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Physical Conditions in Adults > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Risk factors for a TBI?

A

age

gender

prisoner status

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2
Q

What condition often plays an indirect role in the onset of a TBI?

A

substance abuse

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3
Q

More than 50% of patients who experience a TBI found to have what at the time of the injury?

A

elevated blood alcohol levels

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4
Q

Does a prior TBI of any severity affect an individuals risk of a repeat TBI?

A

yes, they are at an increased risk for a repeat TBI

risk rises further with each subsequent TBI.

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5
Q

What complex changes in physical, cognitive, neurobehavioral due to brain damage are seen?

A

Functions potentially compromised:

Coordinated movement
Speech
Memory
Reasoning
Altered behavioral responses
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6
Q

What kind of congenital or degenerative disease is associated with TBIs

A

none

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7
Q

What are the 3 TBI classifications?

A

Mild: <30 min loss of consciousness (GCS 13-15)

Moderate: 30min–24hrs loss of consciousness (GCS 9-12)

Severe: > 25hrs loss of consciousness (GCS 3-8)

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8
Q

What is a primary injury in TBIs?

A

occur at the moment of impact directly due to the actual trauma

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9
Q

What is a secondary injury in TBIs?

A
  • occur as a consequence of the primary injury and can develop anywhere from hours to days after the initial injury.
  • Closed injuries are where the skull and lining of the brain are left intact.
  • Open injuries are where the intracranial vault is exposed to the outside environment.
  • Blunt force trauma refers to impact against a relatively flat object or surface.
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10
Q

What does primary brain damage from a TBI look like?

A
  • May be focal or diffuse
  • Direct impact, acceleration, deceleration, rotation pf the brain, intrusion into the brain by penetrating object
  • DAI= Diffuse Axonal Injuries: Head collision at 15mph or greater; typically results in profound coma and a poor outcome
  • Coup and Contrecoup injuries
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11
Q

Difference between coup and contrecoup injuries?

A

damage to the brain on both sides: the side that received the initial impact (coup) and the side opposite the initial impact (countrecoup)

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12
Q

What does secondary brain damage from a TBI look like?

A

Occurs within hours or days following injury

Factors include:
Inflammatory response
Increased intracranial pressure
Decreased cerebral blood flow or ischemia

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13
Q

Potential medical complications associated with a TBI?

A
  • Hydrocephalus: excessive accumulation of fluid in the brain
  • Seizures
  • Dysautonomia
  • Deep vein thrombosis
  • Coma

Systemic complications:

  • Cardiovascular
  • Respiratory
  • Immunological
  • Hematological
  • Endocrinological
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14
Q

What are the 3 leading causes of TBIs?

A

Falls (most common)

Motor vehicle accidents (most common severe TBI)

Violence

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15
Q

Which age group sees the most ER visits due to TBIs?

A

age 5 and > age 85

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16
Q

Are TBIs that are associated with motor vehicle accidents seen more in males or females?

A

males

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17
Q

Who is at the greatest risk for TBIs?

A

Men ages 15 to 24 greatest risk for injury

Inner city environments have higher incidence rates

American Indian/ Alaskan and African American highest TBI cases

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18
Q

What is the most common medical complication following TBI?

A

hydrocephalus

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19
Q

What is the most common preventable cause of hospital death in TBI?

A

pulmonary emboli which can arise from deep vein thrombosis

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20
Q

What is dysautonomia characterized by?

A

Hypertension

Tachycardia

Increased body

Temperature

Profuse sweating

Decerebrate or decorticate posturing

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21
Q

Difference between decerebrate or decorticate posturing

A

Decerebrate: shoulder adducted, arm extended, forearm pronated, wrist flexed, feet plantar flexed

Decorticate: shoulder adducted, arm flexed, wrist flexed, leg internally rotated, feet plantar flexed

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22
Q

What is Post Traumatic Stress Amnesia (PTA)?

