Unit 1 Flashcards
Traumatic Impact can result in both _____ head injuries and _____ head injuries.
Traumatic impact can result in both closed head injuries and open head injuries.
A coup contrecoup injury is a type of _____(closed or open?) head injury.
A coup contrecoup injury is a type of closed head injury.
What happens during a coup contrecoup injury?
During a coup contre coup injury the head/brain moves forward striking an object, resulting in frontal lobe lesions (coup).
Then head/brain rebounds - moves backwards causing occipital lobe lesion (contrecoup)
What is the difference between a closed head injury and an open head injury?
Closed head injury is non-penetrating, an open head injury is a penetrating injury.
Brain lacerations, contusions and diffuse axonal injury are examples of ______ head injuries.
(closed, open or traumatic inertial?)
Brain lacerations, contusions and diffuse axonal injury are examples of closed head injuries.
What are traumatic inertial injuries?
Traumatic inertial injuries are injuries resulting from inertial forces.
Traumatic inertial injuries are considered non-impact injuries. One common type is acceleration-deceleration forces where the brain is rapidly accelerated within the skull followed by rapid deceleration.
Diffuse axonal injury is caused by what types of forces?
Diffuse axonal injury, caused by rotational or angular forces is an example.
Non-traumatic brain injury is brain injury caused by what type of forces?
Non-traumatic brain injury is brain injury caused by internal factors.
3 examples of non-traumatic brain injuries caused by internal factors are…
Lack of oxygen, exposure to toxins, pressure from a tumor.
What is a primary injury? (vs. a secondary injury)
Primary injury is the initial injury to the brain that defines it as either traumatic or non-traumatic.
What is a secondary injury (vs. a primary injury)
Secondary injury are the secondary aspects or delayed aspects when the injury process extends past the point of time from the initial injury.
There are pathological and delayed non-mechanical processes extending from phase 1 (impaired blood flow, tissue death, metabolic imbalance, membrane permeability) to phase 2 (necrosis, release of excitatory neurotransmitters) until cell death.
Three examples of Phase 1 Secondary Injury:
1) impaired blood flow 2)diffuse axonal injury, 3) metabolic imbalance
A concussion is a…(up to 5 points)
A concussion is also known as a mild TBI.
Caused by a bump, blow or jolt to the head.
A traumatic alteration in mental status.
Concussion may or may not involve loss of consciousness.
75% of all TBIs are mTBI (concussion)
__% of TBIs that occur each year are mild TBIs
75% of TBIs that occur each year are mild TBIs.
An estimated ___ million people sustain a TBI yearly.
An estimated 2.5 million people sustain a TBI yearly.
Brain injury is the ___ most prevalent disability in the U.S.
Brain injury is the 2nd most prevalent disability in the U.S.
There are ___ million Americans living with brain injury.
There are 13.5 million Americans living with brain injury.
List 5 risk factors for determining the effects of brain injury.
1) age
2) alcohol misuse
3) domestic violence
4) service in the military
5) participation in sports are all risk factors for determining the effects of brain injury
After the initial injury the risk of a 2nd brain injury increases to ___x greater.
After the initial injury the risk of a 2nd brain injury increases to 3x greater.
After the second injury the risk of a 3rd brain injury increases to __x greater.
After the second injury the risk of a 3rd brain injury increases to 8x greater.
Age groups most likely to sustain TBI are 1) __ to __ (MVA), 2) __ to __ (firearms) and 3) __ to __ (highest risk of hospitalization and death)
Age groups most likely to sustain TBI are 1) 15 to 19 (MVA), 2) 20 to 24(firearms) and 3) 65 to 75+ (highest risk of hospitalization and death)
Child abuse (non-accidental trauma) is the cause of at least __% of deaths from head trauma in children under 2.
Child abuse (non-accidental trauma) is the cause of at least 80% of deaths from head trauma in children under 2.
Who has higher rates of TBI? Males or females?
Males have higher rates of TBI.
Among children 9 or younger, the most injuries are from…
bicyling and playground injuries
What is the % of women victims of domestic violence with symptoms of brain injury?
67% of women victims of domestic violence have symptoms of brain injury.
What are the 6 screening tools for TBI?
- A
- H
- W
- I
- T
- O
A -ACE H - HELPS W - WARCAT I - ImPACT T - TBIQ O - OSU TBI-ID
What is the difference between the rehabilitation accreditation and licensure organizations JCAHO and CARF?
JCAHO - hospital based programs
CARF - post-acute programs (outpatient, residential, vocational, home and community)
What does CARF stand for?
Commission for the Accreditation of Rehabilitation Facilities
What are the annual costs of TBI?
Over 76 billion annually
Only __% of persons with severe brain injuries have adequate funding for long-term treatment and supports.
5% of persons with severe brain injuries have adequate funding for long-term treatment and supports.
What is the Rehabilitation Act of 1973?
The Rehabiltiation Act of 1973 was the foundation for state vocational programs. It assists people with disabilities who are pursing meaningful careers.
