Traumatic Brain Injury Flashcards
Traumatic brain injury
Physical, cognitive, communicative, and neurobehavioral deficits affect
Level of disability determined within 48 hours of med eval
Based on length amnesia and/ or coma
Glasgow Coma Scale GCS
Lower the score = extensive damage
Mild TBI
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
Moderate TBI
Hospitalization of at least 48 hours, GCS 9-12, LOC 30-24 hours
Severe TBI
Loss of consciousness and/ or post acquired amnesia for more than 24 hours and GCS 3-8
TBI greatest risk
Men ages 15-24
Leading cause of TBI
Falls are most common, MVA most common of sever TBI
Medical sign and symptoms
Seizures
Moderate-severe symptoms: muscle spasms, fainting, fatigue
Hydrocephalus
Occurs with sever injuries, common
Fluid build up in the brain, abnormal walking, stiff, no coordination, mental confusion
Dysautonomia
Hypertension, tachycardia (irregular heartbeat), increased body temp., sweating, decerebrate or decorticating posturing
Deep vein thrombosis (DVT)
Can lead to pulmonary embolism (death), tender in the area, swelling, warm
Decerebrate rigidity
Damage to brainstem causes person to maintain posture of extension of all limbs and/ or trunk (straight, stick like)
Decorticate rigidity
Brainstem intact, severe cortical damage (vision), flexion of arms, extension of legs
Depressed levels of consciousness
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
Spasticity
Too much tone in muscle (contracts), common after mod-severe TBI
Immobility
Due to heterotopic ossification in hips, knees, and elbows
Soft tissue turns to bone, limits mobility
Tremors (4)
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
Ataxia
Incoordination
DAI
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),
Cranial nerve dysfunction
- Visual deficits
- Double vision (most common)
- Loss of sense of smell
- Hearing loss (temporal bone)
- Positional vertigo (extreme dizziness w/o change in position)
- Swelling affects- aspiration
Determining prognosis
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
Retrograde amnesia
Can’t recall from prior to injury, may improve
Anterograde amnesia
Inability to make new memories, last to improve
Inconsistent cognitive function
Impaired routines in ADL, diff. Learning new motor routines, diff. Adapting to new situations
Deficits that become evident as coma subsides… (8)
Poor attention, concentration, memory, comprehension, reasoning, self control, awareness and poor executive functions
Executive functions
Diff. Formulating goals, initiating activities/ movement, plan and carry out a behavior
Behavioral deficits
Impulsivity, perseveration, irritability, poor control of temper, aggression, disinhibition, apathy
Psychological deficits
Depression, low self-esteem, onset of psychiatric disorders, increased rates of suicide, PTSD, substance abuse, aggressive behavior
DAI MVA coup and countrecoup
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
Secondary damage DAI
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)
Medical/ surgical management
In Rehabilitation Stage
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
Impact of client factors
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
Tumors of CNS classification
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
Prevalence
More men, childcare rare but 2nd leading cause of death, African Americans’ higher tumor and death rates
Impact of CNS tumor
- Motor deficits possible, movement
- Mental functions may decline
- Vision, communication deficits
- Pain increase, fatigue increase
- ADL may suffer, IADL, work, leisure
- Can create same deficits as TBI, can be long lasting
