Traumatic Injury to the Central Nervous System: Brain Injury Flashcards
What happens in Rotational Injuries?
skull rotates as brain remains stationary.
Angular forces on the brain and resuls in either focal or diffuse brain damage.
What is a concussion characterized by?
Altered awareness and loss of memory immediately after traumatic incident.
obvious pathologic brain changes may be absent on imaging
What are some behavioral changes of a concussion
- tiredness
- mre distracted as a child
- irritable
- extra clingy to parent
- distrubance in sleep
how long do symptoms last for a concussion
Days to a few months are very typical
*Children may take longer than adults to recover after concussion
What are examples of primary brain damage
- Contusion
- Skull Fractures
- Intracranial Hemorrhages
- Diffuse Axonal Injury
What is a contusion
bruising of the crests of gyri in the cerebral hemispheres; occurs following blunt trauma
-Usually in frontal/temporal lobes
What is skull fractures
seen in both closed head injuries and open, compound head injuries
What is intracranial hemorrhages (2 types)
- Extradural (epidural): occur due to a tearing of an artery in the brain
- Intradural: subdural and Inracerebral and result from trauma or rupture of a congenital vascular abnormality
What is Diffuse Axonal Injury
- not seen on imaging
- usually occurs with rotational injury within cranial vault-
- present with more severe symptoms than othe orms of TBI
What are examples of Secondary Brain Damage
- Cerebral Edema
- Intracranial Pressure increases
- Herniation syndromes
- Hypoxic-Ischemic INjury
- Neurochemical Events
What is the most frequently occuring secondary brain damage from trauma
Cerebral Edema
How do infants accomodate from increased intracranial pressure
- You see swelling in head bc head isn’t fully set
- sutures aren’t fully formed
- seen more in the frontal lobe
Result of herniation syndromes
Result from displacement of brain by expanding lesion and cerebral edema
Neurochemical Events
Oxygen free radicals are released, causing damage
What are other consequences from brain damage
Hydrocephalus
Seizures
Infections
Endocrine Disorders
What is the #1 predictor of the timeline of recovery of injury
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
What are 3 examples of Coma Scales
Glasgow Coma Scales
Children’s Coma Scale (
What is an assessment for orientation and amnesia
Children’s Orientation and Amnesia Test (COAT) –reliable for ages 4-15
What is the duration of post-traumatic amnesia (PTA)
higher predictive factor of future memory function than coma scales
What is the Rancho Los Amigos Levels of Cognitive Functioning
descriptive scale of cognitive and behavioral functioning
The Limitation: “phase of recovery” and prediction of discharge functional ratings is often poorly related
Describe the Glasgow Coma Scale
Standarized for assessing neurologic status of a trauma
Based on patient’s best response to : MOTOR ACTIVITY, VERBAL RESPONSE, AND EYE OPENING
What is the mobility capabilities for an injury at C1-C4?
- sipping or blowing to independently control power wheelchair, power tilt mechanism and environmental controls
What is the transfer ability for a C1-C4 injury?
dependent for all transfers
What is the capability for a C1-C4 injury in doing their ADLs?
dependent for dressing, bathing, and bowel/bladder management
What is the mobility capabilities for an injury at C5?
- addition of biceps and deltoids
- can propel a manual wheelchair with hand rims for short distances on level surfaces
What is the transfer ability for a C5 injury?
- able to assist with transfers and bed mobility
What ability does a C5 injury in doing their ADLs?
able to assist with feeding, grooming with adaptive equipment and set up; dependent for dressing and bathing
What is the mobility capabilities for an injury at C6?
- addition of pectoralis
- able to independently use manual wheelchair with projections on the hand rims
What is the transfer ability for a C6 injury?
assists with sliding board transfers
What ability does a C6 injury have in doing their ADLs?
- independent with self care with equipment
- independent with UE dressing, assists with lower
- I. with bowel program, needs assistance with bladder program
What is the mobility capabilities for an injury at C7-T1?
- addition of triceps
- able to independently propel a manual wheelchair on level surfaces
What is the transfer ability for a C7- T1 injury?
independent transfers with or without sliding board
What ability does a C7-T1 injury have in doing their ADLs?
- independent with adaptive equipment
- can drive a car with hand controls
What is the mobility capabilities for an injury at T4-T6?
