Traumatic Brain Injury (TBI) Flashcards
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.”
Traumatic brain injury
What is the gender difference between men and women?
Men are twice as likely to acquire a TBI
What is the typical age range for TBIs?
15-24 years of age & individuals over 75 years
What are the 4 most common causes of TBIs?
- MVA
- Falls
- Acts of violence
- Sports
What are the 2 classifications of brain injuries?
- open
- closed
What is the major difference between open and closed TBIs?
The meninges are intact with a closed TBI, but they are exposed in an open TBI, which increases the risk of infection
What are the 5 subtypes of closed injuries?
- Concussion
- Contusion
- Hematomas
- Locked-in Syndrome
- Acquired Brain Injuries
Define concussion
A momentary loss of consciousness and reflexes
Why do concussions occur?
Shearing forces disrupt synapses in the brain
What is a contusion?
Bruising on the surface of the brain that is sustained on impact
What are the 2 types of lesions associated with a contusion?
- Coup lesion
- Contrecoup lesion
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.
coup
contrecoup
What are the 2 types of hematomas that can occur as a result of TBI?
- Epidural hematomas
- Subdural hematomas
Where do epidural hematomas occur?
Between the dura mater and the skull
Rupture of what artery in the temporal fossa can cause epidural hematomas?
Middle Meningeal Artery
Where do subdural hematomas occur?
Between the dura mater and the arachnoid layer
Subdural hematomas result because of what?
rupture to the cortical bridging veins
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?
Subdural
What can cause an acquired TBI?
- airway obstruction
- near-drowning
- MI
- CVA
- exposure to toxins
- electrical shock or lightening strike
What percentage of TBI patients have increased intracranial pressure?
70%
What types of activities can cause an increase in ICP?
- cervical flexion
- percussion
- vibration
- coughing
The brain demands __% of the body’s oxygen to maintain proper oxygen saturation levels and metabolic function
20%
What most commonly causes an anoxic injury?
cardiac arrest
What 3 areas of the brain are the most vulnerable to anoxic injuries?
- Hippocampus
- Cerebellum
- Basal Ganglia
It is hypothesized that anoxic injuries lead to what?
amnesia & movement disorders
What can be defined as “a discrete clinical event reflecting temporary, physiologic brain dysfunction, characterized by excessive hypersynchronous cortical neuron discharge”
Seizure
Seizures that result from a TBI are most common in what 3 types of patients?
- open head injuries
- subdural hematoma
- older adults
What are a few examples of in which a seizure may be triggered?
- stress
- poor nutrition
- electrolyte imbalances
- missed mediations or drug use
- flickering lights
- infection
- fever
- worry
- fear
Individuals who score in the - range on the Glasgow coma scale do not usually survive
3-4
What are the 3 classifications of a mild TBI?
- GCS of 13 or higher
- Lss of consciousness less than 20 minutes
- Normal CT scan
What are the 3 classifications of a moderate TBI?
- GCS of 9-12
- Confused
- Unable to answer questions
What are the 2 classifications of a severe TBI?
- GSC of 3-8
- Individual is in a coma
What can be defined as the primitive state of being awake or alert
arousal
What is responsible for level of arousal?
reticular activating system
Define consciousness
The state of being aware
Define coma
A state of decreased level of awareness
Define vegetative state
Time after a coma in which brainstem reflexes and sleep-wake cycles return but the patient remains unconscious
If a person is in a vegetative state for a year or longer they are consider to be in a ______ vegetative state
persisten
Define stupor
Condition of general unresponsiveness
Define obtunded
individuals sleep a great deal of time
Define delirium
disorientation, fear, and misperception of sensory stimuli
What can be defined as a state of being confused, distracted, and having poor memory
Clouding of Consciousness
Describe decerbrate rigidity and what it is formed from
LE & UE extension which is caused by lesion in the midbrain
Describe decorticate rigidity and what it is formed from
LE extension & UE flexion that is caused by lesion above the red nucleus between the BG & thalamus
What are 5 primitive and tonic reflexes that may emerge and inhibit movement following TBI?
- Tonic Labyrinthine Reflex
- Asymmetrical Tonic Neck Reflex
- Symmetrical Tonic Reflex
- Positive Support Reflex
- Flexor Withdrawal Reflex
Describe positioning of the Tonic Labyrinthine Reflex in supine and prone
- In supine position, body and extremities are held in extension
- In prone position, body and extremities are held in flexion
Describe the Asymmetrical Tonic Neck Reflex (ATNR)
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
Describe the positioning of the symmetrical tonic reflex when the head is flexed and when it is extended
- When the head flexes the UEs flex and the LEs extend
* When the head extends the UEs extend and LEs flex
What is the Positive Support Reflex (PSR)?
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
Why may the sense of smell be lost or impaired following TBI?
The cribriform plate or anterior fossa may be fractured
When should PT begin following a TBI?
As soon as the patient is medically stable
What is the ideal position for TBI patients to be placed in? Describe why…
Side-lying and semiprone because they decrease the impact of Tonic Labyrinthine reflexes
What is Heterotopic Ossification (HO)?
Abnormal bone formation in soft tissue and muscles surrounding joints
Which joint is the most affected joint for heterotopic ossification?
hip
How should patients who demonstrate pathological postures/reflexes be positioned?
in the opposite pattern
What scale can assess cognitive functioning?
Rancho Los Amigos Scale of Cognitive Functioning
Rancho Los Amigos Scale of Cognitive Functioning grades patients on a scale of I to X in which I = ________ and X = ______.
no response
alert, oriented, & independent
What are the primary problems during the IP rehab stage of TBI?
- 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
TBI patients must be repositioned every _ hours to prevent what?
2
Skin breakdown and Pneumonia
What are the 2 most desirable positions?
Side lying & Prone
What does sitting assist with?
endurance & bronchial hygiene
