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711: Neurological Rehabilitation > Traumatic Brain Injury (TBI) > Flashcards

Traumatic Brain Injury (TBI) Flashcards

1
Q

What can be defined as “an insult to the brain, not of a degenerative or congenital nature but caused by an external physical force, that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning.”

A

Traumatic brain injury

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2
Q

What is the gender difference between men and women?

A

Men are twice as likely to acquire a TBI

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3
Q

What is the typical age range for TBIs?

A

15-24 years of age & individuals over 75 years

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4
Q

What are the 4 most common causes of TBIs?

A
  • MVA
  • Falls
  • Acts of violence
  • Sports
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5
Q

What are the 2 classifications of brain injuries?

A
  • open

- closed

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6
Q

What is the major difference between open and closed TBIs?

A

The meninges are intact with a closed TBI, but they are exposed in an open TBI, which increases the risk of infection

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7
Q

What are the 5 subtypes of closed injuries?

A
  • Concussion
  • Contusion
  • Hematomas
  • Locked-in Syndrome
  • Acquired Brain Injuries
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8
Q

Define concussion

A

A momentary loss of consciousness and reflexes

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9
Q

Why do concussions occur?

A

Shearing forces disrupt synapses in the brain

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10
Q

What is a contusion?

A

Bruising on the surface of the brain that is sustained on impact

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11
Q

What are the 2 types of lesions associated with a contusion?

A
  • Coup lesion

- Contrecoup lesion

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12
Q

A ____ lesion is a contusion on the same side of the brain as the impact, whereas a ______ lesion is a surface hemorrhage on the opposite side of the brain trauma as a result of deceleration.

A

coup

contrecoup

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13
Q

What are the 2 types of hematomas that can occur as a result of TBI?

A
  • Epidural hematomas

- Subdural hematomas

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14
Q

Where do epidural hematomas occur?

A

Between the dura mater and the skull

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15
Q

Rupture of what artery in the temporal fossa can cause epidural hematomas?

A

Middle Meningeal Artery

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16
Q

Where do subdural hematomas occur?

A

Between the dura mater and the arachnoid layer

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17
Q

Subdural hematomas result because of what?

A

rupture to the cortical bridging veins

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18
Q

Which type of hematoma is typically seen in the elderly after falls in which there is a small blood leak over several hours or weeks?

A

Subdural

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19
Q

What can cause an acquired TBI?

A
  • airway obstruction
  • near-drowning
  • MI
  • CVA
  • exposure to toxins
  • electrical shock or lightening strike
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20
Q

What percentage of TBI patients have increased intracranial pressure?

A

70%

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21
Q

What types of activities can cause an increase in ICP?

A
  • cervical flexion
  • percussion
  • vibration
  • coughing
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22
Q

The brain demands __% of the body’s oxygen to maintain proper oxygen saturation levels and metabolic function

A

20%

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23
Q

What most commonly causes an anoxic injury?

A

cardiac arrest

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24
Q

What 3 areas of the brain are the most vulnerable to anoxic injuries?

A
  • Hippocampus
  • Cerebellum
  • Basal Ganglia
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25
Q

It is hypothesized that anoxic injuries lead to what?

A

amnesia & movement disorders

26
Q

What can be defined as “a discrete clinical event reflecting temporary, physiologic brain dysfunction, characterized by excessive hypersynchronous cortical neuron discharge”

A

Seizure

27
Q

Seizures that result from a TBI are most common in what 3 types of patients?

A
  • open head injuries
  • subdural hematoma
  • older adults
28
Q

What are a few examples of in which a seizure may be triggered?

A
  • stress
  • poor nutrition
  • electrolyte imbalances
  • missed mediations or drug use
  • flickering lights
  • infection
  • fever
  • worry
  • fear
29
Q

Individuals who score in the - range on the Glasgow coma scale do not usually survive

A

3-4

30
Q

What are the 3 classifications of a mild TBI?

A
  • GCS of 13 or higher
  • Lss of consciousness less than 20 minutes
  • Normal CT scan
31
Q

What are the 3 classifications of a moderate TBI?

