Traumatic Brain Injury

Question 1

CHART

Answer 1

Question 2

Glascow Coma Scale (GCS) Score: Mild TBI

Answer 2

13 -15

Question 3

Glascow Coma Scale (GCS) Score: Moderate TBI

Answer 3

9 - 12

Question 4

Glascow Coma Scale (GCS) Score: Severe TBI

Answer 4

3 - 8

Question 5

What measure may be a stronger predictor of FIM scores at discharge?

Answer 5

Post Traumatic Amnesia (PTA)

Question 6

What is decorticate rigidity?

Answer 6

Upper extremities are flexed and the lower extremities are extended.

Question 7

What is decerebrate rigidity?

Answer 7

Both upper and lower extremities are extended.

Question 8

What is an appropriate and important intervention to implement early?

Answer 8

Early (assisted) mobilization.

Question 9

What secondary impairments are possible due to TBI?

Answer 9

Secondary Impairments:
- Contractures
- Decubitus Ulcers
- Pneumonia
- DVT

All things that are due to being sedentary.

Question 10

How often should big position changes in bed be made?

Answer 10

Every 2 hours

Question 11

Intervention: Sensory stimulation

Answer 11

Multisensory stimulation, provided in a highly structured and consistent manner.

Close patient monitoring required to determine their response.

Question 12

Family Education: What is important to teach family members?

Answer 12

• Differences between reflexive and purposeful movements.
• How to perform ROM exercise and how to position the patient.

Question 13

Special Considerations for Confused and Agitated Patients: Consistency

Answer 13

• 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

Question 14

Special Considerations for Confused and Agitated Patients: Expect no carryover

Answer 14

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.

Question 15

Special Considerations for Confused and Agitated Patients: Model Calm Behavior

Answer 15

Assume calm and focused affect

Question 16

Special Considerations for Confused and Agitated Patients: Flexibility/Giving Patient Options

Answer 16

• 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)

Question 17

Special Considerations for Confused and Agitated Patients: Environment

Answer 17

Initially use a closed environment with limited distractions.

Gradually progress to more open environments.

Question 18

What is Coup-Contrecoup Injury

Answer 18

Coup: Injury at point of contact
Contrecoup: Opposite point of impact

Question 19

Examples of Primary Brain Damage?

Answer 19

Axonal Injury

Focal Injury; contusions, lacerations.

Close or Open Injury

Coup-Contrecoup Injury

Question 20

Examples of Secondary Brain Damage

Answer 20

Hypoxic-Ischemic Injury

Swelling/edema; increase ICP

Electrolyte Imbalance

Question 21

For a Rancho Level IV patient, what environment is the most beneficial?

Answer 21

Quiet and safe environment with minimal distractions.