Traumatic Brain Injury Flashcards
1
Q
When is an injury to the CNS considered a TBI?
A
When an external, mechanical force either accidentally or intentionally impacts the head
2
Q
TBI is characterized by a period of what?
A
diminished or altered consciousness that ranges from brief lethargy to prolonged unconsciousness to brain death
3
Q
18%of TBIs are young children between what ages?
A
0-4
4
Q
True or False
Brain injury is the leading cause of death and permanent disability in children between the ages of 1-19.
A
True
5
Q
In every age group the incidence of TBI is __ times greater in boys than girls
A
two
6
Q
What type of patient has the highest number of hospitalizations and TBI-related deaths?
A
boys between 0-4, especially those who are impulsive and hyperactive
7
Q
Death rates are inversely related to socioeconomic status with the highest mortality rate occurring in what race?
A
African Americans
8
Q
Children under the age of 12 months are at the greatest risk of TBI from what?
A
Falls
9
Q
Children from the ages of 1-4 -years are at the greatest risk of TBI from what?
A
abuse
10
Q
Children from the ages of 5-9 years are at the greatest risk of TBI from what type of MVA? What about 4-14? 15-19?
A
Improper restraint in a the car
Hit by a vehicle as a bicyclist or pedestrian
They are the driver of the car
11
Q
What is the second leading cause of trauma death in school-aged children and adolescents?
A
gunshot wounds
12
Q
Sports and recreational causes account for approximately __% of the brain injuries to school-age children and adolescents
A
29%
13
Q
What are the 2 mechanisms of TBI?
A
- acceleration/deceleration injuries
- impression injuries
14
Q
When are acceleration/deceleration injuries caused?
A
When a moving head hits a relatively fixed object (ground, windshield, etc.)
15
Q
What are the 2 directions in which acceleration/deceleration injuries can occur?
A
- translational
- rotational
16
Q
Describe the 2 injuries that occur during a translational injury?
A
- Coup: the injury that results from the initial impact of the skull on the brain
- Countrecoup: the lesion that occurs in the direction opposite of the initial force
17
Q
When does a rotational injury occur?
A
When the skull rotates as the brain remains stationary
18
Q
What does the rotational effect cause?
A
brainstem type injuries
19
Q
The rotation of the brain causes diffuse _____ shearing
A
axonal
20
Q
What type of impairment is most severe with this type of injury?
A
spasticity
21
Q
When do impression injuries occur?
A
when a solid object impacts a stationary head
22
Q
What do impression injuries produce?
A
skull fracture and a focal lesion at the site of the impact
23
Q
True or False
The absence of a skull fracture rules out a significant intracranial injury
A
False
24
Q
_____ brain damage from trauma is a direct result of the forces that occur to the head at the time of initial impact
A
Primary
25
What are the 5 types of primary brain damage?
- concussion
- contusion
- skull fractures
- intracranial hemorrhage
- diffuse axonal injury
26
Define concussion
A complex pathophysiologic process affecting the brain characterized by headache, altered awareness and cognitive function, and impaired balance immediately following trauma.
27
What types of behaviors are noticeable following a concussion?
- clinging behavior
- disturbances in sleep
- irritability
- more distractibility than usual
28
Typically how long do the signs of concussion last?
Depending on the severity a few days to a few months, however most resolve within 7-10 days
29
Define a contusion
A bruising or hemorrhage of the crests or gyri of the cerebral hemispheres
30
Where do contusion injuries occur most commonly?
In the frontal and temporal lobes of the brain
31
Linear comminuted fractures result from impact with ___-velocity objects, whereas depressed fractures generally result from impact with __-velocity objects
low
higher
32
Depressed skull fractures of greater than _ mm are considered significant
5
33
What are the 2 types of intracranial hemorrhages frequently seen following pediatric TBI?
- extradural
| - intradural
34
Extradural hemorrhages occur because of what?
tearing of an artery in the brain, primarily the middle meningeal artery and its branches
35
With unilateral epidural hematoma, there is often herniation of the ____ lobe with what 2 threats ensuing shortly there after?
temporal
coma
cardiorespiratory
36
What are the 2 types of intradural hematoma?
