TBI, SCI, Balance, Outcome Measures Flashcards
1
Q
Effects of a brain injury depend on factors such as _____, ______, and ______.
A
Cause, location, and severity
2
Q
1 cause of TBI are _____
A
Falls
3
Q
Classifications of Brain Injuries:
_____ head injury or _____ head injury
Subtypes:
_______, _______, and _____
A
Open head injury or closed head injury
Concussion, Contusion, and Hematomas
4
Q
Example of a closed head injury:
A
Concussion
5
Q
Open head injury is when something ______ the skull.
A
Penetrates
6
Q
Most common type of TBI?
A
Concussion
7
Q
Which subtype of TBI is a hemorrhage on brain surface?
What two types of lesions are results of this?
A
Contusion
Coup lesion or Contrecoup lesion
8
Q
Def: contusion on same side of brain as the impact
A
Coup lesion
9
Q
Def: hemorrhage on opposite side of trauma due to deceleration
A
Contrecoup lesion
10
Q
_____ hematoma: form between the dura mater and skull, meninges artery. Second to blow to head, MVA, or motorcycle
A
Epidural hematoma
11
Q
_____ hematoma: Between dura and arachnoid, venous leak; slow (hours to days); second to fall in elderly
A
Subdural hematoma
12
Q
____ damage: the result of forces exerted on the brain at the time of injury (coup/contrecoup, foreign body, diffuse axons injury)
A
Primary damage
13
Q
_____ damage: refers to changes in brain function as a result of the brain’s reaction to trauma (edema, decreased cerebral perfusion, hypoxia, hydrocephalus, seizures)
A
Secondary damage
14
Q
Secondary problems of TBIs: increased _____ pressure, _____ injuries, ________
A
Increased intracranial pressure, anoxic injuries, seizures
15
Q
Def: all brain functions including brain stem non-functioning
A
Brain death
16
Q
Def: state of unconsciousness, unable to arouse, unresponsive to stimuli
A
Comatose
17
Q
Def: return of brain stem reflexes and sleep-wake cycles, unaware of external environment
A
Vegetative state
18
Q
Def: a person in a vegetative state > 30 days
A
Persistent vegetative state
19
Q
Def: Vague awareness of self and environment, visually fix on an object, locate sounds, local is noxious stimuli
A
Minimally conscious state
20
Q
Def: Fully conscious, cognition preserved, complete paralysis except vertical eye movements
A
Locked in syndrome
21
Q
Def: state of being aware
A
Conscious
22
Q
Mild, moderate, or severe brain injury?
- Brief, if any, loss of consciousness
- Vomiting and dizziness
- Lethargy
- Memory loss
A
Mild brain injury
23
Q
Mild, moderate or severe TBI?
- Unconscious up to 24 hours
- Signs of brain trauma
- Contusions or bleeding
- Signs of injury on neuroimaging
A
Moderate brain injury
24
Q
Mild, moderate or severe TBI?
- Unconscious exceeding 24 hours (coma)
- No sleep wake cycle during loss of consciousness
- Signs of injury appear on neuroimaging tests
A
Severe brain injury
25
What scale assesses level of arousal and function of the cerebral cortex? Scores range from 3 to 15; pupil response, verbalization, motor response
Glasgow Coma Scale
26
Glasgow coma scale severity classifications:
Mild- __ to __
Moderate- __ to __
Severe- __ to __
Mild 13 to 15
Mod 9 to 12
Severe 3 to 8
27
Motor response post TBI:
Abnormal (spastic) flexion = _____ posture
Extensor (rigid) response = _____ posture
Decorticate
Decerebrate
28
Medical management post TBI:
- Minimize secondary brain injury
- maintain normal _____ ______ (SBP > ___ mm Hg)
- Monitor ICP
- Maintain ___ sats (>___%)
Blood pressure, > 90
O2 sats >90%
29
Dilantin, Tegretol, and Phenobarbital are meds with what action?
Side effects?
Anti-seizure meds
Effects: Sedation, decreased memory, double vision
30
Amantadine is a drug used to increase level of _____.
Alertness
Side effects: Dizziness, syncope, agitation
31
A Mannitol drip by IV is used to decrease ______ ______.
Intracranial pressure
32
Ranch Los Amigos Scale:
Level I - No response to visual, verbal, tactile, auditory, noxious stimuli
Level II - Generalized response
Level III - Localized response
Level IV - Confused-agitated
Level V - Confused-inappropriate
Level VI - Confused-appropriate
Level VII - Automatic-inappropriate
Level VIII - Purposeful and appropriate
Level IX - Purposeful and appropriate (standby assistance on request)
Level X - Purposeful and appropriate (modified independent)
Memorize this, bitch
33
What position has least affect on tone?
Side-lying
34
Heterotopic ossification typically occurs in the ___ or ____ area.
