TBI & Rancho's Levels

Question 1

Coup Injury

Answer 1

• forceful blow to a resting, moveable head
• MAX injury is @ cranial impact
• contusion w/ or w/o skull fracture

Question 2

Contracoup Injury

Answer 2

• injury OPPOSITE to a moving head

- usually affects frontal & temporal lobes

Question 3

Coup/Contracoup Injury

Answer 3

• aka whiplash

- multiple areas of the brain damaged

Question 4

Primary damage (3 things)

Answer 4

• compression
• tensile (stretch)
• shearing: most detrimental;
  DAI = diffuse axonal injury - axons tear away from the cell body

Question 5

Secondary Damage (4)

Answer 5

1. Brain swelling:
   ICP > 12mmHg, can lead to hypoxic ischemic injury
2. Anoxia: w/o oxygen
   due to drowning
3. Hypotension: esp. if brainstem is injured
4. Hematoma: rupturing of blood vessels, usually due to a compression injury
   - Epidural: blood between skull & dura
   - Subdural: between dura & arachnoid space

Question 6

Mild TBI

Answer 6

• no loss of consciousness
• usually concussion or sport/recreation accident
• ST consequence: second impact syndrome - CSF leaks through foramen magnum due to increase in ICP
• LT consequence: mild cog impairment or Alzheimers, chronic traumatic encephalopathy, depression

Question 7

Moderate TBI

Answer 7

• LOSS of consciousness - few min to hours
• days/weeks of confusion
• physical, cognitive, and/or behavioral deficits may lasts months or be permanent
• can make complete recovery

Question 8

Severe TBI

Answer 8

• Coma or prolonged unconsciousness

- can recover but deficits will remain

Question 9

Glascow Coma Test

• 3 categories
• final score

Answer 9

Categories:

1. Eye opening (E) - max 4
2. Verbal response (V) - max 5
3. Motor response (M) - max 6

12 good recovery

Max = 15

Question 10

Decorticate posture

Answer 10

arm flexion & leg extension (grade 3 on glascow coma test)

Question 11

Decerebrate posture

Answer 11

arm & leg extension (grade 2 on glascow coma score)

Question 12

Level I

Answer 12

No Response; Total Assistance

complete absence of observable change in behavior to any stimuli

Question 13

Level II

Answer 13

Generalized response; Total assistance

generalized reflex response
response to repeated auditory stimulus
gross body mvmt or non purposeful vocalization in response to external stimulus
inconsistent & delayed responses

Question 14

Level III

Answer 14

Localized response; Total assistance

withdrawal or vocalization to painful stimulus
turn head away/toward auditory
blink w/ bright light
follows moving object
inconsistent to simple commands

Question 15

Level IV

Answer 15

Confused/Agitated; Max assistance

alert & in heightened state
remove restraints
motor activities w/o apparent reason
brief & nonpurposeful moments of attention
aggressive or flight behavior
unable to cooperate w/ treatment

Question 16

Level V

Answer 16

Confused, Inappropriate responses, NONagitated; Max assistance

alert, not agitated
not oriented to person, place or time
brief periods of nonpurposeful attention w/o distractions
impaired recent memory
absent goal directed
perform previously learned tasks w/ cues
unable to learn new tasks
social behavior impaired
confabulation

Question 17

Level VI

Answer 17

confused, appropriate response; moderate assistance

inconsistent orientation
attend to highly familiar tasks w/o distractions
vague recognition of some staff
emerging awareness of self, family, basic needs
limited new learning
unaware of disability

Question 18

Level VII

Answer 18

automatic & appropriate, minimal assistance for ADLs

consistently oriented to person & place
attend to highly familiar tasks
complete familiar personal & household routine
minimal supervision for safety in routine
unrealistic planning for future
unable to think about consequences
overestimates abilities
unaware of others needs & feelings
unable to recognize inappropriate social behavior

Question 19

Level VIII

Answer 19

purposeful & appropriate; stand by assistance

consistently oriented to time, place & person
can attend to familiar tasks w/ distractions
recall & integrate past and recent events
independent w/ “to do” lists
modify plan w/ min assist
depressed or irritable

Question 20

Level IX

Answer 20

purposeful & appropriate; stand by assist on request

independently shift between tasks
initiate & carry out routine independently
aware of impairments
appropriate corrective action
recognizes consequences
depression, irritable, frustration
self monitors appropriateness of social behavior

Question 21

Level X

Answer 21

purposeful & appropriate; independent

multiple tasks independently
may require more time than usual to complete
anticipate impact of impairments
think independently about consequences/decisions
appropriately estimates abilities for tasks
recognizes other thoughts/feelings