Traumatic Brain Injury

Question 1

Traumatic brain injury

Answer 1

Physical, cognitive, communicative, and neurobehavioral deficits affect
Level of disability determined within 48 hours of med eval
Based on length amnesia and/ or coma

Question 2

Glasgow Coma Scale GCS

Answer 2

Lower the score = extensive damage

Question 3

Mild TBI

Answer 3

No skull fracture, loss of consciousness less than 30 minuets GCS of 13-15, 80% of brain injuries, recovery over 3 months, symptoms of headache, dizziness, fatigue, visual disturbances, memory and executive function difficulties for 1-3+ weeks

Question 4

Moderate TBI

Answer 4

Hospitalization of at least 48 hours, GCS 9-12, LOC 30-24 hours

Question 5

Severe TBI

Answer 5

Loss of consciousness and/ or post acquired amnesia for more than 24 hours and GCS 3-8

Question 6

TBI greatest risk

Answer 6

Men ages 15-24

Question 7

Leading cause of TBI

Answer 7

Falls are most common, MVA most common of sever TBI

Question 8

Medical sign and symptoms

Answer 8

Seizures

Moderate-severe symptoms: muscle spasms, fainting, fatigue

Question 9

Hydrocephalus

Answer 9

Occurs with sever injuries, common

Fluid build up in the brain, abnormal walking, stiff, no coordination, mental confusion

Question 10

Dysautonomia

Answer 10

Hypertension, tachycardia (irregular heartbeat), increased body temp., sweating, decerebrate or decorticating posturing

Question 11

Deep vein thrombosis (DVT)

Answer 11

Can lead to pulmonary embolism (death), tender in the area, swelling, warm

Question 12

Decerebrate rigidity

Answer 12

Damage to brainstem causes person to maintain posture of extension of all limbs and/ or trunk (straight, stick like)

Question 13

Decorticate rigidity

Answer 13

Brainstem intact, severe cortical damage (vision), flexion of arms, extension of legs

Question 14

Depressed levels of consciousness

Answer 14

1- may be short in mild TBI
2- coma typical in moderate to severe
3- Diffuse cerebral hypoxia (lack of oxygen) or extensive cortical damage with little damage to brain stem, may open eyes, move limbs spontaneously, but no response to pain or ability to follow directions

Question 15

Spasticity

Answer 15

Too much tone in muscle (contracts), common after mod-severe TBI

Question 16

Immobility

Answer 16

Due to heterotopic ossification in hips, knees, and elbows

Soft tissue turns to bone, limits mobility

Question 17

Tremors (4)

Answer 17

1- Cerebellar: ataxia, hypotonia, balance disorders, occur with intentional movement
2- Resting: pill-rolling movement at rest, shaking stops when that area is in action
3- Essential: distal muscles, increase with anxiety or maintained positions, occurs when doing simple tasks (writing, tying shoes)
4- Physiologic: seen with aging, increase with fatigue and stress

Question 18

Ataxia

Answer 18

Incoordination

Question 19

DAI

Answer 19

Diffuse axonal injuries, collisions with the head at a velocity at or greater than 15 miles per hour, high running sports, motor vehicle accidents (MVA),

Question 20

Cranial nerve dysfunction

Answer 20

1. Visual deficits
2. Double vision (most common)
3. Loss of sense of smell
4. Hearing loss (temporal bone)
5. Positional vertigo (extreme dizziness w/o change in position)
6. Swelling affects- aspiration

Question 21

Determining prognosis

Answer 21

1- Trauma score, GCS, presence or absence of hypoxia (deficiency of O2 teaching tissues)
2- Neuroimaging studies, electrodiagnostic findings
3- Length of coma, duration of post-traumatic amnesia

Question 22

Retrograde amnesia

Answer 22

Can’t recall from prior to injury, may improve

Question 23

Anterograde amnesia

Answer 23

Inability to make new memories, last to improve

Question 24

Inconsistent cognitive function

Answer 24

Impaired routines in ADL, diff. Learning new motor routines, diff. Adapting to new situations

Question 25

Deficits that become evident as coma subsides… (8)

Answer 25

Poor attention, concentration, memory, comprehension, reasoning, self control, awareness and poor executive functions

Question 26

Executive functions

Answer 26

Diff. Formulating goals, initiating activities/ movement, plan and carry out a behavior

Question 27

Behavioral deficits

Answer 27

Impulsivity, perseveration, irritability, poor control of temper, aggression, disinhibition, apathy

Question 28

Psychological deficits

Answer 28

Depression, low self-esteem, onset of psychiatric disorders, increased rates of suicide, PTSD, substance abuse, aggressive behavior

Question 29

DAI MVA coup and countrecoup

Answer 29

Acceleration of brain forces it to hit front of skill (coup)
Then accelerates off the front and hits the back of the skull (countrecoup)

Can occur over and over

Question 30

Secondary damage DAI

Answer 30

Can occur to lack of O2 which can lead to increased intracranial pressure (causes swelling), ischemia (inadequate blood supply), cerebral hypoxia, or hemorrhage (causes stroke like symptoms)

Question 31

Medical/ surgical management

In Rehabilitation Stage

Answer 31

1- In-patient rehab needed for moderate to severe TBI
2- Ready for in-patient when medically stable, have potential to improve and tolerate therapy of 3 hours a day, 5-7 days a week, sub-acute only tolerate .5 to 2 hours/ day
3- Rehab is directed by a physiatrist, also maybe resp. Therapy
4- Goals of OT: re-establish OT skills, sensorimotor integration and ability to perform daily tasks, compensatory skills PRN, Outpatient focuses on IADL’s, community integration and work skills

Question 32

Impact of client factors

Answer 32

1- regain basic ADL skills
2- long lasting cognitive, emotional, and behavioral problems
3- Lack of self-awareness may hinder ability to return to work,
4- driving, visual impairments or poor self-awareness impact ability

Question 33

Tumors of CNS classification

Answer 33

1 primary- site of origin
2 secondary- where it has spread to (brain last place to develop, primary brain rarely spreads anywhere else)
3 malignant- abnormal cells that multiple rapidly
4 benign- not cancerous, doesn’t spread, but can be life threatening

Question 34

Prevalence

Answer 34

More men, childcare rare but 2nd leading cause of death, African Americans’ higher tumor and death rates

Question 35

Impact of CNS tumor

Answer 35

1. Motor deficits possible, movement
2. Mental functions may decline
3. Vision, communication deficits
4. Pain increase, fatigue increase
5. ADL may suffer, IADL, work, leisure
6. Can create same deficits as TBI, can be long lasting