Traumatic Brain Injury

Question 1

Primary and secondary injuries

Answer 1

Primary- immediate trauma to brain parenchyma at moment of insult injury
Secondary- results after primary injurt; hypoxia/ischemia, edema, and increased ICP.

Question 2

MOIs

Answer 2

Contact (open vs closed injury)
Acceleration- Deceleration (compression, tension, shearing)
Rotation (angular acceleration).

Question 3

4 different pathophysiologies

Answer 3

Focal
Diffuse axonal
Hypoxia-ischemic
Increased ICP

Question 4

ICP- normal and elevated levels

Answer 4

normal- 5-20 cm H20
elevated- >20
severe- >25 (usually means brain herniation)

Question 5

Signs of elevated ICP

Answer 5

decreased conciousness
altered vital signs
widened pulse pressure
irregular (cheyne-stokes) breathing
vomiting
headache
non-reacting pupils (CN 3)
papilledema (optic disc or nerve swelling)
progressive impairment of motor function
seizure activity

Question 6

Treatments of elevated ICP

Answer 6

Elevate head of bed 30 degs- works immediately

Question 7

Neuromuscular Impairments

Answer 7

Impairments similar to stroke
UMN injury

Question 8

Cognitive impairments

Answer 8

arousal levels
attention
concentration
memory
learning
executive functions

Question 9

Arousal levels (different states)

Answer 9

coma
vegetative state
minimally conscious state

Question 10

Other terms to describe consciousness

Answer 10

Stupor- almost unresponsive state
Obtunded- decreased alertness. Sleeps often

Question 11

Memory impairments

Answer 11

Anomia
Anterograde amnesia
Retrograde amnesia
Post-traumatic amnesia

Question 12

Neurobehavioral impairments

Answer 12

agititaiton, apathy, emotional liability, mental inflexibility, disinhibition, anxiety, aggression, poor self image, sexual apathy etc

Question 13

Communication impairments

Answer 13

aphasia, auditory processing deficits, disorganized communication

Question 14

Swallowing Impairments

Answer 14

Dysphagia common

Question 15

Dysautonomia

Answer 15

increased SNS activity following TBI
Increased HR, RR, BP. diaphoresis and hyperthermia

Question 16

Visio-perceptual impairments

Answer 16

damage to occipital lobe can result in visual impairments
perceptual impairments: apraxia, spatial neglect, somatagnosis

Question 17

Post-traumatic seizures

Answer 17

less than half of people with severe TBI develop post-traumatic seizures

Question 18

Heterotopic ossifications

Answer 18

boney growth in muscle after injury. Common in proximal body parts

Question 19

Examinations- key areas

Answer 19

arousal, attention and cognition
integumentary integrity
sensory integrity
motor function
ROM
reflexes
ventilation and respiration

Question 20

Glasgow Coma Scale- uses

Answer 20

measures level of conciousness
helps to determine severity of injury and track progress

Question 21

GCS- scoring (severe, moderate, mild)

Answer 21

total score will be from 3-15
severe: <8
moderate: 9-12
mild: >13

Question 22

The three parts of GCS

Answer 22

Eye opening
Motor response
Verbal response

Question 23

The moderate level of TBI:
GCS scale
loss of conciousness
altered consciousness
post-traumatic amnesia
neuroimaging

Answer 23

GCS scale; 9-12
loss of conciousness; >30 mins and <24hrs
altered consciousness; >24hrs
post-traumatic amnesia; >1 day and <7 days
neuroimaging; normal or abnormal

*mild and severe can be interpretted from these values

Question 24

LOCF

Answer 24

Rancho Los Amigos Levels of Cognitive Functioning
descriptive scale used to track cognitive and behavioural recovery as patient emerges from a coma

Question 25

GOAT- Galveston Orientation and Amnesia Test

Answer 25

questions include name, city, recall of how patient is, where he or she is, day, date, month, year, and event of injury
helps determining outcome or prognosis

Question 26

Predictors of poor outcomes

Answer 26

low initial GCS score
lower education level
very young (<7 yrs old) or older (>40 yrs)
longer periords of post-traumatic amnesia
- <34 days likely to have a good overall recovery

Question 27

PT interventions for TBI

Answer 27

primary goal is to prevent secondary implications (due to prolonged immobility)
patient and family education

Question 28

Special considerations for confused and agitated patients

Answer 28

Consistency
Expect no carryover
Model calm behavior
Expect egocentricity
Flexibility/ Options
Safety