Traumatic brain injury Flashcards
what age range has the highest frequency of admissions for TBI
over 65
older adults more often sustain TBI from falls and have more severe cognitive and functional impairments and might be at greater risk for post-recovery functional decline.
define TBI
brain trauma with specific characteristics that include at least one of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, or, in more severe cases, neurological signs (e.g., positive neuroimaging, a new onset of seizures or a marked worsening of a pre-existing seizure disorder, visual field cuts, anosmia, hemiparesis). To be attributable to TBI, a neurocognitive disorder must present either immediately after the injury or immediately after the individual recovers consciousness after the injury and persist past the acute post-injury period. The cognitive presentation is variable. Difficulties in the domains of complex attention, executive ability, learning, and memory are common as well as slowing in speed of information processing and disturbances in social cognition. In more severe TBI in which there is brain contusion, intracranial haemorrhage, or penetrating injury, there may be additional neurocognitive deficits, such as aphasia, neglect, and constructional dyspraxia.
how is the severity of a TBI scored
The GCS remains the main instrument for classifying the severity of TBI as;
mild (GCS 13–15)
moderate (GCS 9–12)
severe (GCS ≤8)
biomarkers for TBI
Glial Fibrillary Acidic Protein (GFAP)
Ubiquitin Carboxy-terminal Hydrolase L1 (UCH-L1)
GFAP on its own has emerged as an excellent brain injury biomarker for prediction of CT positivity, and MRI positivity in CT-negative individuals.
When compared with more severe TBI, biomarkers were less predictive of outcomes in mild TBI and of incomplete recovery overall.
Beyond the acute phase, NfL values correlate with (and predict) accelerated brain volume loss, functional trajectories, and cognitive performance for months to years after TBI.
what is apathy
A lack of motivation, interest, or emotional response. It often manifests as indifference to activities or outcomes, without necessarily feeling sad or distressed.
Emotional neutrality or blunted emotions.
The person may not feel sadness or distress but rather a lack of emotional engagement.
Impaired initiation and reduced goal-directed behaviour. The individual may not care enough to act but does not necessarily feel cognitively impaired.
what is depression
A mood disorder characterized by persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in most activities. It often includes emotional, cognitive, and physical symptoms.
Strong negative emotions, including sadness, guilt, and despair.
Cognitive difficulties such as indecision, concentration problems, and pervasive negative thought patterns.
how do you assess a TBI
how do you initiate treatment of TBI
how should you follow up a TBI
what are examples of some skill based TBI treatments
cognitive behavioural therapy
behavioural activation
problem solving therapy
mindful based stress reduction
acceptance and commitment therapy
prolonged exposure therapy
anger self msnsgement therapy
how should you communicate with a TBI treatment
One person speaks at a time
Slow down speech (without infantilizing person); use clear precise language Use rephrasing and repetition
Ask patient to repeat to ensure comprehension Address patient at or below his/her eye level
Caregivers use basic behaviour support techniques
Maintain routine, minimize sudden changes, warn patient of necessary changes
Discover and prevent triggers for problematic behaviour Reinforce prosocial behaviour with attention, appreciation
Avoid personalising or becoming defensive, which can escalate aggression/irritability
Ensure that pleasant events are included in schedule Engage in activities within patient’s skill level Redirect patient to recall pleasant memories
Avoid excessive demands that can exacerbate frustration
Avoid having patient do or attend to two things at once; avoid distractions
Use labels/calendars/written cues to decrease memory demands
Help patient engage in activities that confer sense of accomplishment
Provide orientation information and reassurance as needed
