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Neuro Final > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

How many people in the U.S receive treatment for TBI?

A

1.25 million

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2
Q

How many people are living in the U.S with disabilities related to TBI?

A

5.3 million

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3
Q

Most TBIs are closed-head injuries

A

True

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4
Q

How many TBI accidents are caused by motor vehicle accidents?

A

2/3 especially in the adolescent and young males. TBIs for younger children and older adults are most often due to falling

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5
Q

Are males or females more likely to have TBI?

A

Overall, males are two to three times as likely to have TBI as females

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6
Q

What are the risk factors for TBI?

A 
Age
Gender
Substance Abuse
School adjustment and social history (poor academic performers or school dropouts more likely)
personality types
participation in high risk sports
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7
Q

Penetrating brain injuries

A

usually caused by missiles
amount of damage depends on velocity of missile
penetrating brain injuries to brain stem usually fatal

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8
Q

High velocity missiles

A

cause more damage, they pierce the skull & brain and often bring foreign bodies, hair, etc into the brain, causing infection

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9
Q

Low velocity missiles

A

may fracture the skull rather than penetrate it, but the fracture can cause bone fragments to penetrate the brain.

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10
Q

Adults who live after penetrating head injury almost always have some…

A

residual physical, cognitive or language impairment

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11
Q

Nonpenetrating Brain Injuries- Closed Head Injuries (CHI)

A

The meninges are not penetrated

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12
Q

Two categories of CHI

A

nonacceleration and acceleration injuries

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13
Q

Nonacceleration Injuries

A

when the restrained head is struck by a moving object

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14
Q

Acceleration Injuries

A

Injury caused by sudden acceleration or deceleration of the head and results in injury to brain/brainstem due to their movement in the skull. cranial nerves are often damaged

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15
Q

Blows to a moving head can be _ times as severe to a stationary head

A

20

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16
Q

Two types of acceleration injuries

A

linear acceleration and angular acceleration

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17
Q

Linear Acceleration

A

when the head is suddenly hit and pushed into acceleration by an outside force. Causes coup injury or contra coup injury

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18
Q

Coup Injury

A

the skull begins to move in the direction of the outside force, but the inner brain lags in its movement due to inertia. this causes the skull to slam into the brain

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19
Q

Contra Coup Injury

A

After a coup injury, the brain begins to move at the rate at which the skull is moving. the skull stops first (decelerates) and the brain takes a while longer to stop due to the inertia which causes the brain again to be compressed against the skull. this causes localized injury to the area opposite to the area of the first blow.

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20
Q

Coup and contra coup injuries typically happen on the sides of the skull

A

False, typically to the front or back of the head because there is more room

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21
Q

Is the brain tethered in the skull?

A

No
The head only moves so far because it is tethered by the neck muscles but the brain is not so firmly tethered inside the skull

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22
Q

Angular acceleration

A

caused by a blow that hits the head off center and cause the skull to rotate away from the blow. after a few milliseconds the brain begins to move in the same direction as the skull. this causes twisting and shearing motion of the midbrain, basal ganglia, brain stem and cerebellum. there is also a 2nd time of twisting and shearing that occurs when the skull stops but the brain is still moving.

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23
Q

Is angular or linear acceleration more severe?

A

damage caused by angular acceleration is usually more severe than the linear acceleration because of the twisting forces involved

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24
Q

Diffuse axonal injury

A

thought to be the cause of many of the impairments resulting from TBI and can be caused by angular or linear acceleration

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25
Q

Traumatic Hemorrhage & Hematoma

A

caused by cuts and bruises on the surface of the brain

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26
Q

Secondary Consequences of TBI

A

Cerebral Edema
Ischemic brain damage
Cerebral Vasospasm

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27
Q

Cerebral Edema

A

Fluid accumulates in cerebrum & causes increased intracranial pressure

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28
Q

Ischemic brain damage

A

reduced oxygen to brain

29
Q

Cerebral Vasospasm

A

contractions of muscles surrounding blood vessels. Can cause worsening of conditions such as alteration in the blood brain barrier

30
Q

Blood Brain barrier

A

regulates the movement of substances from blood into the brain

31
Q

Prognostic Indicators in TBI

A

Duration of coma
Level of consciousness
Duration of Post traumatic amnesia

32
Q

How to measure level of consciousness (duration of coma)

A

Glasgow Coma Scale (GLS)

The Comprehensive Level of Consciousness Scale (CLOCS)

33
Q

Glasgow Coma Scales

A

based on eye opening, motor behavior and verbal responses. it is a good predictor of recovery.