A

Gradual regaining of consciousness following coma

Permanent memory gap from time of injury to the point at which patient starts to remember events

PTA (with GCS) important predictor of functional recovery

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23
Q

What is the Australia the Westmead Post Traumatic Amnesia Scale?

A

most widely used measure

  • PTA less than 5 minutes = “very mild injury”
  • PTA between 5-60 minutes = “mild injury”
  • PTA between 1-24 hours = “moderate injury”
  • PTA between 1-7 days = “severe injury”
  • PTA greater than 7 days = “very severe injury”.
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24
Q

In the early phase of recovery after a TBI what are the altered levels of consciousness in a more severely injured patient?

A

Coma: State of unconscious – patient cannot be aroused

Vegetative state: Patient exhibits spontaneous arousal through eye opining; No purposeful behavior or communication

Minimally conscious state: Some awareness of self and environment

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25
What does the duration of altered consciousness after a TBI indicate?
level of TBI severity
26
What are the 3 most common early-onset medical complications following a TBI?
Increases in intracranial pressure (ICP) Posttraumatic hydrocephalus (PTH) Posttraumatic agitation
27
What is Increases in intracranial pressure (ICP) | following a TBI?
ICP due to cerebral edema or bleeding can cause compression of brain structures, cerebral ischemia from reduced cerebral blood perfusion, or herniation of the brain through the skull
28
What is Posttraumatic hydrocephalus (PTH) following a TBI?
Caused by blockage of normal cerebrospinal fluid (CSF) flow, overproduction of CSF, or insufficient absorption of CSF back into the body
29
What is Posttraumatic agitation following a TBI?
A subtype of delirium marked by restlessness, impulsivity, aggression, emotional lability, disinhibition, and confusion usually occurring during early recovery
30
What are some ongoing complications of a TBI?
- Hypertension - headache - sleep disturbances - dysautonomia - posttraumatic seizures - deep venous thrombosis (DVT) - malnutrition - bowel-related issues - urological dysfunction - spasticity - pressure ulcers - endocrine dysfunction - heterotopic ossification (HO) - balance and coordination deficits - cognitive and behavioral dysfunction
31
Motor deficits following a TBI
Decerebrate rigidity: Damage to brainstem between the vestibular nuclei and the red nucleus Decorticate rigidity: Brainstem intact despite severe cortical damage Spasticity: Common in adults after moderate to severe TBI Hemiplegia Heterotopic ossification: bone formation at an abnormal soft tissue site Tremors / ataxia
32
What are the 4 types of tremors seen after a TBI?
cerebellar (intention) resting essential physiologic
33
What is a cerebellar (intention) tremor?
slow tremors that occur at the end of purposeful movement associated with ataxia, hypotonia, and balance disorders tend to occur in trunk and proximal muscles with intentional movement
34
What is a resting tremor?
pill-rolling movement at rest
35
What is an essential tremor?
slow constant tremors typically affect more distal musculature
36
What is a physiologic tremor?
A normal phenomenon physiologic tremor occurs in all contracting muscle groups can be exacerbated by fatigue, stress, strong emotions, caffeine, and fever
37
What kind of deficits are most common, difficult, and long-lasting consequences of all levels of TBI in both adults and children?
cognitive deficits
38
What kind of cognitive deficits are seen following a TBI?
Retrograde / anterograde amnesia: Memory loss Sustained attention Reasoning skills Impulse control
39
What kind of psychosocial deficits are seen following a TBI?
Perseveration Poor control of temper Aggression / irritability Apathy Depression Suicide: evidence of aggression and hostility are predictive of suicide attempts PTSD
40
Are visual deficits or perceptual deficits more common following a TBI?
visual deficits
41
Visual deficits seen following a TBI
Diplopia Problems with accommodation Problems with convergence Visual field deficits Saccadic dysfunction Strabismus
42
What is known as the hallmark of visual deficits for persons with TBI and often results in the individual closing one eye to eliminate double vision?
