TBI Exam Strategies Flashcards
What are non-patient identified problems that need to be watched for during the exam for TBI patients?
arousal and cognition
What precautions/contraindications should be looked for when examining a TBI patient?
Elevated ICP
Seizure disorder
Autonomic abnormalities such as HR, BP, and RR
What is sympathetic storming?
How does it present clinically?
uncontrolled activation of the sympathetic nervous system
- temp of 38.5*C
- HTN
- Heart rate over 120
- RR over 40
- agitation
- diaphoresis
- dystonia
What integumentary questions are important when screening TBI patients?
Ask about skin integrity and check for burns or lacerations as well as sites of prolonged exposure
What psycho-emotional questions are important when screening TBI patients?
ask about seizures, vision, dizziness, balance, swallowing, cognition, sleep, and changes in neurological impairments
looking for seizure disorders, cranial nerve integrity, cognitive impairments, concussion, undiagnosed change in neurologic status
Also ask about emotional stability such as mood swings, anxiety, depression, and temper/outbursts
What red flags would warrant an immediate need for referral?
- headaches that worsen
- presence of seizures
- focal neuro signs (numbness/weakness)
- drowsy/can’t be aroused
- repeated vomiting
- slurred speech
- can’t recognize people/places
- increasing confusion/irritability
- neck pain
- unusual behavior change
- change in state of consciousness
What cranial nerves (if injured) would cause issues with the following?
difficulty with lip closure (drooling)
difficulty chewing
difficulty moving bolus posteriorly
difficulty initiating swallow
CN VII
CN V
CN VII (retention of food between cheeks and gums) and CN XII (retention of food in mouth)
CN IX and X
What contributes to simple orientation?
What contributes to higher level orientation?
spontaneous recall of date, time, location, event, and deficits
- able to repeat address of an unknown person
- count backward from 20
- state months in reverse order
- estimate 30 seconds w/o clock
What are atypical orientation responses?
- require logical cueing
- requires options (this or that?)
- needs cueing
- makes mistakes even with cues
- inappropriate response to cues
- unable to respond
What common impairments that interfere with activities such as rolling, sitting, and sit to stand?
- coordination (timing, sequencing, or activation)
- Perception (visual perception and body awareness)
- Somatosensation (proprioception, cutaneous sensation)
- Force Generation (strength or power)
- Flexibility (muscle length or joint motion)
What are the recommended outcome measures for TBI that cover body structure and function?
Coma Recovery Scale Revised (arousal)
Moss Attention Rating Scale (attention)
Agitated Behavior Scale (agitation)
Cognitive TUG: Dual Task
What is the Coma Recovery Scale- Revised?
a 23 item scale with 6 subscales addressing auditory, visual, motor, oromotor, communication and arousal functions
lowest items in each subscale-reflexive activity
highest item on each=cognitively-mediated behaviors
What are appropriate activity level measures for TBI?
- Functional Assessment Measure: adds cognitive items to FIM
- Disability Rating Scale: responsiveness and ADLs
- Community balance and mobility scale: standing and walking items
- 6MWT
- 10 meter Walk Test
- Berg Balance
What are appropriate Participation level measures for TBI patients?
Community Integration Questionnaire: quantifies independence with independence in the community
Dizziness Handicap Inventory: quantifies dizziness symptoms w/ activities
Quality of Life after brain injury
What are the 3 domains of the community integration questionnaire?
home integration
social integration
productive activity
