Traumatic Brain Injury

Question 1

What is TBI?

Answer 1

Any external force to the brain that causes a focal or diffuse pathology

Question 2

How is the severity of TBI categorised?

Answer 2

Via initial GCS and length of PTA, and duration of LOC/COMA

Mild - 12-15, less than 24 hours
Moderate - 9-11, 1-7 days
Severe - 3-8, 1-4weeks
Very severe - greater than 4 weeks

Question 3

What is the Westmead PTA scale?

Answer 3

An assessment of PTA with 12 questions that must be successfully completed on 3 consecutive days

Question 4

What are some features of PTA?

Answer 4

Amnesia and disorientation
"Islands of memory"
Poor attention/concentration
Altered sleep/wake cycle
Fatigue
Irritable/Agitation

Question 5

What is the definition of PTA?

Answer 5

Period of time of TBI to return of continuous memory and orientation

Question 6

How do you manage PTA?

Answer 6

Environmental modification - craig bed, sitter, mitts, reduce stimuli, frequent orientation, constant predictable day-night routine

Pharmacological

• Propranolol - block sympathetic action
• Mood stabilisers - carbamazepine, valproate
• NO benzos, and anti-psychotics as they can prolong PTA

Psycho
- Cognitive rehab once out of PTA

Question 7

What does cognitive rehab in PTA entail?

Answer 7

Cognitive remediation

• Physical/functionally (ADL) based
• Neuroorganise by repetition
• Task specific
• Teach and supervised practice of compensatory technique

Behavioural Management

Question 8

Which 6 areas of cognition does neuropsych assess?

Answer 8

VAMPLE

Attention
Memory
Language
Visual-spatial
Executive function
Personality

Question 9

What are the main aims of rehab in PTA?

Answer 9

• Monitor the duration and reduce behavioural symptoms of PTA
• Prevent complications and treat medical issues as they arise
• Assess cognitive and functional status as they emerge out of PTA
• Remediate disability/functional limitation
• Provide education for patient and carers
• Follow up

Question 10

What is post concussion syndrome?

Answer 10

A condition that a small subset of people with minor head injuries develop characterised by

• Headache
• Dizziness
• Memory impairment - particularly short term
• Fatigue
• Persistent for >3 months after the injury

Question 11

How long do you advise patients with PTA to abstain from EtOH?

Answer 11

12 months