A
  • GCS of 9-12
  • Confused
  • Unable to answer questions
32
Q

What are the 2 classifications of a severe TBI?

A
  • GSC of 3-8

- Individual is in a coma

33
Q

What can be defined as the primitive state of being awake or alert

A

arousal

34
Q

What is responsible for level of arousal?

A

reticular activating system

35
Q

Define consciousness

A

The state of being aware

36
Q

Define coma

A

A state of decreased level of awareness

37
Q

Define vegetative state

A

Time after a coma in which brainstem reflexes and sleep-wake cycles return but the patient remains unconscious

38
Q

If a person is in a vegetative state for a year or longer they are consider to be in a ______ vegetative state

A

persisten

39
Q

Define stupor

A

Condition of general unresponsiveness

40
Q

Define obtunded

A

individuals sleep a great deal of time

41
Q

Define delirium

A

disorientation, fear, and misperception of sensory stimuli

42
Q

What can be defined as a state of being confused, distracted, and having poor memory

A

Clouding of Consciousness

43
Q

Describe decerbrate rigidity and what it is formed from

A

LE & UE extension which is caused by lesion in the midbrain

44
Q

Describe decorticate rigidity and what it is formed from

A

LE extension & UE flexion that is caused by lesion above the red nucleus between the BG & thalamus

45
Q

What are 5 primitive and tonic reflexes that may emerge and inhibit movement following TBI?

A
  • Tonic Labyrinthine Reflex
  • Asymmetrical Tonic Neck Reflex
  • Symmetrical Tonic Reflex
  • Positive Support Reflex
  • Flexor Withdrawal Reflex
46
Q

Describe positioning of the Tonic Labyrinthine Reflex in supine and prone

A
  • In supine position, body and extremities are held in extension
  • In prone position, body and extremities are held in flexion
47
Q

Describe the Asymmetrical Tonic Neck Reflex (ATNR)

A

When the patient turns their head to 1 side their arm and leg on the same side extend while the arm and leg on the opposite side flex

48
Q

Describe the positioning of the symmetrical tonic reflex when the head is flexed and when it is extended

A
  • When the head flexes the UEs flex and the LEs extend

* When the head extends the UEs extend and LEs flex

49
Q

What is the Positive Support Reflex (PSR)?

A

A reflex that occurs if weight is placed on the balls of the feet it will result in stiffening of legs and trunk into extension

50
Q

Why may the sense of smell be lost or impaired following TBI?

A

The cribriform plate or anterior fossa may be fractured

51
Q

When should PT begin following a TBI?

A

As soon as the patient is medically stable

52
Q

What is the ideal position for TBI patients to be placed in? Describe why…

A

Side-lying and semiprone because they decrease the impact of Tonic Labyrinthine reflexes

53
Q

What is Heterotopic Ossification (HO)?

A

Abnormal bone formation in soft tissue and muscles surrounding joints

54
Q

Which joint is the most affected joint for heterotopic ossification?

A

hip

55
Q

How should patients who demonstrate pathological postures/reflexes be positioned?

A

in the opposite pattern

56
Q

What scale can assess cognitive functioning?

A

Rancho Los Amigos Scale of Cognitive Functioning

57
Q

Rancho Los Amigos Scale of Cognitive Functioning grades patients on a scale of I to X in which I = ________ and X = ______.

A

no response

alert, oriented, & independent

58
Q

What are the primary problems during the IP rehab stage of TBI?

A
  • Decreased ROM & potential for contractures
  • Increased muscle tone & abnormal posturing
  • Decreased awareness & responsiveness to the environment
  • Presence of primitive tonic reflexes
  • Decreased functional mobility & tolerance to upright
  • Decreased endurance
  • Decreased sensory awareness
  • Impaired or absent communication system
  • Decreased knowledge of his/her condition
59
Q

TBI patients must be repositioned every _ hours to prevent what?

A

2

Skin breakdown and Pneumonia

60
Q

What are the 2 most desirable positions?

A

Side lying & Prone

61
Q

What does sitting assist with?

A

endurance & bronchial hygiene

711: Neurological Rehabilitation (10 decks)

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