Hip or thigh
35
Decorticate or Decerebrate?
| Indicates more brainstem injury
Decerebrate
36
Confused and Agitated Patients:
Do Not try to teach ____ ____
- Consistency
- Expect no carryover
- Model calm behavior
- Expect egocentricity
- Flexibility/options
- Safety
- Environment
Do not try to teach new activities/skills
37
Describe six clinical signs and symptoms that may emerge in persons with persistent (>7 days) sports-related mild TBI symptoms (GCS score of 13-15):
Mental fatigue, vestibular, ocular motor, migraine, affective/mood, cervical problems
38
What is chronic traumatic encephalopathy and what types of people is it seen in?
Brain degeneration caused by repeated head traumas;
| Seen in athletes and military vets
39
Balance is greatest when the body’s ____ is maintained over it’s ____
COG (or COM) maintained over BOS
40
Balance or postural stability is the term used to describe the dynamic process by which the body’s position is maintained in ______.
Equilibrium
41
Static equilibrium- Body at ____
Dynamic equilibrium- Body in steady-state ____
Rest
Motion
42
Def: The perimeter of the contact area between the body and supporting surface
Base of support
43
Balance requires the interaction of:
_____ system
_____ system
_____ effects (environment)
Nervous
Musculoskeletal
Contextual effects
44
Which sensory system provides information regarding position of head relative to environment, orientation of head to maintain gaze parallel to horizon, direction and speed of head movements?
Visual system
45
Which sensory system provides information regarding position in motion of body parts relative to each other and the support surface??
Somatosensory system
46
Which sensory system provides information relative to position and movement of head relative to gravity in inertia?
*receptors in semicircular canals detect angular acceleration of head and are sensitive to fast head movements; Receptors in otoliths detect linear acceleration of head in response to slow head movements
Vestibular system
47
_________ information has the fastest processing time followed by visual and vestibular responses.
Somatosensory
48
What three types of input combine to produce our sense of orientation to the world around us and produce appropriate movements in response to that orientation?
Vestibular, visual, and somatosensory
49
Def: When sensory input from one system is inaccurate or impaired the CNS may suppress the inaccurate input and select and combine the appropriate sensory inputs from the other two systems
Sensory organization
50
_____ Balance control: Required to maintain a stable anti-gravity position at rest (sitting/standing)
Static Balance control
51
_____ Balance Control: Required to stabilize the body when the support services are moving (escalator, subway) or when the body is moving on a stable surface (transfers, gait)
Dynamic Balance control
52
______ ______ reactions: We use to maintain balance in response to unexpected external perturbations
Automatic postural reactions
53
During gait, the COM is always outside the ____ except in double support.
Our goal is to train the person to allow this to occur without letting the body fall. This requires coordination of gross and fine motor movements to maintain balance, posture, and vertical alignment.
BOS
54
Primary cause of a SCI?
MVA
| *followed by falls and violence
55
Tetraplegia/Quadriplegia is a _____ SCI
Cervical
56
Paraplegia is a SCI to what areas of spinal cord?
Thoracic, lumbar, sacral
57
Mortality rates are significantly higher during the first year after spinal cord injury. Causes of death often _____ and ______.
Pneumonia and septicemia
58
The “______ _____” is the most caudal level of the spinal cord with normal motor and sensory function on both right and left sides of the body.
Neurological level
59
Def: (type of SCI) Penetrating wound; Ipsilateral motor and sensory loss as well as proprioception, light touch, and vibratory sense; Contralateral loss of pain and temperature
Brown-Sequard Syndrome
60
Def: (type of SCI) Hyper-Flexion injury; Loss of motor function, pain, and temperature below level of injury.
Proprioception, light touch, and vibratory sense preserved. Longer length of stay in rehab.
Anterior cord syndrome
61
Def: (type of SCI) Hyperextension injury; Greater motor deficits in UEs than LEs. Sensory deficits generally less than motor deficits. Usually able to ambulate. Moderate to severe impairment of functional tasks due to loss of upper extremity fine motor function.
Central cord syndrome
62
_____ ______ injuries (spinal cord): Direct trauma/fracture-dislocation below L1; Areflexic/flaccid bowel and bladder / saddle anesthesia, variable LE paralysis; LMN injury/potential for regeneration
Cauda Equina Injuries
63
```
Complications post SCI:
[Neurological Dysfunction]
- Spinal shock
- Autonomic Dysreflexia: what is it?
- Cardiovascular
- Temperature control
- Pulmonary
- Bowel and bladder
- Sexual
```
Sudden onset of excessively high blood pressure
64
What is the most common cause of autonomic dysreflexia?
| Greatest risk in pt with injury at ___ and above.
