TBI- Traumatic Brain Injury Flashcards
What can a TBI result in?
Challenges that impact a persons physical, cognitive and psychological functioning
True or false:
The more functional domains that are impacted by the TBI, the more challenging the recovery course
True
Post-TBI; what changes hinder greater functional dependency?
Behavioral
Cognitive
Emotional
Psychosocial
Personality
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
True
What are some risk factors for TBI?
Age
Gender
Prisoner status
Sports (under reported and undiagnosed)
Prior TBI
What percent of patients who experienced a TBI have found to have elevated blood alcohol levels at the time of injury?
50%
The care and medical costs of a person with severe TBI can easily surpass how much over a lifetime?
$1 million
True or false:
Approximately 3.17 million Americans were determined to be living with long term disability related to TBI
True
What functions are potentially compromised from a TBI?
Coordinated movement
Speech
Memory
Reasoning
Altered behavioral responses
What are the 3 TBI classifications?
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)
What is a primary injury of a TBI?
Occurs at the moment of impact due to the actual trauma
What is a secondary injury of a TBI?
Occurs as a consequence of the primary injury and can develop anywhere from hours to days after the initial injury
What is an open injury?
The intracranial vault is exposed to the outside environment
What is a closed injury?
The skull and lining of the brain are left intact
What does blunt force trauma refer to?
Impact against a relatively flat object or surface
What is primary brain damage?
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
What is secondary brain damage?
Occurs working hours or days following the injury
Factors include:
- inflammatory response
- increased intracranial pressure
- decreases cerebral blood flow or ischemia
What are the 3 leading causes of TBI?
Falls (most common)
MVA (most damage)
Violence
What ages are TBI ER visits the most common?
5 to > 85
True or false:
61% of vehicle accidents involve females
False: males
True or false:
1/3 to 1/2 people are intoxicated at the time of injury
True
True or false:
About 1.7 million Americans per year
52,000 die
About 80,000 to 90,000 have a life long disability
True
True or false:
Permanently disabled:
10% mild TBI
66% moderate TBI
100% severe TBI
True
Who is the greatest risk for injury?
Men ages 15-24
True or false:
Inner city environments have the lowest incidence rates
False: HIGHEST
True or false:
American Indians, Alaskan and African Americans have the lowest TBI cases
False: HIGHEST
What is dysautonomia characterized by?
Hypertension
Tachycardia
Increased body temp
Profuse sweating
Decerebrate or decorticate posturing
Is a comas duration an important predictor of functional recovery?
Yes
State of unconsciousness and cannot be aroused
What is post traumatic stress amnesia (PTA)?
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
What is a vegetative state?
Patient exhibits spontaneous arousal through eye opening
No purposeful behavior or communication
What is a minimally conscious state?
Some awareness of self and environment
What are the most common early onset medical complications of TBI?
Increases in intracranial pressure (ICP)
Post traumatic hydrocephalus (PTH)
Post traumatic agitation
Explain increases in intracranial pressure (ICP)
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
Explain post traumatic hydrocephalus (PTH)
Caused by blockages of normal cerebrospinal fluid (CSF) flow, overproduction of CSF, or insufficient absorption of CSF back into the body
Explain post traumatic agitation
A subtype of delirium marked by relentlessness, impulsivity, aggression, emotional liability, disinhibition, and confusion usually occurring during early recovery
What are some complications people with TBI’s deal with that have lifelong medical and rehabilitation management?
Hypertension, headache, sleep disturbances, dysautonomia, Traumatic seizures, Deep vein thrombosis, malnutrition, bowl related issues, coma ETC
What are some motor deficits people TBI have?
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
What is decerebrate rigidity?
Damage to brain stem between the vestibular nuclei and the red nucleus
TEST QUESTION
What are some potential medical complications?
Hydrocephalus- excessive accumulation of fluid in the brain
Seizure
Dysautonomia
Deep vein thrombosis- give rise to pulmonary embolism
Coma
What are cerebellar (intention) tremors?
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
What are essential tremors?
Slow constant tremors
Typically affect more distal musculature
What are resting tremors?
Pill- rolling movement at rest
What are physiologic tremors?
A normal phenomenon
Occurs in all contracting muscle groups
Be exacerbated by fatigue, stress, strong emotions, caffeine, fever
What are cognitive deficits?
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
What are psychosocial deficits?
Preservation
Poor control or temper
Aggression/ irritability
Apathy
Depression
Suicide
PTSD
What are visual deficits?
Diplopia
Problems with accommodation
Problems with convergence
Visual field deficits
Saccadic dysfunction
Strabismus
What is diplopia?
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
What are signs and symptoms of cranial nerve dysfunction?
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
How many years can a TBI reduce your life span by?
9 years
What are prognosis factors?
Trauma score
GCS score
Bio markers
Presence/ absence of hypoxia
Length of coma
Duration of amnesia
What is the disability rating scale (DRS)?
Expanded GCS assessment to more clearly determined disability after TBI
May be use at admission and discharge from rehab
What is the ranchos los amigos scale (levels of cognitive functioning scale- LCFS)?
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
What is the acute phase or surgical and medical management?
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
What are the admission requirements for inpatient rehabilitation?
Medical Stability
Need for close medical supervision
Need for active and ongoing intensive therapy by multiple therapy disciplines
What is acute inpatient rehab?
Must be able to tolerate at least 3 hrs of therapy a day (2 or more therapists)
5-7 days a week
What is subacute inpatient rehab?
Must be able to tolerate 0.5- 2 hrs per day
What does TBI impact in occupational performance?
Community living skills
Meal preparation/ Safety
Feeding skills
Employment
Bathing
Money management
Driving
