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Pediatrics > Traumatic Brain and Spinal Cord Injury > Flashcards

Traumatic Brain and Spinal Cord Injury Flashcards

1
Q

What is it called when an external, mechanical force impacts the head?

A

Occurrence

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2
Q

What characterizes an occurrence?

A
  • diminished or altered consciousness
  • ranges from brief lethargy to prolonged unconsciousness or even brain death
  • not related to brain insult at birth (bleed)
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3
Q

When is the peak period of incidence for falls causing TBIs?

A

less than 1 yr old

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4
Q

When is the peak period of incidence for abuse causing TBIs?

A

less than 4 yr old

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5
Q

When is the other peak period of incidence for causing TBIs? why?

A

mid-late adolesence (15-19)… males have greater incidence because of the frontal cortex developing differently and possibly hormones

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6
Q

What is the leading cause of death and disability in children 1-19?

A

TBI

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7
Q

What are the causes of TBIs in order of frequency of occurrence?

A
  • Falls
  • MVAs (age 5-9 due to improper restraint)
  • Gunshot wounds
  • Abuse/assault
  • Sports/recreation activities
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8
Q

What types of mechanism of injury are there in TBIs?

A
  • Impression

- Accelleration/Deceleration (translational and rotational)

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9
Q

What happens in a translational head injury?

A

Coup and contrecoup

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10
Q

What happens in a rotational head injury?

A

skull rotates as the brain remains stationary

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11
Q

What is a concussion characterized by?

A
  • altered awarenss and loss of memory immediately after traumatic incident
  • obvious changes may be absent on imaging
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12
Q

What behavioral changes should we be aware of in patients with concussion?

A

Nystagmus, dizziness, nausea, altered alertness, emotional lability

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13
Q

How long do concussions last?

A

depends on severity… but usually 7-10 days

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14
Q

What are the different forms of primary brain damage from trauma (4)?

A
  • Contusion
  • Skull fractures
  • Intracranial hemorrhages
  • Diffuse axonal injury
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15
Q

Where does bruising occur after a contusion caused by blunt trauma?

A

crests of gyri in cerebral hemispheres (usually frontal and temporal lobes)

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16
Q

What types of intracranial hemorrhages are there?

A
  • Extradural: occur due to tearing of arter in brain

- Intradural: subdural and intracerebral

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17
Q

What typically causes diffuse axonal injury?

A

rotational injury within the cranial vault (not seen on CT)

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18
Q

What are the types of secondary brain damage from trauma (5)?

A
  • cerebral edema
  • ICP increase
  • herniation syndromes
  • hypoxic-ischemic injury
  • neurochemical events
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19
Q

What happens in infants when ICP increases?

A

fontanels bulge

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20
Q

What causes hypoxic-ischemic injury?

A

drowning, attempted strangulation, choking

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21
Q

What happens in neurochemical events?

A

oxygen free radicals are released, causing damage

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22
Q

What are other consequences from brain damage?

A
  • hydrocephalus
  • seizures
  • infections
  • endocrine disorders (precocious puberty)
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23
Q

What is the best indicator of long-term function in those with TBI?

A

How long they have amneisa

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24
Q

Explain the glascow coma scale

A

Standardized, based on the patient’s best response to motor activity, verbal responses, and eye opening

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25
Q

What ages is the children’s coma scale used for?

A

<36 months

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26
Q

What ages is the pediatric coma scale used for?

A

9-72 months

27
Q

What is typicalls used for assessment of orientation and amnesia?

A

Children’s Orientation and Amnesia (COAT)

28
Q

What ages is the COAT used for?

A

4-15 years

29
Q

What has a higher predictive factor of future memory function than coma scales?

A

Duration of PTA (post traumatic amnesia)

30
Q

What is a descriptive scale of cognitive and behavioral functioning?

A

Pediatric Rancho Scale

31
Q

What ages is the pediatric rancho scale used?

A

infancy-7 y.o.

32
Q

Who shows better recovery when it comes to TBIs? Why?

A

adults- pedatric vessels, neuronal axons, and tissue is not mature and is susceptible to physical damage

33
Q

What do you need to assess for basic sensorimotor status in patients with TBI?

A

abnormal tone (spasticity), ataxia, orthopedic complications

34
Q

What is it called when muscles start calcifying due to brain or spinal cord trauma (quads, glutes, hamstrings)?

A

heterotopic ossification

35
Q

What is the best measure of functional status in patients with TBI?

A

Wee-FIM and PEDI

36
Q

What ages is the Wee-FIM and PEDI used for?

A

6 mo - 7 yr

37
Q

What practice patterns do TBIs fall under?

A

5C, 5D, 5I

38
Q

What is the major difference in rehabilitating a child with TBI vs/ an adult with TBI?

A

more play-based with children and occupation based with adults

39
Q

What does the coma stimulation program involve?

A

Low level: stimulation
Mid level: structure (agitation prevalent)
High level: school/community reintigration

40
Q

What are sources and responses to auditory sensory stimulation?

A

verbal orientation –> localization

41
Q

What are sources and responses to visual stimulation?

A

penlight –> eye blink

42
Q

What are some sources and responses to olfactory sensory stimulation?

A

vinegar –> grimacing

43
Q

What are some sources and responses to tactile sensory stimulation?

A

familiar objects –> posturing

44
Q

What are some sources and responses to vestibular sensory stimulation?

A

turning –> spasticity

45
Q

What are some ideas to prevent pediatric TBIs?

A

bicycle helmets, playground equipment less than 3-4 ft high, traffic behavior, car restraints

46
Q

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

A

90%
5 y.o.
45%

47
Q

What are the main causes of traumatic spina cord injury in children?

A

motor vehicle accidents
birth trauma
child abuse

48
Q

What types of atraumatic spinal cord injuries in children can occur?

A

myelopathies
cancer
stroke

49
Q

What are the different types of myelopathies?

A

compressive

Inflammatory

50
Q

What are different types of compressive myelopathies?

A

stenosis, spondylolisthesis, Chiari malformation, protruding discs

51
Q

What are some different types of inflammatory myelopathies?

A

acute transverse myelitis, guiilain barre, multiple sclerosis, acute disseminated encephalomyelitis, neuromyelitis optica

52
Q

What are some types of stroke?

A

arterial/venous ischemia
arteriovenous malformation
dural arteriovenous fistula

53
Q

What is different about a child’s c-spine?

A

more neutral and more ligamentous laxity

54
Q

What is SCIWORA?

A

distraction or ischemic injury not detected radiographically

55
Q

SCIWORA has been reported in ____-____% of all children who experience SCI.

A

19-34%

56
Q

If lesion is above ____… then autonomic dysreflexia is a risk

A

T6

57
Q

What is the best scale to analyze functional expectations in patients with SCI?

A

ASIA impairment scale

58
Q

What does the ASIA do?

A

designate complete or incomplete injury

59
Q

What tendons are prone to contracture in patients with SCI?

A

hip flexors, adductors, gastroc

60
Q

How old must a child be to independently use a wheelchair?

A

2 y.o.

61
Q

What does therapist documentation help with?

A

equipment needs, school setting, community resources

62
Q

What does education provide for patients?

A

caregivers, school employees

63
Q

With SCI, there is an increased risk of…

A

hip subluxation, skin integrity, renal disease, osteoporosis, and depression

Pediatrics (10 decks)

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