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Physical Conditions > TBI- Traumatic Brain Injury > Flashcards

TBI- Traumatic Brain Injury Flashcards

1
Q

What can a TBI result in?

A

Challenges that impact a persons physical, cognitive and psychological functioning

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2
Q

True or false:

The more functional domains that are impacted by the TBI, the more challenging the recovery course

A

True

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3
Q

Post-TBI; what changes hinder greater functional dependency?

A

Behavioral

Cognitive

Emotional

Psychosocial

Personality

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4
Q

True or false:

In the US in 2010, the CDC estimates 2.5 million TBIs, with approximately 50,000 deaths, 280,000 hospitalizations, and 2.2 million emergency department visits resulting from TBIs

A

True

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5
Q

What are some risk factors for TBI?

A

Age

Gender

Prisoner status

Sports (under reported and undiagnosed)

Prior TBI

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6
Q

What percent of patients who experienced a TBI have found to have elevated blood alcohol levels at the time of injury?

A

50%

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7
Q

The care and medical costs of a person with severe TBI can easily surpass how much over a lifetime?

A

$1 million

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8
Q

True or false:

Approximately 3.17 million Americans were determined to be living with long term disability related to TBI

A

True

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9
Q

What functions are potentially compromised from a TBI?

A

Coordinated movement

Speech

Memory

Reasoning

Altered behavioral responses

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10
Q

What are the 3 TBI classifications?

A

Mild: <30 min loss of consciousness (GCS 13-15)

Moderate: 30 mins to 24 hrs loss of consciousness (GCS 9-12)

Severe: >25 hrs loss of consciousness (GCS 3-8)

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11
Q

What is a primary injury of a TBI?

A

Occurs at the moment of impact due to the actual trauma

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12
Q

What is a secondary injury of a TBI?

A

Occurs as a consequence of the primary injury and can develop anywhere from hours to days after the initial injury

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13
Q

What is an open injury?

A

The intracranial vault is exposed to the outside environment

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14
Q

What is a closed injury?

A

The skull and lining of the brain are left intact

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15
Q

What does blunt force trauma refer to?

A

Impact against a relatively flat object or surface

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16
Q

What is primary brain damage?

A

May be focal or diffuse

Direct impact, acceleration, deceleration, rotation of the brain, intrusion into the brain by penetrating object

DAI= diffuse axonal injuries

  • head collision 15 mph or greater
  • results in coma

Coup and countrecoup injuries

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17
Q

What is secondary brain damage?

A

Occurs working hours or days following the injury

Factors include:

  • inflammatory response
  • increased intracranial pressure
  • decreases cerebral blood flow or ischemia
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18
Q

What are the 3 leading causes of TBI?

A

Falls (most common)

MVA (most damage)

Violence

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19
Q

What ages are TBI ER visits the most common?

A

5 to > 85

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20
Q

True or false:

61% of vehicle accidents involve females

A

False: males

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21
Q

True or false:

1/3 to 1/2 people are intoxicated at the time of injury

A

True

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22
Q

True or false:

About 1.7 million Americans per year

52,000 die

About 80,000 to 90,000 have a life long disability

A

True

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23
Q

True or false:

Permanently disabled:
10% mild TBI
66% moderate TBI
100% severe TBI

A

True

24
Q

Who is the greatest risk for injury?

A

Men ages 15-24

25
Q

True or false:

Inner city environments have the lowest incidence rates

A

False: HIGHEST

26
Q

True or false:

American Indians, Alaskan and African Americans have the lowest TBI cases

A

False: HIGHEST

27
Q

What is dysautonomia characterized by?

A

Hypertension

Tachycardia

Increased body temp

Profuse sweating

Decerebrate or decorticate posturing

28
Q

Is a comas duration an important predictor of functional recovery?

A

Yes

State of unconsciousness and cannot be aroused

29
Q

What is post traumatic stress amnesia (PTA)?

A

Gradual regaining of consciousness following coma

Permanent memory gap from time of injustice to the point at which patient starts to remember events

PTA (with GCS) important predictor if functional recovery

PTA less than 5 min= very mild injury
PTA greater than 7 days= very severe injury

30
Q

What is a vegetative state?

A

Patient exhibits spontaneous arousal through eye opening

No purposeful behavior or communication

31
Q

What is a minimally conscious state?

A

Some awareness of self and environment

32
Q

What are the most common early onset medical complications of TBI?

