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.
What is dual task performance in TBI rehabilitation?
- Dual task performance assesses how safely and efficiently patients can ambulate while performing a secondary cognitive task.
What is the compensatory approach in TBI rehabilitation?
The compensatory approach seeks to improve functional skills by compensating for the lost ability.
What is the restorative approach in TBI rehabilitation?
The restorative approach seeks to restore the normal use of the affected upper extremity.
What are important safety considerations in TBI rehabilitation?
Safety considerations include minimizing use of restraints, handling combativeness, and ensuring a safe environment.
How can memory cues assist TBI patients?
Memory cues such as photos, memory journals, and associations help TBI patients improve recall and orientation.
What are common outcome measures for TBI rehabilitation?
Outcome measures include:
- Berg Balance Scale (BBS)
- High-Level Mobility Assessment (HiMAT)
- Functional Independence Measure (FIM)
- Various gait assessments
What is heterotopic ossification (HO) in TBI patients?
HO involves bone formation outside normal skeletal locations, commonly affecting the hip and elbow.
What is the role of the interdisciplinary team in TBI rehabilitation?
The team approach involves comprehensive care with a continuum of services, including physicians, PT, OT, SLP, rehab nurses, case managers, and social workers.
What is the goal of early medical management in TBI?
Early medical management aims to stabilize cardiovascular and respiratory systems, minimize secondary brain injury, and continuously monitor the patient.
What are the primary goals of early mobility in TBI patients?
Early mobility aims to transfer patients to a sitting position and out of bed to a wheelchair as soon as medically stable to improve alertness and recovery.
What are the principles of neuroplasticity in TBI rehabilitation?
Neuroplasticity principles involve the brain’s ability to reorganize and adapt, which is leveraged in rehabilitation techniques such as BWSTT and CIMT.
What is body-weight supported treadmill training (BWSTT)?
BWSTT is a rehabilitation technique that supports partial body weight to improve walking ability in TBI patients.
What are the key features of an effective task-oriented approach?
Effective task-oriented approaches involve specific, repetitive tasks that challenge the patient’s abilities, enhancing neuroplasticity and functional recovery.
What are common triggers for seizures in TBI patients?
Triggers include:
- stress
- poor nutrition
- electrolyte imbalances
- missed medications
- drug use
- flickering lights
- infection
- fever
- worry
- fear
What are the common medications for seizure management in TBI patients?
Common medications include Phenytoin (Dilantin) and Phenobarbital (Luminal).
What are the steps to take during a seizure?
- turn the person onto their side
- remove hard objects
- loosen tight clothing
- never force anything into the mouth
- ask onlookers to leave
What are the key elements to monitor in the examination of an unconscious TBI patient ?
Monitor:
- arousal
- mental status
- visual and auditory responses
- pupillary response
- cranial nerves
- motor system
- sensory system
- use the Glasgow Coma Scale
What is the importance of family and caregiver education in TBI rehabilitation?
Educating family and caregivers is crucial for providing ongoing support, understanding recovery stages, and assisting with daily activities and rehabilitation exercises.
What are the signs of increasing intracranial pressure (ICP)?
Signs include Cushing’s triad: decreased respirations, bradycardia, and widening pulse pressure, indicating a medical emergency.
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What are common secondary impairments in TBI patients?
Secondary impairments include
- contractures
- decubitus ulcers
- pneumonia
- deep vein thrombosis
- chronic pain
How is a craniectomy different from a craniotomy?
- craniectomy involves removing a piece of the skull that might not be put back immediately
- craniotomy involves removing and immediately replacing the skull piece.
What are common complications seen in TBI?
Common complications include gastrointestinal, genitourinary, respiratory, cardiovascular, dermatological issues, deep vein thrombosis, pressure ulcers, pneumonia, and chronic pain.
Mild TBI
- Loss of consciousness:
- Alteration of consciousness:
- Post-traumatic amnesia:
- Glasgow Coma scale:
Moderate TBI
- Loss of consciousness:
- Alteration of consciousness:
- Post-traumatic amnesia:
- Glasgow Coma scale:
Severe TBI
- Loss of consciousness:
- Alteration of consciousness:
- Post-traumatic amnesia:
- Glasgow Coma scale:
