TBI Revision Flashcards
What is the definition of a TBI?
trauma to the head other than superficial injuries to the face (NICE, 2014)
Massive range in the injury and impact of the TBI
What are some possible causes of TBI?
RTCs
Falls
Sports/Recreation
Assaults
What are the 3 injuries of a TBI?
- Primary injury - the cause of the TBI
- Secondary injury - oxygen shortage
- Tertiary injury - bleeding, bruising and swelling
Describe the first injury in a closed, non-penetrating TBI.
- Caused by rapid acceleration, deceleration or rotation
- Usually through collision
- Most common
- Usually causes diffuse damage
Describe the first injury in an open, penetrating TBI.
- Skull opened with brain tissue exposed and damaged
- Comparatively rare
- Damage typically localised
- could be caused by bullets, shrapnel, knives
Describe the first injury in a crush TBI.
- Least common
- Head is trapped between 2 objects, causing damage to the brainstem and the base of the skull
Describe the second injury in a TBI.
- Hypoxia (lack of oxygen to brain) increases the damage of the first injury
- Occurs minutes after the first injury
- Caused by airway obstruction, cardiac arrest or positioning
Describe coup/contrecoup.
- Coup is the primary impact
Contrecoup is the secondary impact, as the brain rebounds within the skull to the opposite side of the initial impact
Describe the tertiary injury in a TBI.
- Caused by bleeding, bruising, swelling and clotting
- Can increase intracranial pressure and reduce blood flow
- Occurs in days and weeks following initial/secondary injury
- Ongoing damage to the brain caused - can be weeks after the first injury
Describe a hypoxic brain injury.
- HBI is a lack of oxygen to the brain
- Anoxia - complete interruption of oxygen supply to the brain
- Hypoxia - partial interruption of the oxygen supply to the brain
What are potential causes of hypoxic brain injury?
Variety of causes: Suffocation Substance abuse Drowning Poisoning Cardiac arrest
What areas of the brain are particularly susceptable to hypoxic brain injury?
Cerebral cortex
Hippocampus
Basal ganglia
Cerebellum
What is the key function of the cerebral cortex?
Attention Perception, Awareness, Thought, Memory, Language Consciousness
What is the key function of the hippocampus?
Memory
What is the key function of the basal ganglia?
Speech, posture and movement control
What is the key function of the cerebellum?
Balance and coordination
What are the 4 low arousal states?
Coma - unresponsive and unrousable
Vegetative state - unresponsive but some functions working independently - breathing, heart rate, limited sleep/wake cycle
Minimally conscious/responsive state
Emerging minimally conscious/responsive state
Definition of minor brain injury:
Less than 15 minutes loss of consciousness
Less than an hour of post traumatic amnesia
Definition of moderate brain injury:
15 minutes - 6 hours loss of consciousness
1 hour to 24 hours post traumatic amnesia
Definition of severe brain injury:
6 hours - 48 hours loss of consciousness
24 hours - 7 days post traumatic amnesia
Definition of very severe brain injury:
Over 48 hours loss of consciousness
Over 7 days post traumatic amnesia
What are the symptoms of post traumatic amnesia?
- Confusion
- Disorientation
- Memory loss
- Retrograde amnesia - loss of memory shortly before the injury
- Anteretrograde amnesia - difficulty creating new memories post injury
What are the emotional/behavioural effects of brain injury?
- Personality Changes
- Mood Swings/Emotional Lability
- Depression
- Anxiety
- Frustration/Anger
- Abusive/Obscene Language
- Disinhibition
- Impulsiveness
- Obsessive Behaviour
What are the cognitive communication difficulties?
- Difficulty processing and understanding information
- Taking longer/being slow to react
- Difficulty understanding multiple meanings in jokes, sarcasm and adages or figurative expressives such as “a rolling stone gathers no moss” or “take a flying leap”
- Often unaware of errors and can become frustrated or angry and place the blame on others
- Not using/reading non-verbal cues accurately
- Word finding difficulties
- Lengthy and often faulty descriptions or explanations that cover for a lack of understanding or inability to think of a word
- Reading and writing abilities are often worse than those for speaking and understanding spoken words
- Altered turn taking
- Altered ability to talk around a shared topic (topic maintenance)
- Perseverating (topic fixating)
- Altered ability to order information
What are dysexecutive syndrome symptoms (DES)?
- Motivation/Initiation
- Concentration/Attention
- Planning/Organisation
- Self-Monitoring
- Flexible Thinking
- Multi-tasking
- Problem-solving/Making decisions
- Reasoning skills
- Delayed Information Processing
- Memory
- Repetitions
- Visual-perceptual Skills
- Insight/Empathy
- Behaviour/Emotions/Mood
- Social Skills
What is rehabilitation?
Royal College of Physician - 1986:
“The Restoration of patients to their fullest physical, mental and social capability”
Headway:
A period of change through which the head injured person goes in attempting to regain former abilities and to compensate for lost skills
Explain the continuum of care.
Gravell & Johnson - 2002:
Goes through stages of care: paramedics, A&E staff, ICU/Ward staff, inpatient rehab, community/specialist rehab, support and maintenance
What are 4 predictors of recovery?
- Months since injury
- Age
- GCS
- Months of treatment
What is the role of SLT in the acute stage?
- Identifying and promoting arousal/consciousness
- Likely focus on dysphagia management
- Identification/establishing of communication, often through low-tech AAC
- Support and advice to family
- There is a focus on medical stability, consciousness and out of post-traumatic amnesia