The Olmstead Decision
The Olmstead Decision is a Supreme Court decision (1999) that ruled that the plaintiffs must be granted the option to live in the community.
Has gradually created more opportunities for persons with disabilities to be served through cost-effective community-based services. Utilizes Title II of ADA in asserting states administer their services, programs and activities in integrated community settings.
How many state affiliates make up the Brain Injury Association of America?
26 state affiliates. BIAA is the leading organization in the country.
What is the TBI Act of 1996?
The TBI Act of 1996 is the only federal law that specifically and exclusively addresses TBI in the civilian population.
Remains the single most important piece of federal legislation for persons with BI. Set the stage for research and improving systems of care for BI.
Gave authority for:
- CDC to establish projects for prevention and improved services
- NIH to award grants based on research
- HRSA (Health Resources and Services Administration) to make grants to states
What is the TBI Model Systems of Care?
Traumatic Brain Injury Model Systems (TBIMS) is funded through the US Department of Education’s National Institute on Disability and Rehabilitation Research. It contains prospective longitudinal research to demonstrate the course of recovery and outcomes following TBI. It was established in 1987 to conduct research and follow standardized national database for analysis of treatment outcomes.
People with a TBI have a life expectancy reduction of how many years?
People with TBI have a life expectancy reduction of 7 years.
The three layers of the meninges are…
Dura Mater
Arachnoid Layer
Pia Mater
The outer layer of the meninges that is latin for “tough mother”.
Dura Mater is the outer layer of the meninges that is latin for “tough mother”.
The subdural layer is below this layer of meninges.
The subdural layer is below the Dura Mater.
The middle layer of the meninges with consistency similar to a spider web.
The arachnoid layer is the middle layer of the meninges with consistency similar to a spider web.
The subarachnoid layer is beneath this layer of meninges..
The subarachnoid layer is beneath the Arachnoid Layer of meninges.
The third layer of meninges that is latin for “ tender mother”
Pia Mater
The three portions of the brainstem are 1), 2), and 3).
The medulla, pons and midbrain.
This is the smallest part of the brainstem, involved in elementary forms of vision and hearing.
Midbrain
This part of the brainstem plays a pivotal role in alertness and arousal
Midbrain
The part of the brainstem above the medulla. Sits between the medulla and the midbrain.
Pons
The part of the brainstem essential for facial movements, facial sensation, hearing, and coordinating eye movements
Pons
The part of the brainstem that mergers with the spinal cord creating the base of the brainstem
Medulla
The part of the brainstem that serves as a control center for involuntary reflexes (breathing, heart rate, blood pressure, swallowing, vomiting and sneezing).
Medulla
The part of the brainstem responsible for basic living functions
Medulla
The collection of nerve fibers and nuclei within the brainstem that modulates arousal, alertness, concentration and basic biological rhythms.
Reticulating Activating System
Collection of nerve fibers responsible for controlling arousal, alertness and ability to concentrate. Causes sleep and fatigue disturbances.
Reticulating Activating System
The Diencephalon is comprised of the …. and the …..
The Diencephalon is comprised of the thalamus and the hypothalamus.
The part of the diencephalon that sits on top of the brainstem. Sensory input pass through it to the higher levels of the brain. It is the relay station for incoming and outgoing information.
Thalamus
The part of the diencephalon that controls the autonomic nervous system and regulates body temperature. Also regulates hunger and thirst and the sleep wake cycle.
Hypothalamus
The system that its on top of the brain stem and is interconnected with the diencephalon. This system controls emotions and basic feelings.
Limbic System
The limbic system is comprised of (4 parts)
The limbic system is comprised of the hippocampus, amygdala, thalamus and hypothalamus.
The structure of the limbic system that sits within the temporal lobe, associated with memory functioning and susceptible to anoxia/hypoxia.
Hippocampus
The structure of the limbic system controls the “fight or flight” structure
Amygdala
The structure of the limbic system that affects voluntary motor nerves causing slowness and loss of movement, tremor, and muscular rigidity
Basal Ganglia
The portion of the limbic system that helps to handle physical movements by relating information from the cerebral cortex, brainstem and cerebellum
Basal Ganglia
Coordinates and modulates all body movement. Controls the direction, rate, force and steadiness of movements.
Cerebellum
Right Hemisphere information processing (name 5-6 distinctions)
holistic visual spatial intuitive controls left side of body music, art, shapes
Left Hemisphere information processing (name 5-6 distinctions)
linear verbal-analytic logical controls right side of body speaking, reading, writing
The right hemisphere communicates with the left hemisphere via a bond of fibers within the brain that relay information called the…
corpus callosum
List 5-6 frontal lobe functions
planning organizing problem solving judgment impulse control decision making
What are the functions of the temporal lobe?
The temporal lobe functions for memory, language and hearing.
What are the functions of the parietal lobe?
Sensation and perception, responds to touch, temperature and pain, processes sensory information, sensory input integration
Impairments of the parietal lobe include:
Agraphia, acalculia, anosgnosia, aphasia, impaired attention, neglect, left-right disorientation.
