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Adult Neuro One > traumatic brain injury > Flashcards

traumatic brain injury Flashcards

1
Q

traumatic brain injury

A

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

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2
Q

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

A

TBI

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3
Q

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

A

Falls

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4
Q

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

A

1 - being struck by objects
2 - motor vehicle accident

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5
Q

mechanism of injury for TBI

A
  • 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
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6
Q

diffuse axonal injury

A

forces disrupt neurofilaments within the axon, leading to axonal degeneration

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7
Q

what causes secondary injury after TBI

A

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

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8
Q

glasgow coma scale

A

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

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9
Q

name a few poor predictors of recovery from TBI

A

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

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10
Q

post-traumatic amnesia

A

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

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11
Q

name some neuromuscular impairments from TBI (5)

A

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

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12
Q

severe TBI recovery stages

A

1 - coma
2 - vegetative
3 - minimally conscious

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13
Q

coma state

A
  • many start here
  • eyes closed, no sleep-wake cycles
  • ventilator dependent
  • no communication
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14
Q

vegetative state

A
  • brainstem manages cardiac and respiratory function, reflexive movements
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15
Q

minimally conscious state

A

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

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16
Q

heterotopic ossification

A

excessive bone formation dur to prolonged immobility

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17
Q

what are some secondary impairments of TBI

A

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

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18
Q

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

A

30 minutes
24 hours

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19
Q

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

A

1
7

20
Q

primary goals for early medical management of TBIs (5)

A
  • stabilize cardiovascular/ respiratory symptoms
  • prevent secondary injury
  • stabilize neck
  • monitor cerebral perfusion pressure and ICP
  • perform initial eval
21
Q

what do you use to determine level of consciousness upon exam

A

glasgow coma scale

22
Q

5 steps to TBI exam

A

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

23
Q

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

A

30

24
Q

elevated ICP is above ______

A

20
ideal = 10-15

25
Q

cerebral perfusion pressure should be above

A

60

26
Q

decorticate rigidity

A

UE flexed, LE extended

27
Q

decerebrate rigidity

A

UE and LE extended

28
Q

coma recovery scale - revised

A

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

29
Q

ranchos los amigos scale of cognitive functioning

A

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

30
Q

compensatory approach

A

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

31
Q

restorative approach

A

restore “normal” use of the affected UE

32
Q

the ______ approach is better for neuroplasticity

A

restorative
*management is a balance between the two approaches

33
Q

neuroplasticity principles

A

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

34
Q

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

A
  • consistency
  • no carryover
  • model calm behavior
  • be flexible
  • safety
  • environment
35
Q

mild TBI (GCS, loss of consciousness, PTA)

A

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

36
Q

most recover from mild TBI in ______ days

A

7-10

37
Q

common symptoms with mild TBI

A

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

38
Q

return to play protocol for mild TBI

A

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

39
Q

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

A

closed and quiet

40
Q

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

A

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

41
Q

this scale has 55 items and measures attention-related behavior

A

moss attention rating scale

42
Q

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

A

galveston oriented and amnesia
test, 76

43
Q

this measures orientation to time, place, and circumstances

A

0-log

44
Q

what does FIM measure

A

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

45
Q

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

A

CareTool

Adult Neuro One (10 decks)

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