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Pediatrics > Traumatic Injury to the Central Nervous System: Brain Injury > Flashcards

Traumatic Injury to the Central Nervous System: Brain Injury Flashcards

1
Q

What happens in Rotational Injuries?

A

skull rotates as brain remains stationary.

Angular forces on the brain and resuls in either focal or diffuse brain damage.

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2
Q

What is a concussion characterized by?

A

Altered awareness and loss of memory immediately after traumatic incident.
obvious pathologic brain changes may be absent on imaging

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3
Q

What are some behavioral changes of a concussion

A
  • tiredness
  • mre distracted as a child
  • irritable
  • extra clingy to parent
  • distrubance in sleep
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4
Q

how long do symptoms last for a concussion

A

Days to a few months are very typical

*Children may take longer than adults to recover after concussion

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5
Q

What are examples of primary brain damage

A
  • Contusion
  • Skull Fractures
  • Intracranial Hemorrhages
  • Diffuse Axonal Injury
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6
Q

What is a contusion

A

bruising of the crests of gyri in the cerebral hemispheres; occurs following blunt trauma
-Usually in frontal/temporal lobes

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7
Q

What is skull fractures

A

seen in both closed head injuries and open, compound head injuries

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8
Q

What is intracranial hemorrhages (2 types)

A
  1. Extradural (epidural): occur due to a tearing of an artery in the brain
  2. Intradural: subdural and Inracerebral and result from trauma or rupture of a congenital vascular abnormality
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9
Q

What is Diffuse Axonal Injury

A
  • not seen on imaging
  • usually occurs with rotational injury within cranial vault-
  • present with more severe symptoms than othe orms of TBI
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10
Q

What are examples of Secondary Brain Damage

A
  • Cerebral Edema
  • Intracranial Pressure increases
  • Herniation syndromes
  • Hypoxic-Ischemic INjury
  • Neurochemical Events
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11
Q

What is the most frequently occuring secondary brain damage from trauma

A

Cerebral Edema

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12
Q

How do infants accomodate from increased intracranial pressure

A
  • You see swelling in head bc head isn’t fully set
  • sutures aren’t fully formed
  • seen more in the frontal lobe
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13
Q

Result of herniation syndromes

A

Result from displacement of brain by expanding lesion and cerebral edema

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14
Q

Neurochemical Events

A

Oxygen free radicals are released, causing damage

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15
Q

What are other consequences from brain damage

A

Hydrocephalus
Seizures
Infections
Endocrine Disorders

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16
Q

What is the #1 predictor of the timeline of recovery of injury

A

DEPENDS! haha
#1 predictor is length of the coma (unconscious state)
-Most recovery is in first few months but can take up to 3 years

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17
Q

What are 3 examples of Coma Scales

A

Glasgow Coma Scales

Children’s Coma Scale (

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18
Q

What is an assessment for orientation and amnesia

A

Children’s Orientation and Amnesia Test (COAT) –reliable for ages 4-15

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19
Q

What is the duration of post-traumatic amnesia (PTA)

A

higher predictive factor of future memory function than coma scales

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20
Q

What is the Rancho Los Amigos Levels of Cognitive Functioning

A

descriptive scale of cognitive and behavioral functioning

The Limitation: “phase of recovery” and prediction of discharge functional ratings is often poorly related

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21
Q

Describe the Glasgow Coma Scale

A

Standarized for assessing neurologic status of a trauma

Based on patient’s best response to : MOTOR ACTIVITY, VERBAL RESPONSE, AND EYE OPENING

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22
Q

What is the mobility capabilities for an injury at C1-C4?

A
  • sipping or blowing to independently control power wheelchair, power tilt mechanism and environmental controls
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23
Q

What is the transfer ability for a C1-C4 injury?

A

dependent for all transfers

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24
Q

What is the capability for a C1-C4 injury in doing their ADLs?

A

dependent for dressing, bathing, and bowel/bladder management

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25
Q

What is the mobility capabilities for an injury at C5?

A
  • addition of biceps and deltoids

- can propel a manual wheelchair with hand rims for short distances on level surfaces

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26
Q

What is the transfer ability for a C5 injury?

A
  • able to assist with transfers and bed mobility
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27
Q

What ability does a C5 injury in doing their ADLs?

A

able to assist with feeding, grooming with adaptive equipment and set up; dependent for dressing and bathing

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28
Q

What is the mobility capabilities for an injury at C6?

A
  • addition of pectoralis

- able to independently use manual wheelchair with projections on the hand rims

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29
Q

What is the transfer ability for a C6 injury?

A

assists with sliding board transfers

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30
Q

What ability does a C6 injury have in doing their ADLs?

A
  • independent with self care with equipment
  • independent with UE dressing, assists with lower
  • I. with bowel program, needs assistance with bladder program
31
Q

What is the mobility capabilities for an injury at C7-T1?

A
  • addition of triceps

- able to independently propel a manual wheelchair on level surfaces

32
Q

What is the transfer ability for a C7- T1 injury?

A

independent transfers with or without sliding board

33
Q

What ability does a C7-T1 injury have in doing their ADLs?

A
  • independent with adaptive equipment

- can drive a car with hand controls

34
Q

What is the mobility capabilities for an injury at T4-T6?

A
  • addition of upper abdominals

- can ambulate with RGOs for short distances with a walker

35
Q

What is the transfer ability for a T4-T6 injury?

