Traumatic Brain and Spinal Cord Injury Flashcards
What is it called when an external, mechanical force impacts the head?
Occurrence
What characterizes an occurrence?
- diminished or altered consciousness
- ranges from brief lethargy to prolonged unconsciousness or even brain death
- not related to brain insult at birth (bleed)
When is the peak period of incidence for falls causing TBIs?
less than 1 yr old
When is the peak period of incidence for abuse causing TBIs?
less than 4 yr old
When is the other peak period of incidence for causing TBIs? why?
mid-late adolesence (15-19)… males have greater incidence because of the frontal cortex developing differently and possibly hormones
What is the leading cause of death and disability in children 1-19?
TBI
What are the causes of TBIs in order of frequency of occurrence?
- Falls
- MVAs (age 5-9 due to improper restraint)
- Gunshot wounds
- Abuse/assault
- Sports/recreation activities
What types of mechanism of injury are there in TBIs?
- Impression
- Accelleration/Deceleration (translational and rotational)
What happens in a translational head injury?
Coup and contrecoup
What happens in a rotational head injury?
skull rotates as the brain remains stationary
What is a concussion characterized by?
- altered awarenss and loss of memory immediately after traumatic incident
- obvious changes may be absent on imaging
What behavioral changes should we be aware of in patients with concussion?
Nystagmus, dizziness, nausea, altered alertness, emotional lability
How long do concussions last?
depends on severity… but usually 7-10 days
What are the different forms of primary brain damage from trauma (4)?
- Contusion
- Skull fractures
- Intracranial hemorrhages
- Diffuse axonal injury
Where does bruising occur after a contusion caused by blunt trauma?
crests of gyri in cerebral hemispheres (usually frontal and temporal lobes)
What types of intracranial hemorrhages are there?
- Extradural: occur due to tearing of arter in brain
- Intradural: subdural and intracerebral
What typically causes diffuse axonal injury?
rotational injury within the cranial vault (not seen on CT)
What are the types of secondary brain damage from trauma (5)?
- cerebral edema
- ICP increase
- herniation syndromes
- hypoxic-ischemic injury
- neurochemical events
What happens in infants when ICP increases?
fontanels bulge
What causes hypoxic-ischemic injury?
drowning, attempted strangulation, choking
What happens in neurochemical events?
oxygen free radicals are released, causing damage
What are other consequences from brain damage?
- hydrocephalus
- seizures
- infections
- endocrine disorders (precocious puberty)
What is the best indicator of long-term function in those with TBI?
How long they have amneisa
Explain the glascow coma scale
Standardized, based on the patient’s best response to motor activity, verbal responses, and eye opening
What ages is the children’s coma scale used for?
<36 months
What ages is the pediatric coma scale used for?
9-72 months
What is typicalls used for assessment of orientation and amnesia?
Children’s Orientation and Amnesia (COAT)
What ages is the COAT used for?
4-15 years
What has a higher predictive factor of future memory function than coma scales?
Duration of PTA (post traumatic amnesia)
What is a descriptive scale of cognitive and behavioral functioning?
Pediatric Rancho Scale
What ages is the pediatric rancho scale used?
infancy-7 y.o.
Who shows better recovery when it comes to TBIs? Why?
adults- pedatric vessels, neuronal axons, and tissue is not mature and is susceptible to physical damage
What do you need to assess for basic sensorimotor status in patients with TBI?
abnormal tone (spasticity), ataxia, orthopedic complications
What is it called when muscles start calcifying due to brain or spinal cord trauma (quads, glutes, hamstrings)?
heterotopic ossification
What is the best measure of functional status in patients with TBI?
Wee-FIM and PEDI
What ages is the Wee-FIM and PEDI used for?
6 mo - 7 yr
What practice patterns do TBIs fall under?
5C, 5D, 5I
What is the major difference in rehabilitating a child with TBI vs/ an adult with TBI?
more play-based with children and occupation based with adults
What does the coma stimulation program involve?
Low level: stimulation
Mid level: structure (agitation prevalent)
High level: school/community reintigration
What are sources and responses to auditory sensory stimulation?
verbal orientation –> localization
What are sources and responses to visual stimulation?
penlight –> eye blink
What are some sources and responses to olfactory sensory stimulation?
vinegar –> grimacing
What are some sources and responses to tactile sensory stimulation?
familiar objects –> posturing
What are some sources and responses to vestibular sensory stimulation?
turning –> spasticity
What are some ideas to prevent pediatric TBIs?
bicycle helmets, playground equipment less than 3-4 ft high, traffic behavior, car restraints
car restraints can prevent up to _____% of serious and fatal injuries to children under ____ y.o. and use of lap belts can prevent ____% of serious and fatal injuries in children and adolesents
90%
5 y.o.
45%
What are the main causes of traumatic spina cord injury in children?
motor vehicle accidents
birth trauma
child abuse
What types of atraumatic spinal cord injuries in children can occur?
myelopathies
cancer
stroke
What are the different types of myelopathies?
compressive
Inflammatory
What are different types of compressive myelopathies?
stenosis, spondylolisthesis, Chiari malformation, protruding discs
What are some different types of inflammatory myelopathies?
acute transverse myelitis, guiilain barre, multiple sclerosis, acute disseminated encephalomyelitis, neuromyelitis optica
What are some types of stroke?
arterial/venous ischemia
arteriovenous malformation
dural arteriovenous fistula
What is different about a child’s c-spine?
more neutral and more ligamentous laxity
What is SCIWORA?
distraction or ischemic injury not detected radiographically
SCIWORA has been reported in ____-____% of all children who experience SCI.
19-34%
If lesion is above ____… then autonomic dysreflexia is a risk
T6
What is the best scale to analyze functional expectations in patients with SCI?
ASIA impairment scale
What does the ASIA do?
designate complete or incomplete injury
What tendons are prone to contracture in patients with SCI?
hip flexors, adductors, gastroc
How old must a child be to independently use a wheelchair?
2 y.o.
What does therapist documentation help with?
equipment needs, school setting, community resources
What does education provide for patients?
caregivers, school employees
With SCI, there is an increased risk of…
hip subluxation, skin integrity, renal disease, osteoporosis, and depression
