TBI - COMPLETE Flashcards
Difference between ABI thats a TBI vs. ABI thats not a TBI?
TBI - external forces
Non-TBI - internal forces
Acquired Brain Injury
Brain injury acquired after birth
Causes of Non-TBI
Stroke
Toxins
Drugs
Anoxia (e.g. drowning)
Infection
Tumors
TBI: occurrence of injury to the head, with one or more of the following conditions… (5)
- Decreased consciousness
- Amnesia
- Skull fracture
- Objective neuro/neurophysical abnormality
- Intracranial lesion
T/F: TBI can occur in absence of perceptible head injury
TRUE
Classification Systems for TBI (3)
- Glasgow Coma Scale (GCS)
- Post Traumatic Amnesia (PTA)
- Loss of Consciousness (LOC)
The ______ (lower/higher) the score on GCS, the more conscious the patient is.
HIGHER
The ______ (lower/higher) the score on GCS, the less conscious the patient is.
LOWER
T/F: abnormal imaging (MRI/CT) immediately classifies the patient as having a severe TBI
FALSE; moderate
Patient is considered Vegetative if GCS is < ______
3
What qualifies as an Open Head Trauma?
If dura is breached (invasion through skull)
Characteristics of mild TBI
GCS: 13-15
+/- LOC (< 30 min)
Normal imaging
Characteristics of moderate TBI
GCS: 9-12
LOC > 30 min (but < 24 hrs)
Normal or abnormal imaging
Characteristics of severe TBI
GCS: 3-8
Coma
Normal/abnormal imaging
Common Sources of Brain Damage (3)
- Subdural Hematoma (clot b/w dura and arachnoid)
- Diffuse Axonal Injury
- Contusions (bruising of brain)
Diff between Primary and Secondary Damage
Primary — at moment of injury
Secondary — manifests later
Post Traumatic Vision Syndrome (PTVS):
What are some functional vision issues caused by TBI? (7)
- Convergence Insufficiency
- Accommodation Insufficiency
- Oculomotor Dysfunctions
- ET/EP
- Low Blink Rate
- Visual Midline Shift (affects Balance/Posture)
- VF defects
Post Traumatic Vision Syndrome (PTVS):
What are some symptoms caused by TBI? (8)
- Diplopia
- Blur at near
- Loss of reading place
- Asthenopia/HA
- Photophobia
- Visual memory deficits
- Visual perception deficits
- Bumping into things
Key Visual Processing Systems (2)
- MP Pathway
- Top Down Processing
Parvocellular System is for ____ vision and important for _____.
Parvocellular System is for central (foveal) vision and important for clear and precise vision.
Describe course of Parvocellular System
Nerve fibers from retina —> ON —> optic chiasm —> optic tract —> LGN —> optic radiations —> primary visual cortex (occipital lobe) —> temporal lobe
Magnocellular System is for ____ vision and important for _____.
Magnocellular System is for spatial orientation and important for balance, movement, coordination, and posture.
What is the parietal cortex responsible for that contributes to spatial orientation?
- Spatial working memory
- Visually guided action
- Navigation
Function of Top Down Processing
Selectively filters sensory info input
Neuroplasticity
Ongoing reorganization of functional cortical map
What is required for synaptic plasticity? (2)
- Internal Processing
- Repetition
What is the major modulator for neuroplasticity?
Norepinephrine
Why is VT the perfect environment for neuroplasticity? (5)
- Feedback
- Repitition
- Multisensory, intermodal approach
- Motor/sensory match
- Cortical involvement
Causes of Disequilibrium
(And % of each)
- Otologic — 50%
- Idiopathic (includes visual & brain filtering problems)— 25%
- Psychological — 15%
- Central/Neuro — 5%
- Medical — 5%
VOR requires stability of… (3)
- Ocular input
- Binocular input
- Processing of vestibular and visual info
VOR regulates balance with… (4)
- Visual System
- Semicircular canals
- Otolith apparatus
- Vestibular nerve
Feelings of ____, ____, and ___ are important for synaptic formation and thus, important components of VT.
Motivation
Repetition
Feedback
What is the “underlying trigger for [neuroplasticity]”?
Synaptic plasticity
Vision/Optical Related Causes of Disequilibrium (5)
- Aniso
- Uncorrected Hyperopia
- Uncorrected Astigmatism
- PAL Distortion
- Glare
Fixation is a function of _______
Visual attention
When evaluating fixation, we should look for…
Saccadic intrusions and/or latent nystagmus
When evaluating saccades, what should we look for?
Slowness or over/udnershoots
What modification should be made to W4D testing for TBI patients?
Should be dynamic (15 ft to nose)
What does Fixation Dot c Head Shake test for?
Binocular Stability
How to perform Fixation Dot c Head Shake?
- Use R/G glasses
- Ask pt “how many dots do you see?”
- Shake head side to side (1-2 rotations/sec)
- Ask “what happens?”
How to test for Visual Midline Shift Syndrome
- Target (Wolff wand or pen) at 40 cm
- Test horizontally (target held vertical); move from left to right and ask to say when pen is directly in front of nose
- Repeat vertical (target held horizontal, tell when pen at eye level)
Note: examiner should not sit directly in front of— gives clues to midline
Ways to correct for photophobia (4)
- Transitions
- 15% Blue tint and A/R
- Over 40% gray tint
- Wrap sunglasses for outdoors
