Traumatic Brain Injury + Scales

Question 1

HIGHEST incidence of TBIs

Answer 1

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

Question 2

Types of TBI?

Answer 2

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

Question 3

Types TBI:

Open Injury

What is it, Dmg, Ex.

Answer 3

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

Ex. GSW, knife, direct truama

Question 4

Types TBI:

Closed Injury

What is it? Dmg? Ex?

Answer 4

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

Question 5

Types TBI:

Primary

Answer 5

• 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

Question 6

Types TBI:

Secondary

Exactly what it sounds like

Answer 6

• 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

Question 7

Lvls of Consciousness

From UNCONCSCIOUSNESS TO CONSCIOUSNESS

Answer 7

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

Question 8

Lvls of Consciousness

From UNCONCSCIOUSNESS TO CONSCIOUSNESS

Answer 8

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

Question 9

Lvls of Consciousness

Coma

Answer 9

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

Question 10

Lvls of Consciousness

Stupor

Answer 10

State of General unresponsiveness w/ arousal occurring from repeated stim

Question 11

Lvls of Consciousness

Obtundity

Answer 11

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

Question 12

Lvls of Consciousness

Delirium

Answer 12

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

Question 13

Lvls of Consciousness

Clouding of Consciousness

Answer 13

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

Question 14

Lvls of Consciousness

Consciousness

Answer 14

State of alertness, awareness, orientation, memory

Question 15

Concussions!
Usually from -

Answer 15

Blow to the head

Question 16

Concussion Details

Answer 16

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

Question 17

Concussion Grades-American Academy of Neurology

Grade 1

Answer 17

• 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

Question 18

Concussion Grades-American Academy of Neurology

Grade 2

Answer 18

• 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

Question 19

Concussion Grades-American Academy of Neurology

Grade 3

Answer 19

• 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

Question 20

RLA Lvls of Cognitive Functioning (goes worse to better)

Name out the Lvls

Coma Lvl

Answer 20

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

Question 21

RLA Lvls of Cognitive Functioning

Lvl I: No response

Coma lvl

Answer 21

DEEP coma—> NO resp to ANY stimuli

Question 22

RLA Lvls of Cognitive Functioning

Lvl II: Generalized Response

Coma lvl

Answer 22

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

Question 23

RLA Lvls of Cognitive Functioning

Lvl III: Localized Response

Coma lvl

Answer 23

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

Question 24

RLA Lvls of Cognitive Functioning

Lvl IV: Confused-Agitated

Answer 24

• 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)**

Question 25

# RLA Lvls of Cognitive Functioning Lvl V: Confused-Inappropriate

Answer 25

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

Question 26

# RLA Lvls of Cognitive Functioning Lvl VI: Confused-Appropriate | goal-directed behavior one

Answer 26

- **Demo's Goal-Directed behavior** - Now aware of difficulties and familiar people - Retention of **re-learned skills improved**----can be used in other situations -

Question 27

# RLA Lvls of Cognitive Functioning Lvl VII: Automatic-Appropriate

Answer 27

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

Question 28

# RLA Lvls of Cognitive Functioning Lvl VIII: Purposeful-Appropriate | BEST

Answer 28

- **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

Question 29

Glasgow Coma Scale | Initially after injury to det. arousal & cerebral cortex function

Answer 29

- Range 3-15 - **

Question 30

Glasgow Coma Scale: Eye Opening | E: 4-1

Answer 30

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

Question 31

Glasgow Coma Scale: Best Motor | M: 6-1

Answer 31

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

Question 32

Glasgow Coma Scale: Best Verbal | V: 5-1

Answer 32

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

Question 33

GCS range

Answer 33

- 3-15 - **

Question 34

# Memory Impairments Anterograde Amnesia | think FORWARD

Answer 34

- Inability to create new memory - **Usually LAST to recover after coma** - Ex. cannot remember being in hospital after injury

Question 35

# Memory Impairments Post-Traumatic Amnesia | Indicator of damage

Answer 35

- Inability to form Day-to-Day memories - Time bw injury and when able to recall events - **Indicator of extent of damage**

Question 36

# Memory Impairments Retrograde Amnesia | think BACKWARDS

Answer 36

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

Question 37

TBI Intervention/Tx Dependent on....

Answer 37

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

Question 38

TBI Tx: Areas to focus/emphasize | LOTS

Answer 38

- 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!)

Question 39

TBI Tx: INTERVENTIONS

Answer 39

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