TBI Interventions Flashcards
2 main components of mTBI pathophys
Micro vascular supply and metabolic demand imbalance
What are the two main guidelines for acute mTBI
Limit physical and cognitive activities
Decrease symp agg stimuli
Chronic symp tx?
Symptom based approach
How many days puts person with mTBI at a greater risk for another concussion
10 days
What sports are males at higher risk of getting mTBI? Females?
Football and rugby
Soccer and basketball
Ocular signs of mTBI
Reading, visual deficits
Vestibular signs of mTBI
Cervical and ocular deficits; walk, head turn, driving
Mild TBI symptom categories (3) and examples
Attention: difficulty focusing, mem loss
Emotion: irritable, sleep probs
Environment: emotion, sleep, noise
What are the 5 main components of exam
Visual ocular (VOMS)
Balance (visual vestibular)
Coordination and reaction time
Endurance
Gait (head turns) and quick movements
What symptoms are you watching out for during VOMS
HA, vomiting, dizziness, fatigue, visual changes, uneasy
What assessments can you use for balance
BESS, computerized posturography, sway balance systems (BERTEC, APDM)
What tests can you do for coordination and reaction time?
Ruler drop test
Cerebellar exams
What is the gold standard endurance test
Buffalo concussion treadmill stress test
What outcome measures for gait
DGI or FGA
What are 3 main reasons to stop Buffalo
-VAS increased by greater than or equal to 3
-RPE greater than or equal to 17
-if pt stops communicating
What is the fxn of VOR
Keeps eye gaze stable while c/s rotates and/or vertical movements
What are 5 deficits during VOR
Dizziness, inability to read, vertigo, unsteady, eye fatigue
What 3 CN are involved with VOR
Oculomotor (3), trochlear (4), abducens (6)
What connects the oculomotor system
Medial longitudinal fasiculus
With L c/s rotation, which lat and med rectus is turned on
R lat, L med
With R c/s rotation, which lat and med rectus is turned on
R med, L lat
What part of brain involved with short term mem
Hippocampus
What is the unicinate fasciculus
Axonal fiber tract, connects hippocampus and amygdala to lower frontal lobe
Very vulnerable to injury
What part of the brain involved with working mem disturbances in mTBI
Medial prefrontal cortex
What are three 3 general progressive ocular system interventions
-sitting saccades
-smooth pursuit
-target training
What are examples of advanced ocular and vestibular oculomotor exercises
-walking with visual activity (find object w/ visual saccade)
-walking with head turns
What is an important muscular performance deficit from a neurological exam
Motor planning
What is a big sensation deficit from a neurological exam
Perceptual
What is the purpose of the Brock string
Tx convergence insufficiency
What two major things are altered after TBI regarding aerobic ex
Temperature and cardiac auto regulation
What two symps should you stop graded aerobic ex? Why
HA and dizziness; decreased cerebral blood perfusion
What does aerobic ex help increase? Reduce?
BDNF (hippocampal neurons)
Apoptosis and inflam
What are the 4 main categories of mod-severe brain injury interventions
Emotional, cognitive, motor, sensory
What does task based exercise help with in the brain
Engage NS and follow norm brain activiation
Benefits of tasks based ex
-selective visual attention
-facilitates lat wt shift
-handle facilitate pelvis
Neuro development therapy (NDT) purpose
Hands on approach to improve movement and function
What are the 4 priorities for NDT
- Handing core, head and trunk alignment
- LL alignment and connection to trunk
- Motor learning task
- Dual tasking
3 benefits of parallel bar gait training
Provides feedback
Physical barriers and reminders
Safety
3 advantages of task based gait acts
Less verbal interaction
Visual feedback
Planning
What’s an example rx of aerobic act (think FITT)
12 wks, 3x/wk for 30 min at 70-80% THR
What % of total O2 is consumed at rest
20%
The maintenance of cerebral BF =
Precise control of nutrient supply
What is way finding
Navigation through unknown areas
What is the most common permanent post TBI personality change
Irritability
What causes irritability
Environmental distraction
Unable to reach goals
Inability to express self
Communication break down
Main way to reduce irritability
Know triggers: auditory, busy environment, visual
4 main ways to prevent agitation
-edu staff and fam how to approach TBI pt
-use social greetings
-formally end interaction
-provide pt with choice (instead of command)
Two main therapy strats when teaching exercises to mod-severe TBI
Keep acts simple**
Show pts what to perform
