TBI Intro Pt 2 Flashcards
how often is CN 1 damaged in a TBI?
7% of the time, be sure to include it in the CN exam
CN II, III, IV, and VI exam following TBI
Crucial!
- Intact pupillary function indicates injury is above level of brainstem
- CNS vs PNS
- conjugate gaze palsy → CNS
- unilateral gaze palsy → PNS
- tonic downward gaze → injury to thalamus, midbrain or pons
- tonic upward gaze → injury to both hemispheres
- rapid horizontal eye movement → seizure activity
is it more common to damage oculomotor muscles or nerves?
muscles
oculomotor and trochlear nerve damage is uncommon
optic nerve damage from a TBI may result in _______
monocular blindness
absent pupillary responses
how is CN V commonly injured during a TBI?
- injury to where divisions leave orbit
- this results in loss of sensation to the nose, eyebrows and forehead
how is the facial nerve commonly injured during a TBI?
injury to the temporal bone
results in muscle weakness, loss of tear production, decreased saliva secretion, and taste
T/F: autonomic dysfunction is not common after a TBI
FALSE
it is common
cardiovascular regulation shifts from PNS to SNS
list common ANS symptoms with TBI
- HR variability
- RR variability
- elevated body temp
- BP changes
- excessive sweating, salivation, tearing
- dialted pupils
- vomiting
- anxiety, panic disorder, and PTSD all tied to autonomic system imbalance
list several arousal and cogntive outcome measures used with TBI pts
- Glasgow Coma Scale (GCS)
- Rancho Los Amigos Levels of Cognitive Function (LOCF)
- Rappaport’s Disability Rating Scale (DRS)
- Glasgow Outcome Scale (GOS)
- Galveston Orientation and Amnesia Tests (GOAT) and Orientation Log (O-Log)
- Coma Recovery Scale (CRS-R)
- Disorders of Consiousness Scale (DOCS)
what does the GCS measure?
(Glasgow Coma Scale)
classifies acute injury as mild, moderate, severe TBI
what are the components and scoring breakdown of the GCS?
- Components
- pupillary response
- motor activity
- ability to verbalize
- Score
- range from 3-15
- 3-8 = severe
- 9-12 = moderate
- 13-15 = mild
- ***GCS of 3 on presentation results in 65-100% mortality rate
describe the mild level for TBI
- GCS → 13-15
- LOC → 0-30 minutes
- Brief (<24 hours) aleration of consciousness
- Post-traumatic amnesia <1 day
- imaging normal
describe the moderate level of TBI
- GSC → 9-12
- LOC >30 min but <24 hours
- Alteration of consciousness >24 hours
- Post traumatic amnesia >1 but <7 days
- Imaging normal or abnormal
describe the severe level of TBI
- GCS → 3-8
- LOC >24 hours
- Alteration of consciousness >24 hours
- Post traumatic amnesia >7 days
- Imaging normal or abnormal
what is the purpose of the Rancho?
delineates 8-10 cognitive and behavioral levels
whatis the DRS for?
(Rappaport’s Disability Rating Scale)
classifies levels of disability using a wide range of functional behaviors
measures aspects of impairment, function and participation
describe the components of the DRS
- Observer rated, 30 pt scale used to track progress for pts in a coma through community integration phase
- evaluates 8 areas of functioning in 4 categories
- consciousness
- cog ability
- independence/dependence levels of function
- employability
- high scores represent high level of disability
impact of DRS admission scores
scores at admission and D/C from rehab can predict return to work potential (88% accurately)
what is the GOS?
(Glasgow Outcome Scale)
expands on original GCS
includes major disability categories for outcome assessment
how many levels are there in the GOS?
8 levels ranging from dead to various levels of disability (severe, moderate, good recovery)
describe level 1 and 2 on the GOS
- Level 1 = dead
- Level 2 = vegetative state
- condition of unawareness with only reflex responses, but periods of spontaneous eye movements
describe level 3 on the GOS
Low Severe Disability
dependent on daily support, cannot be left alone for >8 hours at home at a time
describe level 4 on GOS
Upper Severe Disability
dependent for daily support, able to be left alone for >8 hours at home at a time
describe level 5 on the GOS
Low Moderate Disability
- have some disability such as aphasia, hemiparesis or epilepsy and/or memory or personality impairments
- but are able to look after themselves
- unable to return to work
describe level 6 on the GOS
Upper Moderate Disability
- have some disability such as aphasia, hemiparesis or epilepsy and/or memory or personality impairments
- able to look after themselves
- able to return to work w/special arrangements
describe level 7 on the GOS
Low Good Recovery
- resumption of normal life within the capacity to work
- even if pre-injry status has not been achieved
- May have minor neurological or psychological deficits, which do remain disabling
describe level 8 on the GOS
Upper Good Recovery
- resumption of normal life within the capacity to work
- even if pre-injury status has not been achieved
- may have minor neurological or psychological deficits, but are not disabling
list several prognostic indicators for TBI
- Age/gender
- GCS score
- Length of PTA
- Traumatic over acquired (vascular/anoxic)
- Higher edu levels/pre-injury IQ
- Early use of neurostimulants
- presence of pre-injury psychological issues or substance abuse
- GOS: Level 1-3
list severe TBI prognostic factors
- older age
- absence of light reflex
- presence of extensive SAH, ICP, and +midline shift
list aspects of community integration
- Assimilation
- Social Support
- Occupation
- Independent Living
what is the goal of community integration?
to help individuals return to their community under a new set of circumstances
- also includes helping individual adapt their own expectations of the outside world
- help them to adapt to what can feel very inaccessible society
- advocate for community awareness
list some residual impairments that should be taken into consideration for community re-integration
- decreased social inhibition (lack of filter)
- impaired MC
- impaired attention, memory sequencing and high level problem solving
- perseveration or word finding issues
- impaired speech
- impaired writing or calculating ability
- vision impairments
- topographic/routing issues
- balance issues/incoordination