A

Increases in intracranial pressure (ICP)

Post traumatic hydrocephalus (PTH)

Post traumatic agitation

33
Q

Explain increases in intracranial pressure (ICP)

A

ICP Due to cerebral edema or bleeding can cause compression of brain structures, cerebral ischemia from reduced cerebral blood perfusion, or herniation of the brain through the skull

34
Q

Explain post traumatic hydrocephalus (PTH)

A

Caused by blockages of normal cerebrospinal fluid (CSF) flow, overproduction of CSF, or insufficient absorption of CSF back into the body

35
Q

Explain post traumatic agitation

A

A subtype of delirium marked by relentlessness, impulsivity, aggression, emotional liability, disinhibition, and confusion usually occurring during early recovery

36
Q

What are some complications people with TBI’s deal with that have lifelong medical and rehabilitation management?

A

Hypertension, headache, sleep disturbances, dysautonomia, Traumatic seizures, Deep vein thrombosis, malnutrition, bowl related issues, coma ETC

37
Q

What are some motor deficits people TBI have?

A

Decerebrate rigidity

Decorticate rigidity- brain stem intact despite several cortical damage

Spasticity- common in adults after moderate to severe TBI

Hemiplegia

Heterotopic ossification

Bone formation at an abnormal soft tissue site

Tremors/ ataxia

38
Q

What is decerebrate rigidity?

A

Damage to brain stem between the vestibular nuclei and the red nucleus

TEST QUESTION

39
Q

What are some potential medical complications?

A

Hydrocephalus- excessive accumulation of fluid in the brain

Seizure

Dysautonomia

Deep vein thrombosis- give rise to pulmonary embolism

Coma

40
Q

What are cerebellar (intention) tremors?

A

Slow tremors that occur at the end of purposeful movement

Associated with ataxia, hypotonia, and balance disorders

Tend to occur in trunk and proximal muscles with intentional movement

41
Q

What are essential tremors?

A

Slow constant tremors

Typically affect more distal musculature

42
Q

What are resting tremors?

A

Pill- rolling movement at rest

43
Q

What are physiologic tremors?

A

A normal phenomenon

Occurs in all contracting muscle groups

Be exacerbated by fatigue, stress, strong emotions, caffeine, fever

44
Q

What are cognitive deficits?

A

Most common, difficult and long lasting consequences of all levels of TBI in adults and children

  • retrograde/ ante retrograde amnesia
  • sustained attention
  • reasoning skills
  • impulse control
45
Q

What are psychosocial deficits?

A

Preservation

Poor control or temper

Aggression/ irritability

Apathy

Depression

Suicide

PTSD

46
Q

What are visual deficits?

A

Diplopia

Problems with accommodation

Problems with convergence

Visual field deficits

Saccadic dysfunction

Strabismus

47
Q

What is diplopia?

A

Double vision has been called the hallmark of visual deficits for persons with TBI

Often results in the individual closing one eye to eliminate double vision

TEST QUESTION

48
Q

What are signs and symptoms of cranial nerve dysfunction?

A

Absent pupillary reflex to light

Fixed dilated pupil

Homonymous hemianopsia

Bitemporal hemianopsia

Loss of sense of smell

High frequency hearing loss

Glossopharyngeal/ vague nerve- absent or depressed gag nerve

49
Q

How many years can a TBI reduce your life span by?

A

9 years

50
Q

What are prognosis factors?

A

Trauma score

GCS score

Bio markers

Presence/ absence of hypoxia

Length of coma

Duration of amnesia

51
Q

What is the disability rating scale (DRS)?

A

Expanded GCS assessment to more clearly determined disability after TBI

May be use at admission and discharge from rehab

52
Q

What is the ranchos los amigos scale (levels of cognitive functioning scale- LCFS)?

A

Used in many rehabilitation programs

Classifies the admitted patient into one of either levels of cognitive functioning

Limitations for the scale Are that it does not adequately reflect small changes in the recovery, may not accurately please a patient with characteristics of two or more categories, and is less accurate at highest levels

53
Q

What is the acute phase or surgical and medical management?

A

Focus- preservation of life, secondary damage and management of complications

Endotracheal tube- maintain patent airway

CAT scan- surgical decompression

Indwelling urinary catheter

Nasogastric tube

Skin integrity

Medications to control seizures

ROM/ splinting

54
Q

What are the admission requirements for inpatient rehabilitation?

A

Medical Stability

Need for close medical supervision

Need for active and ongoing intensive therapy by multiple therapy disciplines

55
Q

What is acute inpatient rehab?

A

Must be able to tolerate at least 3 hrs of therapy a day (2 or more therapists)

5-7 days a week

56
Q

What is subacute inpatient rehab?

A

Must be able to tolerate 0.5- 2 hrs per day

60
Q

What does TBI impact in occupational performance?

A

Community living skills

Meal preparation/ Safety

Feeding skills

Employment

Bathing

Money management

Driving

Physical Conditions (14 decks)

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