Traumatic Brain Injuries

Question 1

Traumatic Brain Injuries

Answer 1

• Caused by an external force
• Can be defined as a closed or open head injury.
• Closed= Non-penetrating
• Open= Penetrating.

Question 2

Glascow Coma Scale

Answer 2

• A common diagnostic tool used to identify severity of brain injury
• Assesses an individual’s level of consciousness and neurological functioning
• Typically performed within 24 hours after injury
• It is a standardized 15-point test that uses these three measures– eye opening, best motor response, and best verbal response
• The results of the three measures are added up and scores range from 3 to 15

Question 3

Mild/Major Brain Injury (Glascow Coma Scale)

Answer 3

Score of 13-15

Question 4

Moderate Brain Injury (Glascow Coma Scale)

Answer 4

Score of 9-12

Question 5

Severe Brain Injury (Glascow Coma Scale)

Answer 5

Score of 3-8

Question 6

The most common type of traumatic brain injury is a…

Answer 6

Concussion, which is also labeled as a mild traumatic brain injury.

Question 7

Concussion

Answer 7

• A concussion can be caused by a direct hit to head, shaking of the head, or a whiplash injury.
• A closed or an open head injury can result in a concussion.

Question 8

Top 3 Causes of Brain Injury

Answer 8

Falls, Motor Vehicle Accidents (MVA’s), and Violence

Question 9

Motor Vehicle Accidents

Answer 9

The most common cause of severe traumatic brain injury

Question 10

Most commonly seen age groups in the ER with TBI

Answer 10

• Children five and under
• Adolescents 15-19 years
• Older adults aged 75 and older

Question 11

The World Health Organization refers to traumatic brain injury as the…

Answer 11

“Silent Epidemic” due to the great incidence of TBI around the world.

Question 12

How many people in the United States are estimated to be living with a brain injury related disability?

Answer 12

Three to five million people

Question 13

Seizures

Answer 13

• A frequent complication with moderate or severe brain injury.
• Clients often are placed on anti-seizure medications for seizure management.

Question 14

Posttraumatic hydrocephalus

Answer 14

• The most common medical complication following brain injury.
• Clients require additional intervention to relieve the increase in fluid in their brain.

Question 15

Dysatonomia

Answer 15

• Often referred to as “storming” in hospital facilities.
• Characterized by increased blood pressure and heart rate, increased sweating, also known as diaphoresis, inability to regulate body temperature, and decerebrate or decorticate posturing.

Question 16

Deep Vein Thrombosis (DVTs)

Answer 16

• Occur due to prolonged immobilization

- Can lead to pulmonary emboli (PE).

Question 17

Pulmonary Emboli

Answer 17

The most common preventable cause of hospital deaths in TBI clients.

Question 18

Heterotopic Ossification (HO)

Answer 18

Bone formation at an abnormal soft tissue site, usually the hips, knees and elbows.

Question 19

Cognitive Impairments (TBI Impairments)

Answer 19

Some of the most common impairments you will see with brain injury.

Question 20

Retrograde Amnesia (TBI Impairments)

Answer 20

Memory loss of information prior to the injury, this may gradually but not completely improve.

Question 21

Anterograde Amnesia (TBI Impairments)

Answer 21

• Impaired memory to learn new long-term declarative information
• This memory loss is usually the last to improve.

Question 22

Executive Functioning (TBI Impairments)

Answer 22

• The ability to initiate, plan, organize, execute and adapt behavior based on the anticipated or actual consequences of actions.
• This deficit in high-level cognitive functioning is seen in all levels of brain injury.
• Clients may have difficulty learning new tasks that are not a part of their regular routine and automatic actions.

Question 23

Neurobehavioral Deficits

Answer 23

Common in all levels of TBI (mild, moderate, and severe)

• May include perseveration, impulsivity, irritability, aggression, disinhibition, and apathy
• May also include poor insight and awareness to their deficits, depression, and low self-esteem

Question 24

Suicide rates in TBI

Answer 24

• Occurrence is high

- Rates vary from 2.7-4.1 times that of the general population

Question 25

Aggressive Behavior in TBI Clients

Answer 25

3x more likley compared to clients with multiple trauma

Question 26

Visual Deficits in TBI Clients

Answer 26

More common, clients may have diploplia (double vision)

Question 27

Sensory and Motor Functions

Answer 27

With TBI these functions of cranial nerves can be damaged and each nerve can be tested

Question 28

Trochlear Nerve (CNIV)

Answer 28

• Moves the eye down and inward

- Damage to this nerve causes dysconjugate gaze, when the eyes do not move together.

Question 29

Optic Nerve (CNII)

Answer 29

• Carries visual messages from the back of the eye to the brain
• Damage causes visual loss depending upon where in the pathway the damage is located

Question 30

Olfactory Nerve (CNI)

Answer 30

Damage to this nerve causes Anosmia (absense of the sense of smell)

Question 31

Glossopharyngeal (CNIX) and Vagus Nerve (CNX)

Answer 31

• Causes dysphagia (impairements in swallowing)
• Clients with this are at risk of aspirating (inhalation of food or mucus into the respiratory tract), and may also contract pneumonia

Question 32

The Ranchos Los Amigos Levels of Cognitive Functioning Scale (LCFS)

Answer 32

• Used in many settings to classify the clients into one of the eight levels.
• TBI client will 1st be seen in the acute care hospital to focus on medical stabilization and preserving life (may be in an ICU at this time before stabilized and moved to a regular room)
• Can progress and move onto inpatient rehabilitation if 3 hours of therapy a day is tolerated.
• Can also move onto sub-acute rehab where 30 min to 2hrs a day is tolerated (this client may be more medically complex)
• Can also return home with family/caregiver support and continue rehabilitation in an outpatient setting or post- acute brain injury (PABI) setting.
• Many clients with TBI will have long term deficits as a result of their injury, lasting long after completion of rehabilitation and possibly throughout their lifespan.

Question 33

Areas of the Occupational Therapy Practice Framework are affected with TBI

Answer 33

• All of them
• Clients have deficits in activities of daily living, including self-care, sexual function; instrumental activities of daily living including cooking, housework, yardwork, financial management; returning to work and being a productive member of society; and returning to play and leisure activities that were once interesting.

Question 34

The role of the OT with TBI may change with the…

Answer 34

Severity of the client.

Question 35

-With a severe TBI client, the OT will…

Answer 35

Evaluate and treat this client, preventing and managing any UE contractures through the use of:

• Orthotics and range of motion
• Education and training to the client and the caregiver/family
• Engaging the client in any functional activity within the client’s available range of motion
• Increasing cognitive awareness to allow for participation in occupations.

Question 36

With the moderate and mild TBI client, the OT will…

Answer 36

• Evaluate and treat this client to allow for increased independence and safety with ADLs, IADLs, returning to work/play, cognitive retraining and education with appropriate strategies, management of potential behavior issues and education/training with the client and their caregiver/family.
• Occupational therapist work with these clients to regain optimal functioning in returning to the occupations they desire to engage in again.