Traumatic Brain Injury Flashcards
What is the prevalence of TBI in the U.S.?
TBI is the leading cause of injury-related death and disability, with 50,000 deaths per year and 1.7 to 2.8 million emergency department visits.
What are the leading causes of TBI?
- Falls (most common) cause
- Motor vehicle accidents (MVA), which are the largest cause of TBI deaths
What are the primary brain damages in TBI?
Primary brain damage includes:
- focal injury (contusions, lacerations, hematoma)
- acceleration/deceleration injuries
- diffuse axonal injury (DAI)
What is diffuse axonal injury (DAI)?
- DAI involves disruption and tearing of axons and small blood vessels from shear-strain of angular acceleration, leading to neuronal death and possible hemorrhage.
- Coup-Contrecoup injury
What are the secondary brain damages in TBI?
- Secondary brain damages result from biochemical events such as hypoxia, edema, increased intracranial pressure (ICP), hypotension, and mass release of damaging neurotransmitters.
What complications can arise from severe TBI?
Complications include:
- gastrointestinal difficulties
- genitourinary problems
- respiratory problems
- cardiovascular issues
- deep vein thrombosis
- pressure ulcers
- pneumonia
- chronic pain
- contractures
- decreased endurance
- muscle atrophy
What is the Glasgow Coma Scale (GCS)?
The GCS is a tool used to categorize TBI as severe, moderate, or mild based on a score between 3-15
- Predicting initial mortality, NOT subsequent function.
What is the normal intracranial pressure (ICP)?
Normal ICP is less than 20 mm Hg.
What are the common methods to measure ICP?
- intraventricular catheter - help remove extra fluid
- subarachnoid screw - just measures pressure
- epidural sensor - sensor
What is Cushing’s triad?
Cushing’s triad is a sign of increasing ICP
- decreased respirations
- bradycardia
- increase in systolic BP
What are the interventions for managing ICP?
head position = ?
Interventions include…
- sedating medications
- moderate head-up positioning (30° elevation)
- surgical decompression
What are the key examination features for TBI?
Features include:
- arousal
- attention
- cognition
- skin integrity
- sensory function
- cranial nerve integrity
- motor function
- ventilation
- posture
- positioning
- pain
What is the Rancho Los Amigos Level of Cognitive Functioning Scale?
It is a scale to examine cognitive and behavioral recovery in individuals with TBI as they emerge from coma, with 10 categories defining typical cognitive and behavioral progress.
What are the interventions for RLA levels 1-3?
Interventions focus on preventing indirect impairments…
- proper positioning
- PROM
- respiratory care
- early transition to sitting postures
What are the interventions for RLA level 4?
RLA Levels 4: Confused-Agitated
- Interventions include a quiet room, structured environment, simple instructions, removal of distractions, consistency, and engagement in task-specific training.
What are the goals for RLA levels 5-6 (Confused Inappropriate / Appropriate) ?
Goals include improving…
- functional mobility
- ADL skills
- gait
- balance
- postural control
- strength
- endurance
- patient and family education
What are the interventions for RLA levels 7-8?
Interventions focus on…
- maintaining and improving performance
- decision-making
- coordination
- fine motor control
- functional tasks in real-life environments
- community reintegration
What are common complications after TBI?
Common complications include gastrointestinal issues, genitourinary problems, respiratory difficulties, cardiovascular issues, deep vein thrombosis, pressure ulcers, and chronic pain.
What is the role of early mobility in TBI management?
Early mobility, such as upright sitting and transferring to a wheelchair, is crucial for addressing treatment goals and improving alertness.
What are motor learning strategies in TBI rehabilitation?
Strategies include:
- distributed practice with frequent rest periods
- random practice schedule after initial learning
- explicit or augmented feedback
What is the task-oriented approach in TBI rehabilitation?
This approach involves principles of neuroplasticity, body-weight supported treadmill training (BWSTT), and constraint-induced movement therapy (CIMT).
What is constraint-induced movement therapy (CIMT)?
CIMT promotes the use of the affected upper extremity by reducing the use of the unaffected limb, with intensive task-oriented training.
What are the benefits of aerobic endurance training for TBI patients?
Benefits include reducing cardiovascular risk, improving sleep hygiene, reducing depression and fatigue, and enhancing cognitive performance.
What is the importance of resistance training for TBI patients?
- Resistance training helps in building strength and endurance.
- Typically performed 2-3 days per week with sets of 8-12 repetitions.
