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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
Q

What does the duration of altered consciousness after a TBI indicate?

A

level of TBI severity

26
Q

What are the 3 most common early-onset medical complications following a TBI?

A

Increases in intracranial pressure (ICP)

Posttraumatic hydrocephalus (PTH)

Posttraumatic agitation

27
Q

What is Increases in intracranial pressure (ICP)

following a TBI?

A

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
Q

What is Posttraumatic hydrocephalus (PTH) following a TBI?

A

Caused by blockage of normal cerebrospinal fluid (CSF) flow, overproduction of CSF, or insufficient absorption of CSF back into the body

29
Q

What is Posttraumatic agitation following a TBI?

A

A subtype of delirium marked by restlessness, impulsivity, aggression, emotional lability, disinhibition, and confusion usually occurring during early recovery

30
Q

What are some ongoing complications of a TBI?

A
  • 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
Q

Motor deficits following a TBI

A

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
Q

What are the 4 types of tremors seen after a TBI?

A

cerebellar (intention)

resting

essential

physiologic

33
Q

What is a cerebellar (intention) tremor?

A

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
Q

What is a resting tremor?

A

pill-rolling movement at rest

35
Q

What is an essential tremor?

A

slow constant tremors

typically affect more distal musculature

36
Q

What is a physiologic tremor?

A

A normal phenomenon

physiologic tremor occurs in all contracting muscle groups

can be exacerbated by fatigue, stress, strong emotions, caffeine, and fever

37
Q

What kind of deficits are most common, difficult, and long-lasting consequences of all levels of TBI in both adults and children?

A

cognitive deficits

38
Q

What kind of cognitive deficits are seen following a TBI?

A

Retrograde / anterograde amnesia: Memory loss

Sustained attention

Reasoning skills

Impulse control

39
Q

What kind of psychosocial deficits are seen following a TBI?

A

Perseveration

Poor control of temper

Aggression / irritability

Apathy

Depression

Suicide: evidence of aggression and hostility are predictive of suicide attempts

PTSD

40
Q

Are visual deficits or perceptual deficits more common following a TBI?

A

visual deficits

41
Q

Visual deficits seen following a TBI

A

Diplopia

Problems with accommodation

Problems with convergence

Visual field deficits

Saccadic dysfunction

Strabismus

42
Q

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?

A

diplopia

43
Q

Cranial nerve disfunctions following a TBI?

A

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
Q

What does dysfunction of the glossopharyngeal and vagus nerve result in?

A

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
Q

By how many years may a TBI reduce a lifespan?

A

9 years

46
Q

prognosis factors

A

trauma score

GCS score

biomarkers

presence / absence of hypoxia

length of coma

duration of amnesia

47
Q

What is commonly associated with mortality from TBI of children <1yr old?

A

abuse

48
Q

3 Common Assessments in TBI

A

GCS (Glasgow Coma Scale/Score)

DRS (Disability Rating Scale)

Ranchos Los Amigos Scale (Levels of Cognitive Functioning Scale – LCFS)

49
Q

What is the DRS (Disability Rating Scale)?

A

expanded GCS assessment to more clearly determine disability after TBI

May be used at admission and discharge from rehab

50
Q

What is the Ranchos Los Amigos Scale (Levels of Cognitive Functioning Scale – LCFS)

A

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
Q

Level 1 of Ranchos Los Amigos Scale

A

no response to external stimuli

appears asleep

52
Q

Level 2 of Ranchos Los Amigos Scale

A

generalized response

react to external stimuli in nonspecific, inconsistent, and purposeful manner w/ stereotypic and limited responses

53
Q

Level 3 of Ranchos Los Amigos Scale

A

localized response

responds specifically and inconsistently w/ delays to stimuli, but may follow simple commands for motor action

54
Q

Level 4 of Ranchos Los Amigos Scale

A

confused, agitated response

bizarre, nonpuposeful, incoherent or inappropriate behaviors

no short-term recall

attention is short and nonselective

55
Q

Level 5 of Ranchos Los Amigos Scale

A

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
Q

Level 6 of Ranchos Los Amigos Scale

A

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
Q

Level 7 of Ranchos Los Amigos Scale

A

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
Q

Level 8 of Ranchos Los Amigos Scale

A

purposeful, appropriate response

patient oriented and responds to the environment but abstract reasoning abilities are decreased relative to premorbid levels

59
Q

What are the management techniques for the acute phase following a TBI?

A

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
Q

What are the inpatient rehabilitation requirements following a TBI (general, acute, subacute)?

A

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
Q

TBI Impact on Occupational Performance

A

Community living skills

Meal preparation / safety

Feeding skills

Employment

Bathing

Money management

Driving

Physical Conditions in Adults (7 decks)

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