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NPTE-NMSK (Josh) > Traumatic Brain Injury + Scales > Flashcards

Traumatic Brain Injury + Scales Flashcards

1
Q

HIGHEST incidence of TBIs

A

MVA’s, falls, high risk behaviors (m>w), GSWs

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2
Q

Types of TBI?

A

Open vs Closed
Primary vs Secondary (sig bc widespread dmg)

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3
Q

Types TBI:

Open Injury

What is it, Dmg, Ex.

A
  • DIRECT penetration THRU skull to brain
  • Damage: depends on loc, depth, pathways involved

Ex. GSW, knife, direct truama

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4
Q

Types TBI:

Closed Injury

What is it? Dmg? Ex?

A
  • NO penetration
  • Ex’s: Contusion, concussion, hematoma, hypoxia, OD, near drown, accel/decel inj’s
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5
Q

Types TBI:

Primary

A
  • INITIAL inj to brain from impact
  • Coup Lesion– Direct lesion of brain under point of impact
  • Contrecoup Lesion (Rebound Effect)– Inj on OPP side of brain (back)

Ex. skull penetration, contusion to gray/white matter

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6
Q

Types TBI:

Secondary

Exactly what it sounds like

A
  • Damage as a response to Initial inj
  • Epidural Hematoma– hemorrhage bw skull & Dura mater
  • Subdural Hematoma– hemorrhage due to venous rupture bw dura & arachnoid

Ex’s: hematoma, hypoxia, ischemia, incd ICP, post-trauma epilepsy

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7
Q

Lvls of Consciousness

From UNCONCSCIOUSNESS TO CONSCIOUSNESS

A

Coma->Stupor->Obtundity->Delirium->Clouding of Consciousness->Consciousness

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8
Q

Lvls of Consciousness

From UNCONCSCIOUSNESS TO CONSCIOUSNESS

A

Coma->Stupor->Obtundity->Delirium->Clouding of Consciousness->Consciousness

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9
Q

Lvls of Consciousness

Coma

A

State of unconscoiusness & lvl of unresponsiveness to ALL int/ext stimuli

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10
Q

Lvls of Consciousness

Stupor

A

State of General unresponsiveness w/ arousal occurring from repeated stim

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11
Q

Lvls of Consciousness

Obtundity

A

State of Consciousness–state of sleep, reduced alert to arousal, delayed response to stim

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12
Q

Lvls of Consciousness

Delirium

A

State of Consciousness–Disorientation, confusion, agitation, loudness*

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13
Q

Lvls of Consciousness

Clouding of Consciousness

A

State of Consciousness–quiet behavior, confusion, poor attn, delayed responses

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14
Q

Lvls of Consciousness

Consciousness

A

State of alertness, awareness, orientation, memory

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15
Q

Concussions!
Usually from -

A

Blow to the head

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16
Q

Concussion Details

A
  • MAYBE temporary LOC
  • Dmg to Reticular Activating System (RAS)==immed changes in Vitals
  • Secondary to acute trauma
17
Q

Concussion Grades-American Academy of Neurology

Grade 1

A
  • Head inj w/ NO LOC, SOME transient confusion
  • Sx’s resove 15mins–may exhibit full memory of event
  • REMOVE athlete from play–RETURN if sx free 1 week
18
Q

Concussion Grades-American Academy of Neurology

Grade 2

A
  • MOD head injury w/ transient confusion >15mins
  • Poor concentration, retro/aterograde amnesia
  • REMOVE athlete immed–medical eval—-CT if sx’s worsen
  • RETURN TO PLAY—asymptomatic 2wks @ rest AND w/ exertion
19
Q

Concussion Grades-American Academy of Neurology

Grade 3

A
  • Head inj w/ ANY form LOC
  • ER transport–full neuro eval
  • Hospitalize if altered consciousness or mental status persists
  • Athlete w/held after Grade 3—-RETURN once Sx free 1mo MIN

Grade 3 concussion 2 diffuse axonal injury—-potential coma

20
Q

RLA Lvls of Cognitive Functioning (goes worse to better)

Name out the Lvls

Coma Lvl

A

Lvl I: No response
Lvl II: Generalized Response
Lvl III: Localized response
Lvl IV: Confused-Agitated
Lvl V: Confused-Inappropriate
Lvl VI: Confused-Appropriate
Lvl VII: Automatic-Appropriate
Lvl VIII: Purposeful-Appropriate