Bowel and bladder distention/irritation
T6 and above
*Hypertension occurs and if not treated can result in seizures, cardiac arrest, SAH, CVA or death
65
S&S of Autonomic Dysreflexia:
Hypertension, bradycardia, severe headache, profuse sweating, increased spasticity, vasodilation, goosebumps, blurred vision
66
If you suspect someone is suffering from autonomic dysreflexia what interventions should you do?
- Raise patient’s head
- Loosen constrictive clothing/abdominal binder
- Monitor BP and pulse
- Check catheter
- Question patient about triggers
- If BP does not respond get nursing/medical attention
67
65% of SCI pt’s have _____. Most common in cervical injuries. Occurs gradually 6 to 12 months post injury. Triggers? Treatment?
Hypertonia
Triggers: Positional changes, ambient temp, fecal impaction, UTI, decubitus ulcers, emotional stress
Treatment: Meds, baclofen pump, Botox injections, surgery
68
Cardio / Pulmonary Impairments and Temp Impairments (SCI):
- (cardiovascular impairment) _____ ______ common in T6 and above
- ______ regulation
- Pulmonary impairment: _____ nerve in high cervical injuries primary cause of death
```
Orthostatic hypotension
Temperature regulation
Phrenic nerve (C1,2 Phrenic nerve innovation and spontaneous respiration are lost)
```
69
Bladder dysfunction: ____ major cause of morbidity and mortality
Bowel:
Lesions above S2 have a ____ bowel (UMN)
S2-S4 lesions have a _____ (areflexive) bowel (LMN)
UTI
Spastic
Flaccid
70
Number 1 cause of death in those who survive SCI:
Respiratory disease
71
“Everything below ___ can drive”
C5
| Including C5
72
Patients with injury at ____ and below can potentially walk
T1
73
SCI rehab: do not stretch what? Why?
Don’t stretch finger flexors
| Tenodesis effect for gripping
74
ASIA Scale classifies what injury?
SCI
75
ASIA scale was created to distinguish among different types of SCI:
A- _______
B- _______
C- _______
A-Complete
B-Sensory incomplete
C-Motor incomplete (less than half of key muscle functions below the single NLI have a muscle grade > or equal to 3)
*D- Motor incomplete (at least half of key muscle functions below single NLI have muscle grade > or equal to 3)
76
```
ASIA scale key muscles tested:
C5-
C6-
C7-
C8-
T1-
L2-
L3-
L4-
L5-
S1-
```
```
C5- Elbow flexors (biceps, deltoid)
C6- Wrist extensors (Ext. carpi radialis)
C7- Elbow extensors (Triceps)
C8- Finger flexors
T1- Abdominals (why does Asia scale say finger abductors??)
L2- Hip flexors
L3- Knee extensors
L4- Ankle dorsiflexors
L5- Long toe extensors
S1- Ankle plantar flexors
```
77
To avoid stress on an unstable surgical site in lumbar region while performing ROM ex., straight leg raises may be restricted to no more than ___ degrees and hip flexion (during combined hip and knee flxn ) no more than __ degrees.
60
| 90
78
With an unstable cervical spine, motion of head and neck may be contraindicated and shoulder flexion and abduction limited to no more than ___ degrees.
90
79
(SCI) Remember to strengthen the key muscles at spinal level and the muscles _____
Above
80
C1-C4 key muscles:
Face and neck muscles (traps), cranial nerve innervation
81
Why do we use outcome measures?
1) Baseline for establishing goals
2) Determine pt’s ability level
3) Monitor progress toward goals
4) Assist with placement decisions
5) Measure effectiveness of intervention
6) Determine pt’s level of safety
82
Def: Does a test measure what it is designed to measure?
Validity
83
Def: Does the test consistently and accurately measure what it is intended to measure?
Reliability
84
Def: test performed by the same therapist time after time; are results consistent?
Intrarater reliability
85
Def: test performed by different therapist on same patient; are results consistent?
Interrater reliability
86
Outcome Measures:
The instrument must be sensitive enough to reflect meaningful change in a pt’s condition. Each test should report a MDC and/or MCID. What do MDC and MCID stand for?
Minimal detectable change
| Minimal Clinical Important Difference
87
FIM (what does it stand for?)- Used in what setting? Looks at level of assistance needed by individual from total independence to total assistance.
Functional independence measure
| In-patient rehab
88
What is OASIS? Used in what setting?
Outcome and Assessment Information Set
Home Health Care
89
At what spinal level in a SCI and below are patient’s completely Independent with ADL’s ?
C7
90
Purpose of Frenkel exercises?
For ataxic conditions (impaired balance/coordination/proprioception
“Designed to help you compensate for the inability to tell where your arms and legs are in space without looking”
91
Lifting strategies
```
Maintain neutral spine
Stabilize core
Perform Kegel
Estimate load weight
Slow lifting speed
Avoid asymmetrical lift
Reduce the load weight
```
