Traumatic BRain Injury

Question 1

Causes of TBIs?

Answer 1

MVA
Falls
Assaults

Question 2

Age for TBIs?

Answer 2

Bimodal

Question 3

2 mechanisms of TBIs

Answer 3

Focal: lesion, contusion, SDH, EDH

Acceleration-deceleration
Diffuse atonal injury

Question 4

Diffuse axonal injury when you see it?

Answer 4

Delayed - weeks

MRI

Question 5

What happens in acceleration-deceleration injury?

Answer 5

Diffuse axonal injury

Question 6

How to assess severity of TBI? 2 ways

Answer 6

Length of time in LOC/Coma

Post-traumatic amnesia

Question 7

When is PTA?

Answer 7

From time of TBI until their memory returns. Includes LOC.

Question 8

When is PTA over?

Answer 8

12/12 on west mead for 3 days in a row

Question 9

What is the Rancho Los Amigos LEvels of Cognitive Functioning Scale used for?

Answer 9

TBI, PTA

Question 10

PTA hallmarks

Answer 10

Poor attention/concentration
Altered sleep/wake cycle
Fatigue
Irritable/agitated

Question 11

Therapy for PTA?

Answer 11

ROM
Nutrition
Swallowing

Question 12

DDX for PTA?

Answer 12

ICP
Infection
Alcohol
Meds
Pain

Question 13

Environmental Mx of PTA?

Answer 13

Low stim

Structured enviro

Question 14

Pharm Mx for PTA?

Answer 14

Propranolol
Mood stabilizers

No BEnzos or antipsychotics

Question 15

Cognitive Rehab

Answer 15

Individualized, goal oriented

Interdisciplinary

Question 16

What is cognitive remediation? How?

Answer 16

ADL based
Task and site specific
Verbal cues
Teach and supervised practice

Question 17

When to use NEuropsycholigist?

Answer 17

Closer to after PTA transition period

Question 18

6 areas of cognitions?

Answer 18

Attention
Memory
Language
Visual-spatial
Executive Function
Personality

Question 19

Symptoms of acceleration/deceleration injury?

Answer 19

Loss of smell : shear off CNI
Or cooking tastes bad

Dizziness
Visual probs

Question 20

Post TBI can get what?

Answer 20

Seizures

Seizures that happen in hospital, likely to have D/c

Question 21

Driving after TBI?

Answer 21

Cognition?
Function? ADLs ok?
Work/school
Vision

Question 22

Important thing to do in TBI for patient, family, employer?

Answer 22

Education, Education, Education!

Question 23

Why not alcohol/illicit drugs? Say to family?

Answer 23

SLOWS your recovery down.

Question 24

Take home points in TBI?

Answer 24

Recognition
Early rehab
Limitations/expectations of rehab
Ongoing input/surveillance of TBIs