34
Q

GCS scores

A

8 or less: coma
3-8: severe head injury
9-12: moderate head injury
13-15: mild head injury

35
Q

CLOCS

A

It has a broader range of responses and is more sensitive to subtle changes than GLS

36
Q

Post traumatic amnesia that lasts less than 2 weeks is associated with good recovery but when it lasts more than 12 weeks, patients don’t make a good recovery

A

True

37
Q

Galveston Orientation and Amnesia Test

A

assesses orientation and memory and is designed for patients emerging from coma

38
Q

Rancho Los Amigos Scales of Cognitive Levels

A

rates levels of arousal, responsiveness, restlessness, attention, memory and executive ability

39
Q

Patient Related Variables

A

age
substance abuse
intelligence and SES
premorbid personality

40
Q

Steps of recovery

A
  • period of unconsciousness from few seconds to months
  • return to consciousness when patient is awake but with little response
  • patient becomes more responsive and focused
  • *Similar to Rancho Los Amigos
41
Q

Assessing Adults with TBI

A
  • Assess level of consciousness & responsiveness
  • Assess orientation
  • Assess cognitive and communication abilities
  • Assess Language and Communication
  • Assess Abstract Thinking
  • Assess Reasoning
42
Q

Agitation with TBI

A

they become frustrated and may pull out tubes, get out of bed or be abusive.

43
Q

Agitated Behavior Scales

A

rates the extent of agitation

44
Q

RLAS level 5

A

period when you can assess for orientation, cognitive and communication abilities, language and communication

45
Q

TBI usually have WNL speech unless

A

there is brain stem, cerebellar or PNS damage so a dysarthria battery can be used to assess

46
Q

TBI language and communication problems

A

irrelevance, confabulation, circumlocution, tangential speech, fragmentation or noncohesion. Their language is usually OK semantically, syntactically and morphologically
*Similar to Wernicke’s

47
Q

Use PPVT to assess

A

auditory comprehension using word finding tests, naming tests and reading tests

48
Q

One main difference between aphasia and TBI

A

patients with TBI have more pragmatic problems

49
Q

How to assess abstract thinking

A

proverb interpretation, similarities and differences, categorizing and sorting tasks

50
Q

To assess reasoning

A

use verbal reasoning tests such as the Stanford-binet or Wechsler IQ scale

51
Q

To assess planning and problem solving

A

tinker toy test

52
Q

Test Batteries for TBI

A

RIPA
Brief Test of Head Injury
SCATBI

53
Q

Tests for general population that can be use to assess TBI

A

Woodcock-Johnson Psychoeducational Battery
Woodcock-Johnson Tests of Cognitive Abilities
Woodcock-Johnson Tests of Achievement
Peabody Individual Achievement Test

54
Q

Treatment of TBI

A 
Sensory Stimulation
Behavior Management
Pharmacologic Management
Orientation Training
Component Training (Cognitive Rehabilitation or Cognitive Therapy)
Compensatory Training
55
Q

Sensory Stimulation

A

pt is presented with different stimuli in short intervals (10 mins) throughout the day. Supposed to bring person out of coma but there is not a lot of evidence to support this

56
Q

Behavior Management

A

they often don’t respond to verbal praise so tangible reinforcement is needed.

57
Q

Component Training (Cognitive Therapy or Cognitive Rehabilitation Therapy)

A

typicaly focuses on attention, memory, language and communication.
Structured hierarchical drills are typical
attention training
Visual processing

58
Q

What does the SLP work on in regards to language and communication

A

SLP works on the underlying impairments

work to improve the appropriateness, relevance and efficiency of the patients communication

59
Q

4 categories of compensatory strategies

A

External compensations
Situational compensations
Recognition compensations
Anticipatory compensations- hardest for TBI

60
Q

2 categories for compensatory strategies used for memory problems

A

Internal Strategies

External Strategies

61
Q

Internal Strategies

A

Mnemonic Devices

Imagery- mental picture to help them remember

62
Q

External Strategies

A
  • Provide cues and reminders to compensate for memory problems
  • Memory reminder can be posted in appropriate places
  • Items can be placed strategically to help pt (closet, kitchen)
  • Environmental Compensation
63
Q

Group Treatment

A

important for TBI pts
allows to practice pragmatics
aids in orientation, support, communication and generalization

64
Q

Community Re-entry

A

final stage of TBI and preparation can take several months and typically occurs in a rehab setting

65
Q

Working with Family 1st Stage where pt is comatose

A

families need objective information as to what is the problem and what the probable outcome will be. needs to be repeated because families cannot take it all in at once

66
Q

Working with Family 2nd Stage where pt returns to consciousness

A

families need to be educated as to usual course of recovery in TBI and the stages involved

67
Q

Working with Family in 3rd Stage where pt is in rehabilitation

A

families may have a hard time adjusting to fact of slow recovery, family needs help in learning how to cope with a future with the impaired TBI pt

68
Q

Which causes more damage? Low velocity or high velocity missiles?

A

high velocity missiles cause more damage because it often leads to infection

69
Q

Which causes more damage? Non-acceleration or acceleration injuries?

A

acceleration injuries

Neuro Final (5 decks)

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