A

independent transfers with or without sliding board

36
Q

What ability does a T4-T6 injury have in doing their ADLs?

A

independent for grooming, bowel, bladder, dressing, and bathing

37
Q

What is the mobility capabilities for an injury at T9-T12?

A
  • addition of lower abs

- household ambulation with RGOs or HKAFOs and AD

38
Q

What is the transfer ability for a T9-T12 injury?

A

independent transfers with or without sliding board

39
Q

What ability does a T9-T12 injury have in doing their ADLs?

A

independent for grooming, bowel, bladder, dressing, and bathing

40
Q

What is the mobility capabilities for an injury at L2-L4?

A
  • addition of gracilis, iliopsoas, QL

- functional ambulation with KAFOs and crutches

41
Q

What is the transfer ability for a L2-L4 injury?

A

independent transfers with or without sliding board

42
Q

What ability does a L2-L4 injury have in doing their ADLs?

A

independent for grooming, bowel, bladder, dressing, and bathing

43
Q

What is the mobility capabilities for an injury at L4-L5?

A
  • addition of hamstrings, quads, and ant. tib

- able to amb. with AFOs with or without AD

44
Q

What is the transfer ability for a L4-L5 injury?

A

independent transfers with or without sliding board

45
Q

What ability does a L4-L5 injury have in doing their ADLs?

A

independent for grooming, bowel, bladder, dressing, and bathing

46
Q

What is the purpose of surgery in a SCI?

A

muscle transfers with the purpose of restoring function

47
Q

How is spasticity medically treated in SCI?

A

baclofen or botulinum toxin

48
Q

How is pain medically treated for SCI?

A
  • nociceptive and neuropathic
  • surgical procedures for pain relief
  • spinal cord stimulators
49
Q

Which tendons are prone to contractures?

A

hip flexors, hamstring, Achilles tendon

biceps if bed bound

50
Q

What should therapists work on?

A

ROM, strengthening, aerobic and endurance conditioning, locomotive training (orhoses)

51
Q

What’s important when the child is transitioning into school/community?

A
  • documentation by PT
  • COMMUNICATION: equipment needs, school setting, community resources
  • Education: caregivers, school employees
52
Q

What are SCI kiddos at an increased risk of?

A
  • hip subluxation
  • scoliosis
  • skin integrity issues
  • renal disease
  • osteoporosis
  • depression
53
Q

Which two tests may be appropriate to use when evaluating a child who has a TBI?

A

WeeFIM and PEDI

54
Q

Where may the Hetertrophic Ossificans be located if present?

A

Occurs in areas exposed to a lot friction, such as the elbows.

55
Q

Coma Stimulation Program -
Low Cognitive Level: _____
Mid Cognitive Level: _____
Higher Cognitive Level: _____

A

Stimulation, Structure, School/Community Reintegration

56
Q

Severity of injuries decreases if the height is less than __ feet

A

10 ft

57
Q

What type of event causes a TBI?

A

When an external, mechanical force impacts the head

58
Q

Anytime someone has a TBI, there will be……

A

some change in consciousness

  • could be diminshed or altered in some way
  • can range from brief lethargy to prolonged unconsciousness
  • can result in brain death
59
Q

TBIs are NOT related to a brain insult that occurs at _____.

A

birth

- they are NOT congenital

60
Q

What are the peak periods of incidence for pediatric TBIs?

A
  • Less than 4 years old
    AND
  • 15-19 years old
61
Q

Do males or females have a higher incidence for TBIs?

A

Male

2:1

62
Q

T/F : Death rates are inversely related to socioeconomic status.

A

True

63
Q

TBI is the leading cause of death and disability for which age group?

A

1-19 year olds

64
Q

What are some common causes of falls in pediatric patients?

A

they are learning how to move, clumsy, gaining balance, gaining confidence, etc

65
Q

What are the causes of TBIs?

A
  1. Falls (35%-50%)
    - usually under 12 months, with under 6 months experiencing greater injuries
  2. MVAs (25%)
    - 5-9 years old
  3. Gunshot Wounds
    - school aged children
  4. Abuse/Assault
    - 0-4 years old
  5. Sports/Recreational Activity
    - School aged children (29%) and adolescents
66
Q

What should you do if you suspect your pediatric patient is being abused?

A
  • Do NOT approach/confront the patient or parent

- You are a mandatory reporter

67
Q

What are the 2 possible mechanisms of injury for a TBI?

A
  1. Impression

2. Acceleration/Deceleration injuries

68
Q

What is Impression?

A

When a solid object hits a stationary head

69
Q

Explain Acceleration/Deceleration injuries.

A
  1. Translational
    - Coup - 1st
    - Countcoup- 2nd
  2. Rotational
    - Skull rotates as the brain remains stationary
70
Q

What kinds of forces are experienced with a rotational injury?

A

Shearing and twisting

71
Q

3 Causes of SCIs in children

A

Motor Vehicle Accident
Birth Trauma
Child Abuse

72
Q

Good seat belt fit

A
  • Booster (bubble bum)
  • lap belt on lap, not belly
  • knee bend without slouching
  • shoulder belt comfortable
73
Q

Bad seat belt fit

A
  • No booster
  • lap belt on soft belly
  • slouching
  • shoulder belt uncomfortable

Pediatrics (13 decks)

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