- subdural
| - intracerebral
37
Acute subdural hematomas occur secondary to what?
injury to the veins in the subdural space
38
Are subdural or intracerebral hematomas associated with higher mortality rates and poorer functional outcomes?
subdural
39
Intracerebral hematomas can result from trauma or rupture of what?
a congenital vascular abnormality
40
These intracerebral hematomas can rupture and lead to what?
intraventricular hemorrhage
41
What can be defined as a microscopic phenomenon not common visible on a CT that is usually seen following rotational injury within the cranial vault?
diffuse axonal injury
42
Diffuse axonal injury is associated with much of the significant damage seen in TBI, including what 3 things?
- loss of consciousness
- extensor rigidity of B extremities
- autonomic dysfunction
43
_____ brain damage from trauma evolves as a result of the pathophysiologic changes initiated by the primary trauma
Secondary
44
What are the 5 types of secondary brain damage?
- cerebral edema
- intracranial pressure
- herniation syndromes
- hypoxic-ischemic injury
- neurochemical events
45
What is the most frequently occurring cause of secondary injuries?
cerebral edema
46
Unchecked cerebral edema accompanied by an increase in intracranial pressure can lead to what 4 things?
- multiple cerebral infarctions
- brain herniation
- brainstem necrosis
- irreversible coma
47
Initial increases in ICP are accommodated by what?
What happens when this compensatory mechanism is no longer effective?
the mechanisms of the ventricular system
intracranial pressure rises
48
How do infant skulls accommodate for increased intracranial pressure?
the fontanels will bulge
49
What happens in children older than 5 when intracranial pressure increases?
the contents of the cranial vault are forced downward through the foramen magnum which causes brainstem compression and may lead to difficult breathing and even cardiopulmonary arrest
50
Prolonged increased ICP may lead to the development of what?
posttraumatic hydrocephalus
51
What do herniation syndromes result from?
The displacement of the brain by an expanding lesion and cerebral edema
52
Herniation can lead to neurologic deterioration which is characterized by what 5 things?
- decreasing levels of consciousness
- altered respiration (decreased)
- hypertonicity
- hemiparesis
- decorticate posturing
53
What types of trauma typically causes hypoxic-ischemic injury?
- drowning
- attempted strangulation
- choking
The brain is deprived of oxygen and nutrients
54
Describe what type of neurochemical events occur when there is brain trauma.
There is a disruption of the BBB and a release of excitatory neurotransmitters and oxygen-free radicals are released into the blood stream causing damage
55
What are 4 other consequences from brain damage?
- hydrocephalus
- seizures
- infections
- endocrine disorders
56
How is shunting typically managed?
VP shunting
57
What are the 2 types of posttraumatic seizures that occur in children?
- grand mal
| - tonic-clonic siezures
58
What are 2 common infections following penetrating wounds?
- meningitis
| - brain abscess
59
What are the best predictors for the development of dysautonomia?
- HTN
- diaphoresis
- dystonia
60
What are 2 endocrine disorders that rarely occur following brain injury?
- hypopituitarism
| - precocious puberty
61
What can be defined as a complete state of unconsciousness in which the child does not open his or her eyes, follow commands, speak, or react to painful stimuli?
coma
62
What is the most commonly used tool to determine the level of unconsciousness?
Glasgow Coma Scale
63
The Glasgow Coma Scale is based on the patient's best response to what 3 categories?
- motor activity
- verbal responses
- eye opening
64
The Children's Coma Scale should be used for patients __ months or less
36
65
The Pediatric Coma Scale can be used in patients ages _-__ months
9-72
66
What is the best indicator of long-term function in children who have experienced unconsciousness?
how long they had the amnesia
67
For children with TBI who had a coma with a duration of ___ or more and survived, it should be noted that a return to regular education is usually not possible
1 week
68
Using the pediatric coma scale a score of _ or less is predictive of a poor outcome, while a score of _ or greater is predictive of a good outcome
4
7
69
What can be defined as the interval between the injury and the moment at which an individual can recall a continuous memory of what is happening in the immediate environment?
post-traumatic amnesia (PTA)
70
What tool can be used in children 4-15 to assess orientation and amnesia?