diplopia
43
Cranial nerve disfunctions following a TBI?
Absent pupillary reflex to light (CN III) Fixed dilated pupil Homonymous hemianopsia (CN II) Bitemporal hemianopsia Loss of sense of smell (CN I) High-frequency hearing loss (CN VIII) Glossopharyngeal (IX) / vagus nerves (X)
44
What does dysfunction of the glossopharyngeal and vagus nerve result in?
absent or depressed gag reflex and decreased movement of the palate and uvula. This decreased oral-motor movement makes swallowing hazardous and may necessitate continued use of nasogastric or gastrostomy feeding tubes
45
By how many years may a TBI reduce a lifespan?
9 years
46
prognosis factors
trauma score GCS score biomarkers presence / absence of hypoxia length of coma duration of amnesia
47
What is commonly associated with mortality from TBI of children <1yr old?
abuse
48
3 Common Assessments in TBI
GCS (Glasgow Coma Scale/Score) DRS (Disability Rating Scale) Ranchos Los Amigos Scale (Levels of Cognitive Functioning Scale – LCFS)
49
What is the DRS (Disability Rating Scale)?
expanded GCS assessment to more clearly determine disability after TBI May be used at admission and discharge from rehab
50
What is the Ranchos Los Amigos Scale (Levels of Cognitive Functioning Scale – LCFS)
used in many rehabilitation programs classifies the admitted patient into one of eight levels of cognitive functioning Limitations: does not adequately reflect small changes in recovery, may not accurately place a patient with characteristics of two or more categories, and is less accurate at higher levels
51
Level 1 of Ranchos Los Amigos Scale
no response to external stimuli appears asleep
52
Level 2 of Ranchos Los Amigos Scale
generalized response react to external stimuli in nonspecific, inconsistent, and purposeful manner w/ stereotypic and limited responses
53
Level 3 of Ranchos Los Amigos Scale
localized response responds specifically and inconsistently w/ delays to stimuli, but may follow simple commands for motor action
54
Level 4 of Ranchos Los Amigos Scale
confused, agitated response bizarre, nonpuposeful, incoherent or inappropriate behaviors no short-term recall attention is short and nonselective
55
Level 5 of Ranchos Los Amigos Scale
confused, inappropriate, nonagitated response random, fragmented, and nonpurposeful responses to complex or unstructured stimuli - simple commands are followed consistently memory and selective attention are impaired new information is not retained
56
Level 6 of Ranchos Los Amigos Scale
confused, appropriate response context appropriate, goal-directed responses, dependent upon external input for direction carry-over for relearned, but not for new tasks recent memory problems exist
57
Level 7 of Ranchos Los Amigos Scale
automatic, appropriate response behaves appropriately in familiar settings, performs daily routines automatically, and shows carry-over for new learning at lower than normal rates initiates social interactions, but judgment remains impaired
58
Level 8 of Ranchos Los Amigos Scale
purposeful, appropriate response patient oriented and responds to the environment but abstract reasoning abilities are decreased relative to premorbid levels
59
What are the management techniques for the acute phase following a TBI?
Focus: preservation of life, prevention of secondary damage, management of complications Endotracheal tube: To maintain a patent airway CAT scan: Possible surgical decompression Indwelling urinary catheter Nasogastric tube Skin integrity Medications to control seizures ROM/Splinting
60
What are the inpatient rehabilitation requirements following a TBI (general, acute, subacute)?
Moderate to severe TBI Admission requirements: Medical stability, Need for close medical supervision, Need for active and ongoing intensive therapy by multiple therapy disciplines Acute Inpatient Rehab: Must be able to tolerate at least 3 hrs of therapy per day (2 or more therapies) 5-7 days/week Subacute Inpatient Rehab: Must be able to tolerate 0.5-2 hrs per day
61
TBI Impact on Occupational Performance
Community living skills Meal preparation / safety Feeding skills Employment Bathing Money management Driving

Physical Conditions in Adults (7 decks)

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