Traumatic Brain Injury Flashcards
1
Q
What is a concussion?
A
- A significant blow to the head which may or may not result in loss of consciousness and/or amnesia events surrounding injury. Can be caused by shearing of cells, and usually undetectable by CT or MRI
Grade 1: mild concussion occurs when the person does not lose consciousness but may seem dazed
Grade 2: slightly more severe form; person does not lose consciousness but has a period of confusion and does not recall the event
Grade 3: classic concussion; most severe form; occurs when the person loses consciousness for a brief period of time and has no memory of the event
2
Q
What is a hematoma?
A
- Blood leak collects in a confined area of the brain or skull
- Subdural: between the brain and dura
- Epidural: between the skull and dura
- Intracerebral: deep in the bran
- Subarachnoid: inside subarachnoid space
3
Q
What is anoxia or hypoxia?
A
- Cell death resulting from brain cells receiving no oxygen or lack of oxygen
4
Q
What is a diffuse axonal injury?
A
- Injury is not localized, involves multiple areas of the brain. Damage occurs to the axons that connect the different areas of the brain. This occurs when the brain tissue twists or rotates inside the skull at the time of injury
- Commonly seen in MVAs
5
Q
What is a coup-contrecoup injury?
A
- Coup: injury at the site of impact
- Coup/Contrecoup: impact causes the brain to bump to the opposite side of the skull. Damage occurs at the site of impact (coup) and on the opposite side of the brain (contrecoup)
6
Q
How does a CVA differ from a TBI?
A
- Damage from a CVA is usually isolated to one area, whereas damage from a TBI is diffuse
- In a CVA there is unilateral flaccidity or spasticity and in a TBI there is commonly more pronounced bilateral spasticity or rigidity
- Cognition may be impaired from a CVA but is commonly impaired from a TBI
- Perception may be impaired from a CVA but is commonly impaired from a TBI
- Speech is less commonly affected in TBI
- CVA associated problems: high BP
- TBI associated problems: multi-trauma: internal/soft tissue injuries, fractures, dislocations, cosmetic
7
Q
How is intracranial hypertension managed?
A
- Proper positioning of patient
- Avoid overstimulation
- Decrease agitation through sedation
- Paralyzing of voluntary muscles
- Decreasing the metabolism of the brain through phenobarbital coma to decrease cerebral blood volume
- Dehydrating the brain through mannitol infusion
- Removing SCF through ventriculostomy drainage
8
Q
What are initial precautions that are taken when a patient has increased intracranial pressure?
A
- Check the patient and discontinue evaluation/treatment if ICP rises above 20 mm Hg
- Observe for pupil changes, neurological responses, abnormal brainstem reflexes, flaccidity, vomiting, or changes in pulse rate
- Do not flex neck in sidelying with high ICP
- Check physicians orders for head elevation before initiating oral motor, facial, and neck movements
- Be alert to post-traumatic seizures. If a person is having a seizure, roll them to their side and time it
- Follow restraint instructions
- Know patient’s respiratory status
- Avoid testing muscles with increased muscle tone
- Prevent edema and deformities by appropriate positioning
- Provide a safe environment to avoid injury due to possible disorientation
- Use caution in treatment of agitated patient. Be cognizant of expected recovery stages. Recognize storming: uncontrollable BP, increased ICP, etc.
- Be aware of sensory deficits and monitor the patient’s prolonged positioning watching for skin breakdown from position/orthotics
- Be aware of unilateral neglect as it affects patient’s safety during functional mobility
- Be aware of deficits in communication which may cause misunderstanding
9
Q
What is a coma?
A
- An altered state of consciousness
- No arousal or awareness
10
Q
What is a vegetative state?
A
- An altered state of consciousness
- Person appears awake but has no purposeful interaction with the environment (persistent is when the state lasts longer than one month)
11
Q
What is locked-in syndrome?
A
- An altered state of consciousness
- Person is awake and alert but can only communicate through eye movements and computer technology
12
Q
What are the stages of a coma?
A
- Stage 1: patient exhibits no response
- Stage 2: patient exhibits decerebrate rigidity
- Stage 3: patient exhibits decorticate rigidity; patient flexes UE while extending LE
- Stage 4: patient has a massive withdrawal from the stimulus and may display non-purposeful movement of limbs
- Stage 5: patient begins to localize to stimulus
- Stage 6: patient responds appropriately to stimulus
13
Q
How is a patient in a coma evaluated?
A
- State of consciousness: Glasgow or Rancho
- Presence and quality of reflexes
- Sensory awareness and level of motor response
- PROM
- Muscle tone
- Cognition
- Pre-feeding and oral motor skills
14
Q
What are the ranges for the Glasgow Coma Scale?
A
- Severe: less or equal to 8
- Moderate: 9-12
- Minor: greater or equal to 13
15
Q
What are the Rancho Levels of cognitive functioning?
A
Stages of brain recovery
- Evaluation tool used by rehabilitation professionals
- Used to describe the patterns or stages of recovery typically seen after a brain injury
- Helps rehab team understand and focus on person’s abilities and design appropriate treatment program
- Each person progresses at their own rate, depending on level of severity and length of time since TBI
- Some individuals will pass through all 10 stages while others may progress to a certain level and fail to change to the next higher level