Children’s Orientation and Amnesia Test (COAT)
71
What is the name of the tool that is a descriptive scale of cognitive and behavioral functioning that is used primarily during IP rehab?
Rancho Los Amigos Levels of Cognitive Functioning
72
What is the main limitation of the Rancho Scale?
the "phases of recovery" and prediction of discharge functional ratings is often poorly related
73
What is the name of the tool that is an adapted version of the Rancho Los Amigos Scale that can be used to evaluate young children between the ages of infancy and 7 years?
Pediatric Rancho Scale
74
Do young children have in increased vulnerability to the effects of TBI than an adult?
Although the plasticity of the developing brain can allow for dramatic recovery of function, the effects of a diffuse insult produced by TBI may ultimately result in greater cognitive impairment due to the vessels and neuronal axons being immature
75
What is the primary goal for children with TBI upon admission to a rehab unit?
recover walking
76
True or False
In families of children between the ages of 6-12, it has been shown that greater parental distress and burden was associated with poorer fine motor dexterity, behavioral control, and academic performance.
True
77
Trauma that damages what brain structures may result in impairment of arousal and orientation of the child with the TBI?
frontal lobe and brainstem
78
What are 2 common changes in behavior noted during the time of rehab?
agitation and confusion
79
What is the most common cognitive impairment in children with TBI?
memory impairment
80
What are 2 tone abnormalities that can be found in the child with TBI?
- spasticity
| - ataxia
81
What can be defined as the formation of mature lamellar bone in soft tissue following TBI?
Heterotopic Ossification
82
Where does Heterotopic Ossification typically occur?
in the musculature around the hips (quads, glutes, and hamstrings)
83
What should PT intervention entail in a child with Heterotopic Ossification?
gentle but persistent ROM exercises and management of spasticity with medications or nerve blocks
84
What are 2 standardized tests used to assess functional status in children? What is the age range for each?
1) Wee-FIM
2) PEDI
6 months to 7 years
85
What is a major difference in rehabilitating a child with a TBI vs. an adult with a TBI?
Child therapy is more play-based and the main goal is to attain motor milestones
86
PT management for children with TBI functioning at low cognitive levels (Ranchos Levels I-III and Pediatric Levels of V-III) is aimed at what?
the PREVENTION of complications from prolonged inactivity and sensory deprivation
87
What are 3 common complications of prolonged inactivity?
- skin breakdown
- respiratory complications
- contracture development
88
What will assist with improving pulmonary hygiene, maintaining skin integrity, preventing contractures, and providing support for body alignment?
POSITIONING
89
Changes in position for the child confined in a bed should be made how often?
In sitting?
every 2 hours
every 30 minutes
90
What position may be preferred to help decrease the influence of abnormal primitive reflexes?
side-lying
91
What should low cognitive level PT focus on?
stimulation
92
What was developed on the premise that structured stimulation could prevent sensory deprivation and accelerate recovery?
Coma Stimulation Program
93
Sensory input may be provided though what 5 systems in the coma stimulation program?
- auditory
- visual
- olfactory
- tactile
- vestibular
94
What should midcognitive level PT focus on?
structure
95
What are the typical 2 responses to structured PT?
- agitation
| - confusion
96
What should higher cognitive level PT focus on?
School/Community Reintegration
97
What are 4 ways in which TBIs can be prevented?
- bike helmets
- playground equipment no higher than 5 feet
- appropriate traffic behavior
- proper use of car restraints
98
Proper placement and use of can prevent up to __% percent of serious and fatal injuries to children under 5 years of age and the use of lap and shoulder belts can prevent __% of serious and fatal injuries in older children and adolescents.
90
45
