Traumatic Brain Injury Flashcards
CHART
Glascow Coma Scale (GCS) Score: Mild TBI
13 -15
Glascow Coma Scale (GCS) Score: Moderate TBI
9 - 12
Glascow Coma Scale (GCS) Score: Severe TBI
3 - 8
What measure may be a stronger predictor of FIM scores at discharge?
Post Traumatic Amnesia (PTA)
What is decorticate rigidity?
Upper extremities are flexed and the lower extremities are extended.
What is decerebrate rigidity?
Both upper and lower extremities are extended.
What is an appropriate and important intervention to implement early?
Early (assisted) mobilization.
What secondary impairments are possible due to TBI?
Secondary Impairments:
- Contractures
- Decubitus Ulcers
- Pneumonia
- DVT
All things that are due to being sedentary.
How often should big position changes in bed be made?
Every 2 hours
Intervention: Sensory stimulation
Multisensory stimulation, provided in a highly structured and consistent manner.
Close patient monitoring required to determine their response.
Family Education: What is important to teach family members?
- Differences between reflexive and purposeful movements.
- How to perform ROM exercise and how to position the patient.
Special Considerations for Confused and Agitated Patients: Consistency
- Address inappropriate behaviors in a consistent manner. (includes all team members, family)
- Patient be seen by same person, same time, same location (every day)
- Daily Routine
Special Considerations for Confused and Agitated Patients: Expect no carryover
Patient may have no recall of the previous day’s performance.
Walking or brushing teeth does not indicate general leaning as these are automatic skills.
Special Considerations for Confused and Agitated Patients: Model Calm Behavior
Assume calm and focused affect
Special Considerations for Confused and Agitated Patients: Flexibility/Giving Patient Options
- Have many activities prepared. (back up options)
- Give control to patient when safe and appropriate: give options such as “would you like to walk or play with the ball”, do not say “what would you like to do”. (provide safe choices)
Special Considerations for Confused and Agitated Patients: Environment
Initially use a closed environment with limited distractions.
Gradually progress to more open environments.
What is Coup-Contrecoup Injury
Coup: Injury at point of contact
Contrecoup: Opposite point of impact
Examples of Primary Brain Damage?
Axonal Injury
Focal Injury; contusions, lacerations.
Close or Open Injury
Coup-Contrecoup Injury
Examples of Secondary Brain Damage
Hypoxic-Ischemic Injury
Swelling/edema; increase ICP
Electrolyte Imbalance
For a Rancho Level IV patient, what environment is the most beneficial?
Quiet and safe environment with minimal distractions.
