Traumatic Brain Injury Flashcards
Alteration of brain function caused by exterior force
TBI
What gender is dominant in obtaining TBI?
Male> Female
What are the following accidents that causes TBI?
- Falls
- MVA
- Assaults
- Sports
What is the common accident in TBI?
Falls
An injury that happens when a moving force hits the head
Acceleration Injury
An injury that happens when moving head meets stationary object
Deceleration Injury
An injury that happens when the injury of the brain is on the site of impact
Coup Injury
An injury that happens when an injury of the brain is on the opposite site of the impact
Counter-coup Injury
Shearing of subcortical axons within the myelin sheath
Diffuse Axonal Injury (DAI)
(+) mechanical strain that leads to Wallerian Degeneration
DAI
A nerve lesion that has a retrograde degeneration of distal end of axon
Wallerian Degeneration
Usually caused by high velocity acceleration/deceleration forces
DAI
What is the other name for Cerebral COntusions
Cotrical Bruises
it results from a low velocity impacts
Cerebral Contusions
What type of injury are commonly associated with Cerebral Contusions?
Coup and Counter-coup Injury
What are the site affected when the pt. had Cerebral Contusions?
(FITA)
inferior frontal
anterior temporal
A secondary brain injury that happen due to decreased oxygen and blood supply to the brain, tissue undergoes death and infraction
Hypoxic-Ischemic Injury
What are the causes of Hypoxic-Ischemic Injury?
(SAD)
- Systemic Hypotension
- Anoxia
- Damage to vascular territories
If the ICP level of the pt. increases, what will happen?
- Normal Pressure Hydrocephalus
- brain Herniations
- Papilledema
Also known as bulging of the eyes
Papilledema
What are the Hakim’s Triad?
(Brady-Brady-Hyper)
- Bradycardia
- Bradypnea
- Hypertension
A secondary brain injury that one of its signs is (+) Cushing Sign
Increased Intracranial Pressure
What structure is affected during Uncal Herniation?
Uncus of the temporal lobe, white matter
What are the affected structures in Uncal herniation?
(CROP)
- C- Cerebral Penducle
- R- Reticular Activating System
- O- Optic Nerve
- P- PCA
Herniation that affects the Diencephalon / part of temporal lobe
Central Herniation
What are the affected structures in Central Herniation?
(PMR)
- PM- Pons and Midbrain
- R- RAS
Herniation that is (+) for decerebrate posture
Central Herniation
Adult form of hydrocephalus
Normal Pressure Hydrocephalus
Normal Pressure Hydrocephalus is a _________ type of reabsorption of CSF in the arachnoid villi
Communicating
What are the TRIAD of NPH?
(DIG)
- D- Dementia
- I- Incontinence
- G- Gait Ataxia
What is the management for NPH?
Ventriculoperitoneal (VP) Shunt
What are the normal manifestations of TBI?
(PAMP)
- P- Paresis
- A- Abnormal Tone
- M- Motor Function
- P- Postural Control
What are the different cognitive impairments of TBI?
- Consciousness
- Attention
- Concentration
- Executive Function
- Memory
- Learning
(-) sleep-wake cycle
Ventilator Dependent
Comatose
(+) sleep-wake cycle
(-) ventilatory support
(-) environmental awareness
Vegetative State
Describe the characteristics of pt. in minimally conscious-state
Minimal evidence of environmental awareness
Describe the characteristics of pt who is in stupor condition.
Pt can be aroused only briefly with vigorous, repeatedly sensory stimulation
Describe the characteristic of pt that is obtunded
- Pt sleeps often
* when aroused, shows decreased alertness & interest in the environment
Enumerate the different impairments of pt. with TBI
(AIMADE) A- Agitation/Aggression I- Irritability M- Mental Inflexibility A- Apathy D- Disinhibition/impulsivity E- Emotional Lability
Enumerate the different s/sx of dysautomania
(IHDHDT) * increased BP, PR, RR (v/s) * Hyperthermia * Diaphoresis * Hypertonia *Decorticate/ Decerebrate posturing Teeth Grinding
What is the Mx that pt c post-traumatic seizure take?
Anticonvulsant drugs (phenyltoin)
Length of time between the injury and time at which the patient is able to consistently remember on going events
Post-traumatic Amnesia
Post-traumatic Amnesia is measured by?
- Galveston Orientation Amnesia Test (GOAT)
* Orientation Log Test
What are other manifestations of TBI?
- Pressure Ulcers
- DVT
- Heterotopic Ossification
- fracture
- Muscle Atrophy
- Contractures
- Pneumonia
What is the commonly used diagnostic tool used for TBI?
CT-scan
Enumerate or write the grading for severity of TBI
Enumerate or write the table of responses in Glasgow Coma Scale
Enumerate or write the Glasgow Outcome Scale Extended
- pt appears to be in deep sleep
unresponsive to any stimuli
RLA
I. No respone
- Responses may be physiological changes or in nature
- Gross body movement and/or vocalizations
- Responses are not related to the type of stimulus presented
RLA
II. Generalized Response
- Pt is in heightened state of activity
- Behavior is bizarre and non-purposeful
- Pt. lacks short and long-term recall
IV. Confused Agitated
- Responses are directly related to the type of stimulus presented
- May follow simple commans in an inconsistent and delayed manner
RLA
III. Localized Response
- Pt. is able to respond to simple command fairly consistently
- Memory is severely impaired
- Unable to learn new Info
RLA
V. Confused Inappropriate
- Pt. shows goal directed behavior
- May follow simple directions
- There is a carry over re-learned tasks such as self-care activities
RLA
VI. Confused Appropriate
- Learning at a decreased rateJudgement remains impaired
- Robot-like behavior
- May initiate social/recreational activities
RLA
VII.Automatic Appropriate
- There is environmental awareness
- (+) learning without supervision
RLA
VIII> Purposeful Appropriate
the center of the team
Patient et Family
overseeing the care of the patient with a brain injury
Physician
- Examines, evaluates, and treats communication, swallowing and cognitive impairments
- With their guidance, the team will be able to devise the most effective and consistent way to communicate with the patient
- will also be able to instruct the team in how the patient’s cognitive impairments may impede new learning
Speech-Language Therapist
Examines, evaluates, and treats the patient’s diminished ability to perform ADL
Occupational Therapist
Responsible for dispensing medications and closely monitoring their effects will initiate a bowel and bladder retraining program to assist the patient in learning to become continent again
Rehab Nursing
- Often a nurse, social worker, or other health professional
- Will direct team meetings, schedule family conferences, and act as a liaison with third-party payers
Case Manager/ Team Coordinator
Provides much needed support to both the patient and family
Social Worker
- Will often perform neuropsychological testing when appropriate to determine the patient’s base-line cognitive functioning
- will also assist the team in developing a behavioral management program
Neuropsychiatrist
Failure to drive specific brain function can lead to functional degradation
Use it or lose it
Training that drives a specific brain function can lead to an enhancement of that functions
Use it to Improve it
the nature of the training experience dictates the nature of the plasticity
Specificity
Induction of plasticity requires sufficient repetition
Repetition Matters
Induction of plasticity requires sufficient training intensity
- increase difficulty
Intensity Matters
Different form of plasticity occur at different times during training
Time Matters
The training experience must be sufficiently salient to induce plasticity
- the training should be meaningful to the patient’s condition
Salience Matters
Training-induced plasticity occurs more readily in younger brains
Age Matters
Plasticity in response to one training experience can enhance the acquisition of similar behaviors
- one training can enhance the other
Transference
Plasticity in response to one experience can interfere with the acquisition of other behaviors
Interference
