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DPT 752 - Neurological Rehab I > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

What is the prevalence of TBI in the U.S.?

A

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.

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2
Q

What are the leading causes of TBI?

A
  • Falls (most common) cause
  • Motor vehicle accidents (MVA), which are the largest cause of TBI deaths
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3
Q

What are the primary brain damages in TBI?

A

Primary brain damage includes:

  • focal injury (contusions, lacerations, hematoma)
  • acceleration/deceleration injuries
  • diffuse axonal injury (DAI)
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4
Q

What is diffuse axonal injury (DAI)?

A
  • 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
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5
Q

What are the secondary brain damages in TBI?

A
  • Secondary brain damages result from biochemical events such as hypoxia, edema, increased intracranial pressure (ICP), hypotension, and mass release of damaging neurotransmitters.
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6
Q

What complications can arise from severe TBI?

A

Complications include:

  • gastrointestinal difficulties
  • genitourinary problems
  • respiratory problems
  • cardiovascular issues
  • deep vein thrombosis
  • pressure ulcers
  • pneumonia
  • chronic pain
  • contractures
  • decreased endurance
  • muscle atrophy
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7
Q

What is the Glasgow Coma Scale (GCS)?

A

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.
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8
Q

What is the normal intracranial pressure (ICP)?

A

Normal ICP is less than 20 mm Hg.

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9
Q

What are the common methods to measure ICP?

A
  • intraventricular catheter - help remove extra fluid
  • subarachnoid screw - just measures pressure
  • epidural sensor - sensor
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10
Q

What is Cushing’s triad?

A

Cushing’s triad is a sign of increasing ICP

  • decreased respirations
  • bradycardia
  • increase in systolic BP
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11
Q

What are the interventions for managing ICP?

head position = ?

A

Interventions include…

  • sedating medications
  • moderate head-up positioning (30° elevation)
  • surgical decompression
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12
Q

What are the key examination features for TBI?

A

Features include:

  • arousal
  • attention
  • cognition
  • skin integrity
  • sensory function
  • cranial nerve integrity
  • motor function
  • ventilation
  • posture
  • positioning
  • pain
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13
Q

What is the Rancho Los Amigos Level of Cognitive Functioning Scale?

A

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.

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14
Q

What are the interventions for RLA levels 1-3?

A

Interventions focus on preventing indirect impairments…

  • proper positioning
  • PROM
  • respiratory care
  • early transition to sitting postures
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15
Q

What are the interventions for RLA level 4?

A

RLA Levels 4: Confused-Agitated

  • Interventions include a quiet room, structured environment, simple instructions, removal of distractions, consistency, and engagement in task-specific training.
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16
Q

What are the goals for RLA levels 5-6 (Confused Inappropriate / Appropriate) ?

A

Goals include improving…

  • functional mobility
  • ADL skills
  • gait
  • balance
  • postural control
  • strength
  • endurance
  • patient and family education
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17
Q

What are the interventions for RLA levels 7-8?

A

Interventions focus on…

  • maintaining and improving performance
  • decision-making
  • coordination
  • fine motor control
  • functional tasks in real-life environments
  • community reintegration
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18
Q

What are common complications after TBI?

A

Common complications include gastrointestinal issues, genitourinary problems, respiratory difficulties, cardiovascular issues, deep vein thrombosis, pressure ulcers, and chronic pain.

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19
Q

What is the role of early mobility in TBI management?

A

Early mobility, such as upright sitting and transferring to a wheelchair, is crucial for addressing treatment goals and improving alertness.

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20
Q

What are motor learning strategies in TBI rehabilitation?

A

Strategies include:

  • distributed practice with frequent rest periods
  • random practice schedule after initial learning
  • explicit or augmented feedback
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21
Q

What is the task-oriented approach in TBI rehabilitation?

A

This approach involves principles of neuroplasticity, body-weight supported treadmill training (BWSTT), and constraint-induced movement therapy (CIMT).

22
Q

What is constraint-induced movement therapy (CIMT)?

A

CIMT promotes the use of the affected upper extremity by reducing the use of the unaffected limb, with intensive task-oriented training.

23
Q

What are the benefits of aerobic endurance training for TBI patients?

A

Benefits include reducing cardiovascular risk, improving sleep hygiene, reducing depression and fatigue, and enhancing cognitive performance.

24
Q

What is the importance of resistance training for TBI patients?

A
  • Resistance training helps in building strength and endurance.
  • Typically performed 2-3 days per week with sets of 8-12 repetitions.
25
Q

What is dual task performance in TBI rehabilitation?