21
Q

RLA Lvls of Cognitive Functioning

Lvl I: No response

Coma lvl

A

DEEP coma—> NO resp to ANY stimuli

22
Q

RLA Lvls of Cognitive Functioning

Lvl II: Generalized Response

Coma lvl

A
  • Sleeps MOST of time, awake briefly
  • Responses/Body mvmts are reflexive, NONpurposeful
23
Q

RLA Lvls of Cognitive Functioning

Lvl III: Localized Response

Coma lvl

A
  • Alert greater than brief pds
  • Reacts to commands INconsistently BUT…
  • Responds to specific types of stimuli (Ex. touch produces w/draw)
24
Q

RLA Lvls of Cognitive Functioning

Lvl IV: Confused-Agitated

A
  • Behavior==marked confusion & agitation as awareness INCs–> aggressive, inapprop.
  • Speech incoherent
  • **Not able to actively participate in tx d/t lack of attn
  • Cannot perform ADLs (eat, brush)**
25
Q

RLA Lvls of Cognitive Functioning

Lvl V: Confused-Inappropriate

A
  • INconsist. ability to follow commands
  • **LTM returning
  • Well-known skills (eating) returning BUT…**
  • Complex tasks diff as are NEW skills + concentration
26
Q

RLA Lvls of Cognitive Functioning

Lvl VI: Confused-Appropriate

goal-directed behavior one

A
  • Demo’s Goal-Directed behavior
  • Now aware of difficulties and familiar people
  • ## Retention of re-learned skills improved—-can be used in other situations
27
Q

RLA Lvls of Cognitive Functioning

Lvl VII: Automatic-Appropriate

A
  • Performs ADLs w/ more ease, robot-like
  • Able to learn NEW skills
  • Noticeable impairs in short-term memory & problem solving
28
Q

RLA Lvls of Cognitive Functioning

Lvl VIII: Purposeful-Appropriate

BEST

A
  • Able to function w/in community–even w/…
  • Cont’d impairments in cognitive ability and social/emo. ability

Revised: Lvl IX: Standby Assist on Request; Lvl X: Moderately IND

29
Q

Glasgow Coma Scale

Initially after injury to det. arousal & cerebral cortex function

A
  • Range 3-15
  • </= 8– Coma (correlated w/ LTC needed
  • 9-12= Mod
  • 13-15= Mild
  • 3 components: Eye Opening, Best Motor, Best Verbal
30
Q

Glasgow Coma Scale:
Eye Opening

E: 4-1

A

4= Spontaneous EO
3= Open to command
2= Open to pain stim (noxious)
1= No response

31
Q

Glasgow Coma Scale:
Best Motor

M: 6-1

A

6= Obeys command
5= Localizes
4= W/draws
3= Decorticate (Flexion)
2= Decerebrate (Extension)
1= No response

32
Q

Glasgow Coma Scale:
Best Verbal

V: 5-1

A

5= Oriented
4= Responsive but disoriented, confused
3= Inappropriate
2= Moans
1= No response

33
Q

GCS range

A
  • 3-15
  • </=8—Coma
34
Q

Memory Impairments

Anterograde Amnesia

think FORWARD

A
  • Inability to create new memory
  • Usually LAST to recover after coma
  • Ex. cannot remember being in hospital after injury
35
Q

Memory Impairments

Post-Traumatic Amnesia

Indicator of damage

A
  • Inability to form Day-to-Day memories
  • Time bw injury and when able to recall events
  • Indicator of extent of damage
36
Q

Memory Impairments

Retrograde Amnesia

think BACKWARDS

A
  • Inability to remember events PRIOR to injury
  • Progressively DECs w/ recovery
  • Ex. cannot remember being in car (if MVA)
37
Q

TBI Intervention/Tx
Dependent on….

A

Primary Dx,2 comps, co-morbs, lvl of impairment

38
Q

TBI Tx: Areas to focus/emphasize

LOTS

A
  • Motivation, promoting IND, Goal-directed/Functional, Orientation & behavior modification activities, REPETITION!, structure of Tx, AVOID overstimulation (simple commands, soft voice), familiar/enjoyable activities, family edu/support, flexibility needed based on immediate needs and state of mind (Cornerstone to mobility!)
39
Q

TBI Tx:
INTERVENTIONS

A
  • Cognition/Orientation training
  • TherEX
  • Positioning
  • Sensory integration
  • Balance/vestib
  • ROM
  • Motor function
  • W/C & adaptive equip Rx
  • Splinting/serial casting
  • Mobility

NPTE-NMSK (Josh) (4 decks)

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