- addition of upper abdominals
- can ambulate with RGOs for short distances with a walker
What is the transfer ability for a T4-T6 injury?
independent transfers with or without sliding board
What ability does a T4-T6 injury have in doing their ADLs?
independent for grooming, bowel, bladder, dressing, and bathing
What is the mobility capabilities for an injury at T9-T12?
- addition of lower abs
- household ambulation with RGOs or HKAFOs and AD
What is the transfer ability for a T9-T12 injury?
independent transfers with or without sliding board
What ability does a T9-T12 injury have in doing their ADLs?
independent for grooming, bowel, bladder, dressing, and bathing
What is the mobility capabilities for an injury at L2-L4?
- addition of gracilis, iliopsoas, QL
- functional ambulation with KAFOs and crutches
What is the transfer ability for a L2-L4 injury?
independent transfers with or without sliding board
What ability does a L2-L4 injury have in doing their ADLs?
independent for grooming, bowel, bladder, dressing, and bathing
What is the mobility capabilities for an injury at L4-L5?
- addition of hamstrings, quads, and ant. tib
- able to amb. with AFOs with or without AD
What is the transfer ability for a L4-L5 injury?
independent transfers with or without sliding board
What ability does a L4-L5 injury have in doing their ADLs?
independent for grooming, bowel, bladder, dressing, and bathing
What is the purpose of surgery in a SCI?
muscle transfers with the purpose of restoring function
How is spasticity medically treated in SCI?
baclofen or botulinum toxin
How is pain medically treated for SCI?
- nociceptive and neuropathic
- surgical procedures for pain relief
- spinal cord stimulators
Which tendons are prone to contractures?
hip flexors, hamstring, Achilles tendon
biceps if bed bound
What should therapists work on?
ROM, strengthening, aerobic and endurance conditioning, locomotive training (orhoses)
What’s important when the child is transitioning into school/community?
- documentation by PT
- COMMUNICATION: equipment needs, school setting, community resources
- Education: caregivers, school employees
What are SCI kiddos at an increased risk of?
- hip subluxation
- scoliosis
- skin integrity issues
- renal disease
- osteoporosis
- depression
Which two tests may be appropriate to use when evaluating a child who has a TBI?
WeeFIM and PEDI
Where may the Hetertrophic Ossificans be located if present?
Occurs in areas exposed to a lot friction, such as the elbows.
Coma Stimulation Program -
Low Cognitive Level: _____
Mid Cognitive Level: _____
Higher Cognitive Level: _____
Stimulation, Structure, School/Community Reintegration
Severity of injuries decreases if the height is less than __ feet
10 ft
What type of event causes a TBI?
When an external, mechanical force impacts the head
Anytime someone has a TBI, there will be……
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
TBIs are NOT related to a brain insult that occurs at _____.
birth
- they are NOT congenital
What are the peak periods of incidence for pediatric TBIs?
- Less than 4 years old
AND - 15-19 years old
Do males or females have a higher incidence for TBIs?
Male
2:1
T/F : Death rates are inversely related to socioeconomic status.
True
TBI is the leading cause of death and disability for which age group?
1-19 year olds
What are some common causes of falls in pediatric patients?
they are learning how to move, clumsy, gaining balance, gaining confidence, etc
What are the causes of TBIs?
- Falls (35%-50%)
- usually under 12 months, with under 6 months experiencing greater injuries - MVAs (25%)
- 5-9 years old - Gunshot Wounds
- school aged children - Abuse/Assault
- 0-4 years old - Sports/Recreational Activity
- School aged children (29%) and adolescents
What should you do if you suspect your pediatric patient is being abused?
- Do NOT approach/confront the patient or parent
- You are a mandatory reporter
What are the 2 possible mechanisms of injury for a TBI?
- Impression
2. Acceleration/Deceleration injuries
What is Impression?
When a solid object hits a stationary head
Explain Acceleration/Deceleration injuries.
- Translational
- Coup - 1st
- Countcoup- 2nd - Rotational
- Skull rotates as the brain remains stationary
What kinds of forces are experienced with a rotational injury?
Shearing and twisting
3 Causes of SCIs in children
Motor Vehicle Accident
Birth Trauma
Child Abuse
Good seat belt fit
- Booster (bubble bum)
- lap belt on lap, not belly
- knee bend without slouching
- shoulder belt comfortable
Bad seat belt fit
- No booster
- lap belt on soft belly
- slouching
- shoulder belt uncomfortable