A
  • Dual task performance assesses how safely and efficiently patients can ambulate while performing a secondary cognitive task.
26
Q

What is the compensatory approach in TBI rehabilitation?

A

The compensatory approach seeks to improve functional skills by compensating for the lost ability.

27
Q

What is the restorative approach in TBI rehabilitation?

A

The restorative approach seeks to restore the normal use of the affected upper extremity.

28
Q

What are important safety considerations in TBI rehabilitation?

A

Safety considerations include minimizing use of restraints, handling combativeness, and ensuring a safe environment.

29
Q

How can memory cues assist TBI patients?

A

Memory cues such as photos, memory journals, and associations help TBI patients improve recall and orientation.

30
Q

What are common outcome measures for TBI rehabilitation?

A

Outcome measures include:

  • Berg Balance Scale (BBS)
  • High-Level Mobility Assessment (HiMAT)
  • Functional Independence Measure (FIM)
  • Various gait assessments
31
Q

What is heterotopic ossification (HO) in TBI patients?

A

HO involves bone formation outside normal skeletal locations, commonly affecting the hip and elbow.

32
Q

What is the role of the interdisciplinary team in TBI rehabilitation?

A

The team approach involves comprehensive care with a continuum of services, including physicians, PT, OT, SLP, rehab nurses, case managers, and social workers.

33
Q

What is the goal of early medical management in TBI?

A

Early medical management aims to stabilize cardiovascular and respiratory systems, minimize secondary brain injury, and continuously monitor the patient.

34
Q

What are the primary goals of early mobility in TBI patients?

A

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.

35
Q

What are the principles of neuroplasticity in TBI rehabilitation?

A

Neuroplasticity principles involve the brain’s ability to reorganize and adapt, which is leveraged in rehabilitation techniques such as BWSTT and CIMT.

36
Q

What is body-weight supported treadmill training (BWSTT)?

A

BWSTT is a rehabilitation technique that supports partial body weight to improve walking ability in TBI patients.

37
Q

What are the key features of an effective task-oriented approach?

A

Effective task-oriented approaches involve specific, repetitive tasks that challenge the patient’s abilities, enhancing neuroplasticity and functional recovery.

38
Q

What are common triggers for seizures in TBI patients?

A

Triggers include:

  • stress
  • poor nutrition
  • electrolyte imbalances
  • missed medications
  • drug use
  • flickering lights
  • infection
  • fever
  • worry
  • fear
39
Q

What are the common medications for seizure management in TBI patients?

A

Common medications include Phenytoin (Dilantin) and Phenobarbital (Luminal).

40
Q

What are the steps to take during a seizure?

A
  • turn the person onto their side
  • remove hard objects
  • loosen tight clothing
  • never force anything into the mouth
  • ask onlookers to leave
41
Q

What are the key elements to monitor in the examination of an unconscious TBI patient ?

A

Monitor:

  • arousal
  • mental status
  • visual and auditory responses
  • pupillary response
  • cranial nerves
  • motor system
  • sensory system

  • use the Glasgow Coma Scale
42
Q

What is the importance of family and caregiver education in TBI rehabilitation?

A

Educating family and caregivers is crucial for providing ongoing support, understanding recovery stages, and assisting with daily activities and rehabilitation exercises.

43
Q

What are the signs of increasing intracranial pressure (ICP)?

A

Signs include Cushing’s triad: decreased respirations, bradycardia, and widening pulse pressure, indicating a medical emergency.

44
Q

.

A
45
Q

What are common secondary impairments in TBI patients?

A

Secondary impairments include

  • contractures
  • decubitus ulcers
  • pneumonia
  • deep vein thrombosis
  • chronic pain
46
Q

How is a craniectomy different from a craniotomy?

A
  • craniectomy involves removing a piece of the skull that might not be put back immediately
  • craniotomy involves removing and immediately replacing the skull piece.
47
Q

What are common complications seen in TBI?

A

Common complications include gastrointestinal, genitourinary, respiratory, cardiovascular, dermatological issues, deep vein thrombosis, pressure ulcers, pneumonia, and chronic pain.

48
Q

Mild TBI

A
  • Loss of consciousness:
  • Alteration of consciousness:
  • Post-traumatic amnesia:
  • Glasgow Coma scale:
49
Q

Moderate TBI

A
  • Loss of consciousness:
  • Alteration of consciousness:
  • Post-traumatic amnesia:
  • Glasgow Coma scale:
50
Q

Severe TBI

A
  • Loss of consciousness:
  • Alteration of consciousness:
  • Post-traumatic amnesia:
  • Glasgow Coma scale:

DPT 752 - Neurological Rehab I (22 decks)

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