Traumatic Brain Injury

Question 1

TBI

Answer 1

damage to the brain from an external mechanical or blunt force accompanied by a loss of consciousness, posttraumatic amnesia, skull fracture, or other unfavorable neurologic findings attributed to the event

Question 2

Incidence and Cuase

Answer 2

Most common cause of death and disability in youth between 16 and 30. Leading causes are falls, MVA, Striking or being struck by an object, Assault. Strong link with substance use

Question 3

Focal Brain Injury

Answer 3

direct blow to the head resulting from collision with external object, a fall, or a penetrating injury

Question 4

Multifocal and Diffuse Brain Injury

Answer 4

sudden deceleration of the body and head, possibly from a motor vehicle, bicycle, or skateboard accident or a fall from high surface

Question 5

Decorticate Rigidity

Answer 5

UEs are in spastic flexed position with internal rotation and adduction. LEs are in spastic extended position, internally rotated and adducted

Question 6

Decerebrate Rigidity

Answer 6

UE and LEs are in spastic extension, adduction, and internal rotation. Wrist and fingers flexed, planter portions of feet flex and inverted, trunk extn and head retracted

Question 7

Cerebellum Damage

Answer 7

ataxia

Question 8

Midbrain damage

Answer 8

impaired righting reflexes

Question 9

Basal Ganglia Damage

Answer 9

absence of equilibrium reactions and protective extn

Question 10

Limited Joint Motion

Answer 10

resulting from increased muscle tone, volitional resistance, contractures, heterotrophic ossification, fractures or dislocations

Question 11

Continuum of Consciousness

Answer 11

Coma < Vegetative State < Minimally Conscious State

Question 12

Coma

Answer 12

absence of response to environmental stimuli, no evidence of sleep/wake cycle, no intentional movement, eyes do not open

Question 13

Vegetative State

Answer 13

no awareness or ability to interact with self or environment, no sustained/reproducable/voluntary/behavior response to stimuli, no apparent receptive language comprehension or verbal expression, sleep wake cycles of variable length, can self-regulate temp, breathing, circulation for survival, incontinence, variable and unpredictable cranial nerves and reflexes,

Question 14

Minimally Conscious State

Answer 14

Ability to follow commands, gestural or verbal yes-no response, intelligible verbalizations, purposeful movement

Question 15

Glasgow Coma Scale: Motor Responses

Answer 15

1. no response
2. rigid and extended response to pain (decerebrate)
3. flexion in response to pain (decorticate)
4. Pulls Part of body away in response to pain
5. Purposeful movement to painful stimulus
6. obeys commands to perform various movements

Question 16

Glasgow Coma Scale: Verbal Responses

Answer 16

1. No response
2. incomprehensible speech
3. inappropriate words
4. confused conversation but able to answer words
5. Oriented to Person/place/time

Question 17

Glasgow Coma Scale: Eye Opening

Answer 17

1. no response
2. To pain only
3. When asked with loud voice
4. Spontaneous - opens eyes on own

Question 18

RLA: I (No Response)

Answer 18

no response - completely unresponsive to any stimuli presented

Question 19

RLA: II (Generalized Response)

Answer 19

exhibits inconsistent and nonpurposful reactions to stimuli

Question 20

RLA: III (Localized Response)

Answer 20

Reacts specifically to stimuli, though inconsistently

Question 21

RLA: IV (Confused/Agitated)

Answer 21

heightened state of activity with severely decreased ability to process information

Question 22

RLA: V (Confused/Inappropriate/Non agitated)

Answer 22

appears alert with fairly consistent reactions, although increased complexity of commands cause more random responses

Question 23

RLA: VI (Confused/Appropriate)

Answer 23

exhibits goal-directed behavior but is dependent on external input for direction

Question 24

RLA: VII (Automatic/Appropriate)

Answer 24

behaved appropriately and is oriented to place and routine, but frequently displays shallow recall

Question 25

RLA: VIII-X (Purposful/Appropriate)

Answer 25

is alert and oriented and able to recall and integrate past and recent events. Each level now represents a decreasing need for assistance with routine daily living skills

Question 26

OT Evaluation

Answer 26

begins with establishing occupational profile. info may be gathered from family depending on level of consciousness. Evaluate performance skills and client factors in areas of motor functioning and emotion regulation

Question 27

OT intervention: Acute Phase

Answer 27

occur in intensive and acute care of hospitals with preventative and restorative approaches.

• Positioning in WC and in Bed to prevent breakdown, improve respiration and swallowing, and normalizing tone
• PROM as a prep for preventing development of secondary impairment
• Splinting/Casting to increased ROM, normalize tone and decreased contractures
• Sensory Stimulation with controlled input
• Management of agitation using strategies to avoid reinforcing inappropriate behavior during medically necessary treatments,
• Family/Caregiver Education to focus on sensory regulation, positioning, and ROM

Question 28

OT intervention: Inpatient Rehab Phase

Answer 28

generally begin at RLA V. and aims to accomplish:

• optimize motor function learning, skill acquisition, exercise beginning with gross motor functions using occupation-based activities (ataxia..use weights/apraxia..use HOH or picture sequence)
• optimize visual abilities, compensatory strategies, contrasting colors, textures, sunglasses, using neglected side during activities, environmental adaptation,
• optimize cognition, emphasize self-awareness of deficits, engagement in ADLs/IADLs to develop problem solving, planning, organization, concentration, frustration tolerance
• optimize voice and speech function, expressive aphasia with conversation exercises, communication devices
• restore self-maintenance tasks
• Bed mobility
• wheelchair management and positioning
• functional ambulation
• community mobility
• transfers
• home management
• community reintegration
• behavior and emotional adaptation

Question 29

OT intervention: Postacute rehabilitation phase

Answer 29

rehab transitions from inpatient to home-based, residential, day treatment, outpatient community reentry
Intervention in addressing residual deficits in cognition, vision/perception, self-maintenance and restore competence in leisure, social participation, and work