Traumatic Brain Injury Flashcards
What is the purpose of the Balance Error Scoring System (BESS)
Objective measure of assessing static postural stability (designed for the mild head injury population to assist in return to sports play decision)
Describe the Balance Error Scoring System (BESS)
6 condition each tested barefoot, eyes closed for 20 seconds each:
Double leg stance (feet together)
Single leg stance (non-dominant foot)
Tandem stance (non-dominant foot in back)
Score of 0-60 (lower scores indicate better balance and less errors)
What is the Purpose of the Cog-Log and O
Measures general cognitive abilities in a cursory way, designed to be used as a companion to the Orientation-Log (O-Log)
Describe the Cog-Log and O
The Cog-Log includes the 3 most difficult orientation items from the O-Log, and 7 additional items that test other cognitive ability
1. (O-Log) Name of facility
2. (O-Log) Date
3. (O-Log) Time of day
4. Repeat an address
5. Counting backwards from 20-1
6. Reciting the months of the year in reverse order
7. Estimating the passage of 30 seconds
8. Repeat a motor sequence (fist-edge-palm)
9. Raising finger to “red” and do nothing to “green”
10. Address recall
Score 0 to 30
What is the purpose of the “Community Balance and Mobility Scale,” and what area does it assess?
Used to detect “high level” balance and mobility deficits based on tasks that are commonly encountered in community environments.
Describe the Community Balance and Mobility Scale.
A performance measure of 13 challenging tasks with 6 tasks performed on both sides
Score the 1st trial for each item
Item scores range from 0 to 5 and reflect progressive task difficulty
A score of “0” = complete inability to perform the task
A score of “5” = the most successful completion of the item possible
All tasks performed without ambulation aides
Patients are permitted to wear an orthotic
What is the purpose of the Disorders and Consciousness Scale (DOCS)?
The DOCS is a bed side test measuring neurobehavioral functioning during coma recovery. It was developed to detect subtle changes in observable indicators of neurobehavioral functioning
Describe the DOCS.
23 items
The rating scale describes levels of neurobehavioral integrity and a level is assigned to responses to test stimuli. The rating scale points are as follows:
0 = No Response
1 = Generalized Response
2 = Localized Response
The rating scale defines transition from low to middle to high neurobehavioral functioning within the continuum of altered consciousness
What is the purpose of the Dizziness Handicap Inventory?
This is a 25-item self-assessment inventory designed to evaluate the self-perceived handicapping effects imposed by dizziness
Describe the Dizziness Handicap Inventory
25 items
Self-report questionnaire
Quantifies the impact of dizziness on daily life by measuring self-perceived handicap
Three Domains: Functional (9 Qu, 36 pnts), Emotional (9Qu, 36 pnts), and Physical (7Qu, 28 pnts)
Maximum score of 100 – Minimum score of 0. The higher the score, the greater the perceived handicap due to dizziness
Answers are graded 0 (no), 2 (sometimes), and 4 (yes)
What is the Purpose of the Disability Rating Scale (DRS)?
The Disability Rating Scale (DRS) was developed and tested with older juvenile and adult individuals with moderate and severe traumatic brain injury (TBI) in an inpatient rehabilitation setting. One advantage of the DRS is its ability to track an individual from coma to community.
Describe the Disability Rating Scale (DRS).
Items in this scale address all three World Health Organization categories: impairment, disability and handicap (WHO,1980).
The DRS rating must be reliable, i.e., obtained while the individual is not under the influence of anesthesia, other mind-altering drugs, recent seizure, or recovering from surgical anesthesia.
The scale is intended to measure accurately general functional changes over the course of recovery.
Describe the Functional Assessment Measure (FAM).
The FAM consists of 12 items is typically added to the 18 items of the FIM. The total 30 item scale combination is referred to as the FIM+FAM.
The 12 +18 Dimensions assessed include:
Swallowing, Car transfer, Community access, Reading, Writing, Speech intelligibility, Emotional status, Adjustability to limitations, Employability, Orientation, Attention, Safety judgment
What is the Purpose of the Global Fatigue Index (GFI)?
To measure Fatigue
Describe the GFI
GFI is derived from 15 items to measure fatigue across 4 dimensions
What is the Purpose of the Quality of Life (QOL) After Brain Injury assessment?
A health-related QOL instrument for survivors of TBI, which includes the person’s subjective perspective
Describe the QOL After Brain Injury assessment.
37-item scale with six subscales
• Responses to each item were scored 1 (‘Not at all’) to 5 (‘Very’), and the sum of all items was converted arithmetically to a percentage scale, with 0 representing the lowest possible HRQoL on the questionnaire and 100 the best possible HRQoL
T/F: A BESS score of 0 represents complete instability.
False: Score of 0-60 (lower scores indicate better balance and less errors)
The DOCS measure neurobehavioral integrity and a level is assigned to responses to test stimuli. What rating would you give to a localized response to test stimuli?
2 = Localized response
T/F: The higher the score on the Disability Rating Scale (DRS), the more debilitating the injury.
True: The maximum score a patient can obtain on the DRS is 29 (extreme vegetative state). A person without disability would score zero.
TBI
Bump, blow or jolt to head disrupting normal brain functions
Ranges from mild to severe
Most common causes TBI
MVA, Falls, Acts of Violence, Sports
Factors predicting outcomes from TBI
Premorbid characteristics:
Intellect, Level of education, Memory
Open versus Closed injuries
Open: penetrating wounds, skull fractures, meninges compromised
Close: Impact but no skull fracture, brain tissue damaged, dura remains intact
Subtypes of closed injuries
Concussion, contusion, hematomas, locked-in syndrome, acquired brain injuries
Concussion
Momentary loss of consciousness (may or may not lose) & reflexes
Concussion symptoms
Dizziness, disorientation, blurred vision, difficulty concentration, sleep pattern altered, nausea, headache, loss of balance
Retrograde vs. post-traumatic amnesia
Retro: Loss of memory of events before injury
Post: Unable to remember or learn new information
Coup versus Contrecoup Lesion
Coup: Contusion same side as impact
Contre: Surface hemorrhages in opposite side of trauma (from deceleration)
Hematoma
3rd category of closed head injuries
Epidural Hematoma
B/N dura mater & skull
3 results: Unconsciousness, alert, deteriorate
Subdural Hematoma
Rupture to cortical bridging veins, between dura & arachnoid
Blood leaks slowly over hours/weeks
Seen in elderly after falls, similar symptoms to CVA
Locked-in Syndrome
Paralysis of all voluntary muscles except eye movements, individual remains conscious but can’t move
Acronym to Improve Patients’ Functional Capabilities
REWARDING R-Rehab E-Education is a MUST W-Who A-Able to address cognitive & motor components R-Real and creative activities D-Discharge I-Introduce more difficult activities as patients progress N-Not every patient will be the same! G-Get input
Acquired Brain Injuries
Causes: airway obstruct, drowning, MI, CVA, toxins
Cognitive, communication, memory, attention & concentration, reasoning, abstract thinking, psychosocial behavior & information processing
Increased Intracranial Pressure
occurs within hours or several months later
Compresses brain tissue, decrease perfusion to brain tissue or herniations