Traumatic Brain Injury Flashcards
Primary and secondary injuries
Primary- immediate trauma to brain parenchyma at moment of insult injury
Secondary- results after primary injurt; hypoxia/ischemia, edema, and increased ICP.
MOIs
Contact (open vs closed injury)
Acceleration- Deceleration (compression, tension, shearing)
Rotation (angular acceleration).
4 different pathophysiologies
Focal
Diffuse axonal
Hypoxia-ischemic
Increased ICP
ICP- normal and elevated levels
normal- 5-20 cm H20
elevated- >20
severe- >25 (usually means brain herniation)
Signs of elevated ICP
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
Treatments of elevated ICP
Elevate head of bed 30 degs- works immediately
Neuromuscular Impairments
Impairments similar to stroke
UMN injury
Cognitive impairments
arousal levels
attention
concentration
memory
learning
executive functions
Arousal levels (different states)
coma
vegetative state
minimally conscious state
Other terms to describe consciousness
Stupor- almost unresponsive state
Obtunded- decreased alertness. Sleeps often
Memory impairments
Anomia
Anterograde amnesia
Retrograde amnesia
Post-traumatic amnesia
Neurobehavioral impairments
agititaiton, apathy, emotional liability, mental inflexibility, disinhibition, anxiety, aggression, poor self image, sexual apathy etc
Communication impairments
aphasia, auditory processing deficits, disorganized communication
Swallowing Impairments
Dysphagia common
Dysautonomia
increased SNS activity following TBI
Increased HR, RR, BP. diaphoresis and hyperthermia
Visio-perceptual impairments
damage to occipital lobe can result in visual impairments
perceptual impairments: apraxia, spatial neglect, somatagnosis
Post-traumatic seizures
less than half of people with severe TBI develop post-traumatic seizures
Heterotopic ossifications
boney growth in muscle after injury. Common in proximal body parts
Examinations- key areas
arousal, attention and cognition
integumentary integrity
sensory integrity
motor function
ROM
reflexes
ventilation and respiration
Glasgow Coma Scale- uses
measures level of conciousness
helps to determine severity of injury and track progress
GCS- scoring (severe, moderate, mild)
total score will be from 3-15
severe: <8
moderate: 9-12
mild: >13
The three parts of GCS
Eye opening
Motor response
Verbal response
The moderate level of TBI:
GCS scale
loss of conciousness
altered consciousness
post-traumatic amnesia
neuroimaging
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
LOCF
Rancho Los Amigos Levels of Cognitive Functioning
descriptive scale used to track cognitive and behavioural recovery as patient emerges from a coma
GOAT- Galveston Orientation and Amnesia Test
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
Predictors of poor outcomes
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
PT interventions for TBI
primary goal is to prevent secondary implications (due to prolonged immobility)
patient and family education
Special considerations for confused and agitated patients
Consistency
Expect no carryover
Model calm behavior
Expect egocentricity
Flexibility/ Options
Safety
