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Neuro 2 > TBI Intro Pt 2 > Flashcards

TBI Intro Pt 2 Flashcards

1
Q

how often is CN 1 damaged in a TBI?

A

7% of the time, be sure to include it in the CN exam

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2
Q

CN II, III, IV, and VI exam following TBI

A

Crucial!

  1. Intact pupillary function indicates injury is above level of brainstem
  2. 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
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3
Q

is it more common to damage oculomotor muscles or nerves?

A

muscles

oculomotor and trochlear nerve damage is uncommon

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4
Q

optic nerve damage from a TBI may result in _______

A

monocular blindness

absent pupillary responses

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5
Q

how is CN V commonly injured during a TBI?

A
  1. injury to where divisions leave orbit
    • this results in loss of sensation to the nose, eyebrows and forehead
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6
Q

how is the facial nerve commonly injured during a TBI?

A

injury to the temporal bone

results in muscle weakness, loss of tear production, decreased saliva secretion, and taste

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7
Q

T/F: autonomic dysfunction is not common after a TBI

A

FALSE
it is common

cardiovascular regulation shifts from PNS to SNS

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8
Q

list common ANS symptoms with TBI

A
  1. HR variability
  2. RR variability
  3. elevated body temp
  4. BP changes
  5. excessive sweating, salivation, tearing
  6. dialted pupils
  7. vomiting
  8. anxiety, panic disorder, and PTSD all tied to autonomic system imbalance
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9
Q

list several arousal and cogntive outcome measures used with TBI pts

A
  1. Glasgow Coma Scale (GCS)
  2. Rancho Los Amigos Levels of Cognitive Function (LOCF)
  3. Rappaport’s Disability Rating Scale (DRS)
  4. Glasgow Outcome Scale (GOS)
  5. Galveston Orientation and Amnesia Tests (GOAT) and Orientation Log (O-Log)
  6. Coma Recovery Scale (CRS-R)
  7. Disorders of Consiousness Scale (DOCS)
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10
Q

what does the GCS measure?

A

(Glasgow Coma Scale)

classifies acute injury as mild, moderate, severe TBI

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11
Q

what are the components and scoring breakdown of the GCS?

A
  1. Components
    • pupillary response
    • motor activity
    • ability to verbalize
  2. Score
    • range from 3-15
    • 3-8 = severe
    • 9-12 = moderate
    • 13-15 = mild
  3. ***GCS of 3 on presentation results in 65-100% mortality rate
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12
Q

describe the mild level for TBI

A
  1. GCS → 13-15
  2. LOC → 0-30 minutes
  3. Brief (<24 hours) aleration of consciousness
  4. Post-traumatic amnesia <1 day
  5. imaging normal
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13
Q

describe the moderate level of TBI

A
  1. GSC → 9-12
  2. LOC >30 min but <24 hours
  3. Alteration of consciousness >24 hours
  4. Post traumatic amnesia >1 but <7 days
  5. Imaging normal or abnormal
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14
Q

describe the severe level of TBI

A
  1. GCS → 3-8
  2. LOC >24 hours
  3. Alteration of consciousness >24 hours
  4. Post traumatic amnesia >7 days
  5. Imaging normal or abnormal
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15
Q

what is the purpose of the Rancho?

A

delineates 8-10 cognitive and behavioral levels

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16
Q

whatis the DRS for?

A

(Rappaport’s Disability Rating Scale)

classifies levels of disability using a wide range of functional behaviors

measures aspects of impairment, function and participation

17
Q

describe the components of the DRS

A
  1. Observer rated, 30 pt scale used to track progress for pts in a coma through community integration phase
  2. evaluates 8 areas of functioning in 4 categories
    • consciousness
    • cog ability
    • independence/dependence levels of function
    • employability
  3. high scores represent high level of disability
18
Q

impact of DRS admission scores

A

scores at admission and D/C from rehab can predict return to work potential (88% accurately)

19
Q

what is the GOS?

A

(Glasgow Outcome Scale)

expands on original GCS

includes major disability categories for outcome assessment

20
Q

how many levels are there in the GOS?

A

8 levels ranging from dead to various levels of disability (severe, moderate, good recovery)

21
Q

describe level 1 and 2 on the GOS

A
  1. Level 1 = dead
  2. Level 2 = vegetative state
    • condition of unawareness with only reflex responses, but periods of spontaneous eye movements
22
Q

describe level 3 on the GOS

A

Low Severe Disability

dependent on daily support, cannot be left alone for >8 hours at home at a time

23
Q

describe level 4 on GOS

A

Upper Severe Disability

dependent for daily support, able to be left alone for >8 hours at home at a time

24
Q

describe level 5 on the GOS

A

Low Moderate Disability

  1. have some disability such as aphasia, hemiparesis or epilepsy and/or memory or personality impairments
  2. but are able to look after themselves
  3. unable to return to work
25
Q

describe level 6 on the GOS

A

Upper Moderate Disability

  1. have some disability such as aphasia, hemiparesis or epilepsy and/or memory or personality impairments
  2. able to look after themselves
  3. able to return to work w/special arrangements
26
Q

describe level 7 on the GOS

A

Low Good Recovery

  1. resumption of normal life within the capacity to work
    • even if pre-injry status has not been achieved
  2. May have minor neurological or psychological deficits, which do remain disabling
27
Q

describe level 8 on the GOS

A

Upper Good Recovery

  1. resumption of normal life within the capacity to work
    • even if pre-injury status has not been achieved
  2. may have minor neurological or psychological deficits, but are not disabling
28
Q

list several prognostic indicators for TBI

A
  1. Age/gender
  2. GCS score
  3. Length of PTA
  4. Traumatic over acquired (vascular/anoxic)
  5. Higher edu levels/pre-injury IQ
  6. Early use of neurostimulants
  7. presence of pre-injury psychological issues or substance abuse
  8. GOS: Level 1-3
29
Q

list severe TBI prognostic factors

A
  1. older age
  2. absence of light reflex
  3. presence of extensive SAH, ICP, and +midline shift
30
Q

list aspects of community integration

A
  1. Assimilation
  2. Social Support
  3. Occupation
  4. Independent Living
31
Q

what is the goal of community integration?

A

to help individuals return to their community under a new set of circumstances

  1. also includes helping individual adapt their own expectations of the outside world
  2. help them to adapt to what can feel very inaccessible society
  3. advocate for community awareness
32
Q

list some residual impairments that should be taken into consideration for community re-integration

A
  1. decreased social inhibition (lack of filter)
  2. impaired MC
  3. impaired attention, memory sequencing and high level problem solving
  4. perseveration or word finding issues
  5. impaired speech
  6. impaired writing or calculating ability
  7. vision impairments
  8. topographic/routing issues
  9. balance issues/incoordination

Neuro 2 (29 decks)

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