traumatic brain injury

Question 1

traumatic brain injury

Answer 1

an alteration in brain function, or other evidence of brain pathology, caused by an external force

Question 2

what is the leading cause of injury-related death and disability in america

Answer 2

TBI

Question 3

what is the most common cause of TBI in the elderly and children

Answer 3

Falls

Question 4

other than falls, what are two other common causes of TBI

Answer 4

1 - being struck by objects
2 - motor vehicle accident

Question 5

mechanism of injury for TBI

Answer 5

• an external force causes brain tissue to make direct contact with an object (skull or penetrating object)
• rapid acceleration or deceleration
• blast waves from explosion

Question 6

diffuse axonal injury

Answer 6

forces disrupt neurofilaments within the axon, leading to axonal degeneration

Question 7

what causes secondary injury after TBI

Answer 7

the chain of cellular events following tissue damage (accumulation of free radicals cause an increase in ICP and leads to cell death)

Question 8

glasgow coma scale

Answer 8

eyes, verbal, motor
Max - 15 pts
below 8 - coma

Question 9

name a few poor predictors of recovery from TBI

Answer 9

low initial scores on GCS, age, race, lower education, petechial hemorrhages, midline shift, subdural hematoma, subarachnoid bleed, obliteration of left ventricle

Question 10

post-traumatic amnesia

Answer 10

length of time between injury and time where patient can consistently remember events
*the longer it is, the poorer the prognosis

Question 11

name some neuromuscular impairments from TBI (5)

Answer 11

UE/LE paresis, coordination, postural control, abnormal tone, abnormal gait

Question 12

severe TBI recovery stages

Answer 12

1 - coma
2 - vegetative
3 - minimally conscious

Question 13

coma state

Answer 13

• many start here
• eyes closed, no sleep-wake cycles
• ventilator dependent
• no communication

Question 14

vegetative state

Answer 14

• brainstem manages cardiac and respiratory function, reflexive movements

Question 15

minimally conscious state

Answer 15

some evidence of awareness, reproducible/sustained behavior, can localize stimuli

Question 16

heterotopic ossification

Answer 16

excessive bone formation dur to prolonged immobility

Question 17

what are some secondary impairments of TBI

Answer 17

DVT
heterotopic ossification
pressure ulcers
pneumonia
chronic pain
atrophy
fracture
contractures
decreased endurance

Question 18

if you lose consciousness for less than ______ minutes it is a mild TBI and if its for more than ____ hours it is a severe TBI

Answer 18

30 minutes
24 hours

Question 19

if PTA is less than _____ day it is a mild TBI and if its greater than _____ days it is severe

Answer 19

1
7

Question 20

primary goals for early medical management of TBIs (5)

Answer 20

• stabilize cardiovascular/ respiratory symptoms
• prevent secondary injury
• stabilize neck
• monitor cerebral perfusion pressure and ICP
• perform initial eval

Question 21

what do you use to determine level of consciousness upon exam

Answer 21

glasgow coma scale

Question 22

5 steps to TBI exam

Answer 22

1 - chart review
2 - determine level of consciousness
3 - assess arousal, attention and cognition
4 - assess skin, sensation, motor function, ROM, reflexes, and ventilation
5 - early mobilization

Question 23

whenever there is raised ICP, you should keep the bed elevated at -_____ degrees

Answer 23

30

Question 24

elevated ICP is above ______

Answer 24

20
ideal = 10-15

Question 25

cerebral perfusion pressure should be above

Answer 25

60

Question 26

decorticate rigidity

Answer 26

UE flexed, LE extended

Question 27

decerebrate rigidity

Answer 27

UE and LE extended

Question 28

coma recovery scale - revised

Answer 28

assess patients with disordered consciousness 0-23, higher indicates better functionr

Question 29

ranchos los amigos scale of cognitive functioning

Answer 29

1 - no response 2 - generalized response 3 - localized response 4 - confused-agitated response 5 - confused-inappropriate response 6 - confused appropriate response 7 - automatic appropriate response 8 - purposeful appropriate response

Question 30

compensatory approach

Answer 30

seeks to improve functional skills by compensating for the lost ability using alternative strategies (less affected extremity)

Question 31

restorative approach

Answer 31

restore "normal" use of the affected UE

Question 32

the ______ approach is better for neuroplasticity

Answer 32

restorative *management is a balance between the two approaches

Question 33

neuroplasticity principles

Answer 33

1 - use it or lose it 2 - use it and improve it 3 - specificity 4 - repetition matters 5 - intensity matters 6 - time matters 7 - salience matters 8 - age matters 9 - transference 10 - interference

Question 34

name some things to consider when working with confused or agitated patients

Answer 34

- consistency - no carryover - model calm behavior - be flexible - safety - environment

Question 35

mild TBI (GCS, loss of consciousness, PTA)

Answer 35

GCS = 13-15 LOC = 0-30 min PTA = <24 hours

Question 36

most recover from mild TBI in ______ days

Answer 36

7-10

Question 37

common symptoms with mild TBI

Answer 37

headache nausea dizziness poor balance fatigue light/noise sensitivity vision difficulties difficulty concentrating

Question 38

return to play protocol for mild TBI

Answer 38

1 - no activity 2 - light aerobics 3 - sport-specific exercises 4 - non-contact training drills 5 - full contact practice 6 - return to play

Question 39

A mild TBI exam should be performed in what kind of environment

Answer 39

closed and quiet

Question 40

is the berg balance scale or the community balance and mobility scale higher level?

Answer 40

community balance and mobility scale ** the HiMAT is similar to this one

Question 41

this scale has 55 items and measures attention-related behavior

Answer 41

moss attention rating scale

Question 42

this scale measures for post traumatic amnesia and greater than ____ indicates PTA

Answer 42

galveston oriented and amnesia test, 76

Question 43

this measures orientation to time, place, and circumstances

Answer 43

0-log

Question 44

what does FIM measure

Answer 44

function, mobility, cognition, communication *assigns level of assistance needed

Question 45

this is more commonly used than FIM in clinical practice to measure global functioning

Answer 45

CareTool