Traumatic Brain Injury

Question 1

coup injury

contrecoup injury

Answer 1

site of impact

opposite side of impact

Question 2

diffuse injuries

Answer 2

falls and MVA produce acceleration, deceleration, and rotation forces

coma results from damage to axons in the midbrain reticular activation system (RAS)
(sleep/wake cycles)

Question 3

focal injuries

Answer 3

can result from contusions and lacerations to the brain

firearms, work-related injuries

interrupts connection to subcortical limbic structures

phineas gage-personality changes following injury to frontal love

memore, motivation, sex, drugs, rock and roll

Question 4

Secondary effects of TBI

Answer 4

cerebral blood flow changes
intracranial hemorrhage
ischemic brain damage
intracranial infection
abnormal ANS responses (HR, stop breathing, blood pressure)

Question 5

Glasgow Coma Scale

Answer 5

objective assessment of mod to sever TBI using 15 pt system
Eye opening (E)
verbal response (V)
motor response (M)

3 (very severe) to 15

document individual score and sum score

Question 6

Best Eye Response

Answer 6

4, for four eyes
4   Spontaneous
3   Voice
2   Pain
1   none

Question 7

Best Verbal Response

Answer 7

V: roman numeral 5
5   Oriented
4   Confusion
3   Inappropriate words
2   Incomprehensible sounds
1   none

Question 8

Best Motor Response

Answer 8

6 cylinder motor
6   follows commands
5   localizes pain
4   withdraws from pain
3   abnormal flexion to pain
2   extension to pain
1   no response

Question 9

Severity of TBI

Answer 9

severe: 6 hrs
moderate: 9-12, post traumatic amnesia of 1-24 hrs
mild: 13-15, trauma induce with any of the following, loss of memory, alteration in mental state, or focal neurological deficit, not very accurate for more mild injuries

Question 10

UMN damage: rigidity

decerebrate

decorticate

Answer 10

extension

flexion, not as severe

Question 11

TBI Eval

Answer 11

ADL performance
Biomechanical (ROM, strength)
Neuromuscular (tone, spasticity)
Cognitive and psychosocial (main concerns)

talk with fam to find out prior functionality

Question 12

TBI Assessment tooi

Answer 12

Ranchos los amigos!

Question 13

Ranchos los amigos

Answer 13

uses behavioral observations to categorize functions

lower scores correspond with lower cognitive levels

Question 14

Ranchos los amigos level

Answer 14

I. no response
II. generalized response (eye opening)
III. localized response
IV. confused, agitated,
V. confused, inappropriate
VI. confused, appropriate
VII. automatic, appropriate
VIII.  purposeful appropriate (with SBA)
IX.  purposeful appropriate (with supervision)
X.  purposeful and appropriate (MI) safe to discharge without supervision

Question 15

interventions for patients in severely altered state

Answer 15

goals: foster alertness and behavioral responses
prevent complications 2nd to prolonged immobilization

intervention:
PROM (slooooowly)
positioning (to avoid contractures and tightness)
tone alteration
family/caregiver suppose and education!
sensory simulation (controversial)

** sideline inhibits lots of tone