Traumatic Brain Injury Flashcards
what is traumatic brain injury caused by? (8)
- falls
- road traffic accidents
- violence/ aggression/ crime
- concussion
- skull fracture
- cerebral laceration
- hematomes
- haemorrhages
how many people are affected annually in the world by TMI?
- 10 million people are affected annually by TMI
how many people in the UK attend A&E with head injuries?
- 900,000
how many people are admitted to hospital each year in the UK with TMI?
- 160,000 people
who is TMI more prevalent in?
- more prevalent in men compared to women
what is brain injury caused by?
- external force
- head impact
- blunt trauma
- penetrating injuries
- blast injuries
what does TBI vary in?
- varies in severity
how is TMI classified?
- classified by type, severity injury and physiological response to injury
how can TBI be classified by clinical severity?
- classified as mild, moderate or serve based on neurobehavioral deficits and advanced imaging findings after the injury
what is concussion interchangeable with?
- interchangeable with mild TBI
what is TBI severity generally classified based on?
- based on clinical criteria that assess the depth of impaired consciousness and neurological functioning
what are the most common metrics used for TBI classification?
- glasglow coma scale
- duration of loss of consciousness
- length of post- traumatic amnesia
what does the score of glasglow coma scale mean?
- score closer to 15 means higher alertness whereas 0 means the individual is on a worsened condition
what is mild TBI duration of LOC?
- less than 30 minutes
what is the moderate TBI duration of LOC?
- LOC for 30 minutes to 24 hours
what is the severe TBI duration of LOC?
- LOC for more than 24 hours
what is PTA?
- post traumatic amnesia
what is post traumatic amnesia?
- refers to the time after the injury during which the patient cannot form continuous day- to- day memories
what is mild TBI length of PTA?
- PTA less than 1 hour
what is the moderate TBI length of PTA?
- PTA for 1 to 24 hours
what is the severe TBI length of PTA?
- for more than 24 hours
what is the primary damage of TBI? (6)
- contusion
- epidural haematoma or haemorrhages
- subdural hematoma
- diffuse axonal injuries
- penetrating injuries
- blast injuries
what is the secondary damage/ insults of TBI? (6)
- increased intracranial pressure
- cerebral hypoxia or ischemia
- intracranial haemorrhage
- electrolyte and acid- base imbalance
- infection
- seizures from pressure of scarring
what are the four disorders of consciousness?
- coma
- vegetative state
- minimally conscious state
- post- traumatic confusion or clouding of consciousness
what is a coma state?
- patient in a state of unconsciousness and unresponsiveness
what are individuals in a coma state unable to do?
- unable to open their eyes, speak or follow commands
when does the coma state typically occur?
- typically occurs following severe TBI weeks
how long does a coma last?
- lasts a few days to weeks
what is the vegetative state?
- individuals may have periods where they appear awake with their eyes open and basic non- purposeful movements, but they do not demonstrate awareness of themselves or environment
what may people in the vegetative state have?
- may have sleep wake cycles
what do people in the vegetative state lack?
- lack purposeful interaction
what is the minimally conscious state characterised by?
- characterised by minimal awareness but definite behaviour evidence of self or their environment
what can patients in the minimally conscious state follow?
- can follow simple commands
- have yes/ no responses
what do individuals in the minimally conscious state exhibit and show? what are these responses often?
- exhibit intelligible speech
- show purposeful behaviour
- responses are often inconsistent
what does the post- traumatic confusion of clouding of consciousness state involve?
- awake most of the time
- confused
- easily distracted
- faulty memory
- slowed consistent responses to stimuli
what are the common outcome measures for disorders of consciousness?
- glasglow coma scale (GCS)
- Rancho Los Amigos Scale (RLAS)
- levels of cognitive functioning scale and JFK coma recovery scale revised (CRS-R)
what are the neurological examinations of DOCs? (3)
- assessing brainstem reflexes, motor responses, and other neurological functions
what 6 other tests can be completed for DOCs?
- electroencephalogram
- evoked potentials
- MRI
- CT scan
- functional MRI
- Positron Emission Tomography
what is the main aim of medical management of TBI?
- stabilisation
which patients have an assessment for inpatient rehabilitation?
- patients who are in hospital with new cognitive, communicative, emotional, behavioural or physical difficulties that continue 72 hours after a TMI
what are the 8 motor changes from TMI?
