TBI Intro: Clinical Presentation Flashcards
what cognitive deficits do they have
- arousal dysfxn
- disorientation
- poor attention span
- loss of memory
- poor organization & reasoning skills
- inability to control emotional responses
- learning difficulties
walkie talkie pt’s typically ..
- may be able to ambulate independently without an AD negotiating barriers but might not remember their name or family members
- may fill in info with fabricated stories: confabulation
- could be more problematic to functional independence than the physical limitations
what is the most common and debilitating cognitive deficit following tbi
impaired attention
executive function deficits looks like
impairment to volition/planning, problem solving, insight, social pragmatics, self-regulation
what can u see with executive fxn deficits
- difficulties with motivation, preparation and organization
- poor problem solving
- impulsivity
- mood disturbances
- difficulty in social situations
what memory deficits do we see
- retorgrade and/or anterograde amnesia
- posttraumatic amnesia
- short term > long term memory deficits
- declarative and procedural memory often impaired
what is common about language deficits
- non-aphasic nature and related to cognitive impairment
- disorganized and tangential oral and written communication, imprecise language, word retrieval difficulties, disinhibited language
most enduring and socially disabling of impairments after TBI
- sexual disinhibition
- apathy
- aggressive disinhibition
- agitation
- hyperactive, restless
- low frustration tolerance
- depression
- easily over stimulated**
dysexecutive syndrome
frontal lobe syndromes
orbitofrontal lobe syndrome
- disinhibited
- impulsive behavior
- inappropriate jocular affect, euphoria
- emotional liability
- poor judgement and insight
- distractibility
frontal convexity syndrome
- apethetic
- apathy
- indifference
- psychomotor retardation
- motor perseveration and impersistence
- stimulus bound behavior
- motor programming deficits
- poor word list generation
focal lesions result in what strength deficits
hemiparesis/hemiplegia
diffuse injury results in what strength deficits
motor control and coordination deficits over true strength deficits
tone abnormalities could look like
flaccidity
rigidity
hypertonicity
brainstem injuries result in
posturing
decorticate rigidity
LE ext & UE flex
decerabrate rigidity
LE & UE ext
what sensory deficits are most common
proprioceptive and kinesthetic
how often is CN I damaged in TBIs
7% of them
what CN are crucial to examine
optic
occulomotor
trochlear
abducens
intact pupillary fxn indicates what about the location of the injury …
the injury is above the level of the brainstem
if a pt has conjugate gaze palsy, what is that due to
CNS
if a pt has unilateral gaze palsy, what is that due to
PNS
if a pt has tonic downward gaze, what is that due to
severe injury to thalamus, midbrain or pons
if a pt has tonic upward gaze, what is that due to
severe injury to both hemispheres
if a pt has rapid horizontal eye movement, what is that due to
seizure activity
optic n. damage may result in what
monocular blindness, absent pupillary response
what is the common culprit of gaze abnormalities
abducens n.
which nerve damage is the most uncommon with tbi and what do you see instead
CN 3 & 4
damage to actual muscle bellies/tendons
where is the trigeminal n. damaged and what is the effect of that
peripheral injury to where divisions leave orbit
loss of sensation to the nose, eyebrow and forehead
where is the facial n. damaged and what is the effect of that
perioheral injury when the temporal bone damaged
muscle weakness, loss of tear production, decreased saliva secretion, taste
how many pt’s experience vestibular dysfunction
50% - dizzy and imbalance
how do you end up with vestibular dysfunction
injury to vestibulocochlear n.
injury to vestibulocerebellum
damage to brainstem or cortex involving vestibular pathways
S&S for vestibular dysfunction
dizziness vertigo imbalance nausea vomiting inability to perform sensory integration for balance
for pt’s who have TBI, how long does vestibular rehab take
3x as long compared to those not with TBI
what are common ANS symptoms seen with TBI
HR, RR, BP variability elevated body temp excessive sweating, salivation, tearing dilated pupils vomiting anxiety, panic disorder, PTSD
