Traumatic Brain Injury CAT

Question 1

What causes a TBI?

Answer 1

• Open head injury (penetration through skill)
• Closed head injury (brain impacts w/ the skull due to acceleration/deceleration)
• Secondary to anoxia w/ cardiac arrest or near drowning

Question 2

Leading causes for TBI

Answer 2

• Falls
• MVA

Question 3

High risk groups for TBI

Answer 3

• 0-4
• 15-19
• 65+
• Males > females

Question 4

Clinical presentation for TBI

Answer 4

• Varies w/ type, area, extent of injury, and secondary damage to the brain
• Altered consciousness (coma, obtundity, delirum)
• Cognitive and behavioral deficits
• Changes in personality
• Motor impairments
• Alterations in tone
• Speech and swallowing issues

Question 5

Labs/imaging for TBI

Answer 5

• CT/MRI to rule out hemorrhage, infarction, and swelling
• X-ray for c-spine damage

Question 6

Additional measures for consideration

Answer 6

• Glasgow coma scale
• Rancho Los Amigos Levels of Cognitive Functioning

Question 7

Medical management of TBI

Answer 7

• Initiated at the site of injury or ER
• Initial goal is to stabilize, control intracranial pressure, prevent secondary complications
• Surgery may be needed to regain homeostasis
• PT is initiated once pt is stabilized

Question 8

PT management of TBI

Answer 8

• Sensory stimulation and PROM for comatose pt
• Pathfinding and high-level balance for mild injury
• Functional mobility, behavior modification, serial casting, compensatory strategies, vestibular rehabilitation, task specific activities, WC prescription, pulmonary intervention

Question 9

Pharmacological management of TBI

Answer 9

• Cerebral vasoconstrictive agents
• Psychotropic agents
• Hypertensive agents
• Antispasticity agents
• Meds to assist w/ cognition and attention