Traumatic Brain Injury

Question 1

Types of Brain Injury

Answer 1

Open: direct penetration through the skull to brain
Closed: Injury to the brain without penetration through the skull

Primary: Initial injury to the brain via impact
Secondary: Occurs a response to initial injury

Question 2

Levels of consciousness

Answer 2

Coma: unresponsiveness to all internal and external stimuli
Stupor: general unresponsiveness with arousal from repeated stimuli
Obtundity: Sleep, reduced alertness to arousal, delayed responses to stimuli
Delirium: disorientation, confusion, agitation, and loudness
Clouding of consciousness: quiet behavior, confusion, poor attention, and delayed responses

Question 3

Levels of concussion

Answer 3

Grade 1: No loss of consciousness but often some transient confusion. Symptoms typically resolve within 15 minutes. Should be removed from sports and return after 1 week of rest if symptom free.
Grade 2: Transient confusion for longer than 15 minutes. Poor concentration and retrograde and anterograde amnesia. Can return to play after asymptomatic for 2 weeks at rest and with exertion.
Grade 3: Loss of consciousness. Should report to ER. Hospitalization warranted if altered consciousness or mental status persists. Can return to play if symptom free for at least 1 month.

Question 4

Rancho Los Amigos Levels of Cognitive Functioning: I. No Response

Answer 4

Completely unresponsive to any stimuli

Question 5

Rancho Los Amigos Levels of Cognitive Functioning: II. Generalized Response

Answer 5

Reacts inconsistently and non-purposely to stimuli. Responses may be physiological, gross body movements, or vocalization

Question 6

Rancho Los Amigos Levels of Cognitive Functioning: III. Localized Response

Answer 6

Reacts specifically but inconsistently to stimuli. May follow simple commands like closing the eyes or squeezing the hand in an inconsistent, delayed manner.

Question 7

Rancho Los Amigos Levels of Cognitive Functioning: IV. Confused-Agitated

Answer 7

Behavior is bizarre and non-purposeful. Unable to cooperate directly with treatment efforts. Verbalizations may be incoherent and/or inappropriate to environment. Gross attention to environment is brief. Lacks short and long-term recall.

Question 8

Rancho Los Amigos Levels of Cognitive Functioning: V. Confused-Inappropriate

Answer 8

Able to respond to simple commands fairly consistently. Gross attention to environment but highly distractible and lacks attention to specific task. Verbalization often inappropriate and confabulatory. Memory severely impaired. May perform previously learned tasks with structure but unable to learn new tasks.

Question 9

Rancho Los Amigos Levels of Cognitive Functioning: VI. Confused-Appropriate

Answer 9

Shows goal-directed behavior but is dependent on external input/direction. Follows simple directions consistently and shows carryover for relearned tasks. Past memories have more depth and detail than recent memory.

Question 10

Rancho Los Amigos Levels of Cognitive Functioning: VII. Automatic-Appropriate

Answer 10

Goes through daily routine automatically. Minimal to no confusion. Shows carryover for new learning but at a decreased rate. Judgment remains impaired.

Question 11

Rancho Los Amigos Levels of Cognitive Functioning: VIII. Purposeful-Appropriate

Answer 11

Can recall and integrate past and recent events and is aware of and responsive to environment. Shows carry over for new learning and needs no supervision once activities are learned. May show decreased ability for abstract reasoning, tolerance for stress, and judgment in emergencies/unusual circumstances.

Question 12

Glasgow Coma Scale

Answer 12

Used initially after injury to determine arousal and cerebral cortex function.
Score of less than 8 is severe brain injury and coma in 90% of patients
Score of 9-12 is moderate brain injury
Score of 13-15 is mild brain injury