- paralysis or paresis
- cranial nerve injury
- poor coordination
- abnormal reflexes
- abnormal muscle tone
- asymmetrical cerebellar and pyramidal sign
- loss of selective motor control
- loss of bladder and bowel control
what are the 7 sensory and perceptual changes from TMI?
- hypersensitivity to light or noise
- loss of hearing or sight
- loss of somatosensory functions
- dizziness and vertigo
- agnosia
- apraxia
- visuospatial abnormalities
what are the 8 cognitive changes from TMI?
- memory loss
- limited attention span
- concentration deficits
- confusion
- limited motivation
- executive function loss
- reduced problem- solving skills
- loss of reasoning
what are the 8 behavioural changes from TMI?
- agitation
- aggression
- irritability
- apathy
- depression
- anxiety
- PTSD
- OCD
what should individuals with post- traumatic amnesia practice?
- practice whole tasks that are relevant to the patient instead of only practicing parts of it
how do you ensure consistency of environment for individuals with post- traumatic amnesia?
- set up the exercise in the same way each time and structure the environment to make the task easier to perform
what should you use when working with an individual in post- traumatic amnesia?
- use concrete goals and specific number of reps
how should you teach exercises to individual in post- traumatic amnesia?
- demonstrate and perform the exercise with the patient
- briefly instruct the patient allowing them time to process the instruction
what should you do if physical or cognitive fatigue is apparent?
- provide short and frequent sessions
what can you consider when exercising patients?
- consider the time of day when the patient is more alert
what should be removed when working with an individual in post- traumatic amnesia?
- remove distractions and triggers for outbursts of aggressive behaviour e.g., noise and other individuals from the training environment
how do you ensure safety when working with an individual in post- traumatic amnesia?
- consider a safe distance wherever possible
- safety of objects used for training
- additional staff members if you are at all concerned
what should you time physiotherapy with if needed?
- time it with pain medication
what are the complications of the cardio and respiratory system?
- reduced cardiovascular fitness
- reduced chest mobility and expansion
- thrombophlebitis
- associated injuries
what are some MSK complications?
- reduced joint mobility
- muscle atrophy
- associated injuries (fractures)
- muscle force production
what are skin and pressure area complications?
- pressure sores
- lacerations
- abrasions
- associated injuries
what are nervous system complications?
- sensorial and perceptual deficits
- behavioural changes
- cognitive deficits
- associated injuries - peripheral, spinal
what three factors are limited due to TBI?
- strength and muscle force generation
- muscle length and joint ROM
- muscle tone
how do you assess muscle strength?
- assess muscle strength in function > completing functional tasks, postural settings (edge lying, sitting, standing), reaching and grasping, manipulation of objects and MMT
how do you asses muscle length and joint ROM?
- muscle tone
- AROM and PROM
- weight bearing
- positioning
- orthotics/ casting
- activity
- exercise
how do you assess muscle tone?
- modified ashworth scale
- multifactorial assessment
what should spasticity management be?
- patient centred
- multidisciplinary
- goal directed
what are integrated approaches for spasticity management?
- positioning
- strengthening
- engagement in activity and function
- orthotics
what are the four main assessments of function and limitations?
- functional mobility
- sitting balance
- standing balance
- gait and dual task ability
what is necessary to be discharged from the hospital?
- a certain level of mobility is necessary for the individual to be discharged from the hospital and walk safely in the community
how do you improve mobility?
- high repetitions of part- task and whole- task practice can be used e.g., stepping practice
why do individuals with TBI experience reduce cardiorespiratory?
- due to combination of injury factors and prolonged inactivity
what is physical inactivity common during?
- common during inpatient rehabilitation
how is physical activity promoted?
- pre exercising screening
- monitoring
- patient centred goals
what are the three outcome measures for traumatic brain injury?
- functional assessment measure
- Barthel index
- berg balance scale
what is the functional assessment measure?
- assessment tool that measures disability across population
- measures a patient’s self care independence in 18 items using a seven level scale
what does the barthel index assess?
- assesses the ability of an individual with a neuromuscular or musculoskeletal disorder to care for him/ herself
what is the berg balance test?
- 14 item objective measure that assesses static balance and fall risk in adults
