglia, white matter, superior cerebellar peduncles
what is a diffuse axonal injury
subcortical axon shearing within the myeling sheath due to high velocity acceleration/deceleration forces
what typically causes a epidural hematoma
blow to side of head or MVA
describe the pathogenesis of an epidural hematoma
alert > unconscious > lucid; rapid deterioration of the condition
in what patient population do we typically see a subdural hematoma?
older adults after a fall or blow to the head
describe the pathogenesis of a subdural hematoma
hematoma accumulates more slowly over hours to a week
how does a subdural hematoma generally present
sxs mimic a CVA
in what population do we typically see an intracerebral hematoma
acceleration/deceleration forces that shear cortical vessels beneath a skull fracture
what is required for a functional arousal response
ARAS needs to be intact (upper 2/3 of brainstem connecting the thalamus to the cerebrum)
what qualifies an intact arousal response
since its a primitive response, it is intact if the patient opens eyes spontaneously or in response to external stimulus
T/F: awareness (of self and environment) is a primitive response
false: it is complex and requires cerebral function
describe coma in two words, then define
unarousable unawareness: complete failure of arousal, no spontaneous eye opening, and no response to vigorous stimuli
describe a vegetative state
arousal in the absence of awareness combined with sleep and wake cycles with either full or partial preservation of hypothalamic and brainstem autonomic function
describe a minimally conscious state
demonstrated minimal but definite behavioral evidence of self or environmental awareness
which three things qualify brain death
coma, absent brainstem reflexes, and apnea
what is the most reliable and valid scale for determining recovery from a coma
DOC Scale CRS-R (coma recovery scale - revised)
T/F: premorbid status influences TBI outcomes
true, disease and neural loss can negatively affect outcomes
what three things are cause primary neurological damage
- focal lesions
- coup-countrecoup trauma
- DAI
what is the most common source of secondary neurological damage
increased ICP
what four things most commonly raise ICP
- cervical flexion
- coughing
- body position changes
- increased blood and abdominal-thoracic pressure
what is a typical precaution noted for patients with an ICP bolt
HOB at 30-45
which areas of the brain are most susceptible to secondary hypoxia ischemia
hippocampus (memory), cerebellum, and basal ganglia
what happens during a post-traumatic seizure
sudden, explosive, disorderly discharge of cerebral neurons causing transient alteration in brain function
why do seizures hold potential for progressive brain injury and irreversible damage
during a seizure, oxygen is consumed about 60% more than normal, glucose is depleted, and lactate accumulates.
what is auto-destructive cellular phenomena
surges of excitatory NTs which can contribute to further neural destruction following an DAI
What can a RLA cognitive screen help you to determien
it can predict the sequence of cognitive and behavioral recovery in patients with TBI
T/F: patients with severe cognitive issue will have severe motor issues
false: any cognitive function can be paired with any level of physical function
what are the 8 levels of RLA from worst to best
- no response
- generalized response
- localized response
- confused-agitated
- confused-inappropriate
- confused-appropriate
- automatic-appropriate
- purposeful-appropriate
what is a RLA generalized response
response is inconsistent but has gross verbal or motor response
what is a RLA localized response
different responses based on different stimulus/location of stimulus
what is a RLA confused-agitated response
combative heightened state of activity
what is a RLA confused-inappropriate response
inappropriate responses must be redirected
what is a RLA automatic-appropriate response
robotic movements, aware of environment, independent, slow learning
what are the two major and two minor direct impairments related to TBI
cognition and behavior are major; communication and neuromuscular are minor
what is the key strategy for addressing behavioral deficits
structure, consistency, positivity, and calmness
what are goals of low level 1-3 treatment
- prevent secondary impairment
- minimize immobility
- manage tone
- interact with environment
- behavioral correction
describe manual technique to normalize tone
slow repetitive rotation to dampen general motor response/hypertonicity/posturing
what can be done in TBI neuro patients to facilitation muscle contraction?
tapping the muscle belly
what is a technique to relax the muscle
provide constant pressure across the muscle
what is the first joint you should address when concerned about UE tone and ROM
ST joint
how often should the coma stimulation approach be used
several times a day and 15 min per session
how is the coma stimulation approach organized
1-2 multisensory modalities at a time allowing adequate response time in a controlled environment
what is the goal of level 4 TBI management
minimize loss of function
what is the goal of level 5-6 TBI management
maximize function through consistent patient participation and conditioning
what is the goal of level 7-8 TBI management
wean from structure and reintegration into the community and decision making