Difficulty identifying sensation, location, temperature, pain, movement
Divisions of the spinal column
Cervical (7 topmost vertebrae)
Thoracic (12 vertebrae)
Lumbar (5 vertebrae)
Magnetic Resonance Imaging (MRI) uses…
MRI uses magnetic field
radio frequency pulses
computer to produce detailed pictures of organs, soft tissue and bone
MRI provides better detail than CT
MRI measures and maps ….
MRI measures and maps brain activity by detecting changes associated with blood flow.
What is an acceleration-deceleration (traumatic inertial) injury?
Rapid acceleration of the brain followed by rapid deceleration. Results in the shearing of axons and blood vessels rendering white matter tracts non-functional.
The ability of the nervous system to change itself, form new connections and create new neurons in order to compensate for injury or adapt to changes in the environment.
Neuroplasticity
What is synaptogenesis?
The greater the numbers of synapses within a grouping of neurons, the greater the speed and efficiency with which those neurons communicate.
The formation of synapses between neurons.
Define cortical reorganization.
The brain’s cortical map can change through rehabilitation (directed exercise, constraint induced movement therapy)
__% of brain injury in the United States are mTBI.
75%
Potential neuroprotective agents for TBI include…1), 2), 3)
1) Magnesium
2) Progesterone
3) Nicotinimide
Definitive characteristics of a mTBI: Structural Imaging LOC - loss of consciousness AOC - PTA GCS - Glasgow Coma Scale
Definitive characteristics of a mTBI:
- Normal structural imaging
- LOC = 0-30 minutes
- AOC= 1 moment up to 24 hours
- PTA = 0-1 day
- GCS = 13-15
Definitive characteristics of a MODERATE TBI: Structural Imaging LOC AOC PTA GCS
Definititive characteristics of a MODERATE TBI:
- Normal or abnormal structural imaging
- LOC >30 min and <24 hrs
- AOC > 24 hr severity based on other criteria
- PTA > 1 and <7 days
- GCS = 9-12
Definitive characteristics of a SEVERE TBI: Structural Imaging LOC AOC PTA GCS
Definitive characteristics of a SEVERE TBI:
* Normal or abnormal structural imaging
LOC >24 hrs
PTA >7 days
GCS = 3-8
___to ___% of mTBI do not seek care.
16-25% of mTBI do not seek care.
mTBI definition from ACRM.
Alteration of mental state
Feeling dazed or confused
Difficulty answering simple questions
unclear thinking
What does ACRM stand for?
American Congress of Rehabilitation
3 primary causes of mTBI
Primary causes of mTBI include:
Acceleration - deceleration (MVA)
Striking head against hard surface (falls)
Blasts or explosions
What is mTBI - Second Impact Syndrome?
After one mTBI, the brain is significantly more affected by the neurochemical cascade of each successive injury.
What is the most common form of damage in a mTBI?
Diffuse axonal injury
What is diffuse axonal injury?
Axonal shearing occurs, disrupting neuronal communication due to damage to myelinate white matter
Difficult to visualize during neuroimaging
The MRI and CT for mTBI are likely to show up as…
normal
What happens with neurotransmitters during mTBI?
There is a massive release of the neurotransmitter glutamate (high levels become toxic, impacting amount of fuel available to the brain)
When do mTBI symptoms resolve?
2-4 weeks
What % of people continue to have problems after most mTBI symptoms have resolved?
10-15%
What is the most common mTBI symptom?
Headache
more likely to arise due to mental not physical fatigue
Besides headache, what are 3 more most common mTBI symptoms?
Fatigue
Poor restorative sleep
Vision changes (blurred vision, eyes can’t focus)
What is a change to balance in the inner ear caused by mTBI called?
Benign Paroxysmal positional vertigo is a common inner ear disorder after mTBI.
How are mTBI headaches treated?
Similarly to migraine. There may be hypersensitivity to sound
What is the mTBI cycle of symptom overlap?
Cycle of headache, lack of sleep which increases headache which causes it to be hard to sleep…
What does research say about early intervention and management for mTBI
Early intervention and management is the most effective means of reducing disability in mTBI.
Physical therapy for vestibular rehabilitation in mTBI focuses on (3)
Physical therapy for vestibular rehab of mTBI focuses on
Gaze and Posture instability
Motion sensitivity
mTBI sensory sensitivity means that _____ is common due to the brain’s slower processing.
mTBI sensory sensitivity means that overstimulation is common due to the brain’s slower processing.
What is Persistent Post-Concussive Symptoms (PPCS)?
PPCS is a complex disorder following a concussion, lasting for weeks or months, consisting of symptoms such as headaches and dizziness.
Disorders of consciousness classification system includes 3 generally accepted levels: 1) - 2) - 3)
Coma - Vegetative - Minimally Conscious
of people in a vegetative state each year ____. # of people living with a DOC.
4,200 in U.S. 315,000 living with a DOC.
How to treat Persistent Post-Concussive Symptoms (PPCS)?
Persistent Post-Concussive Symptoms (PPCS) is a complex disorder following a concussion, lasting for weeks or months, consisting of symptoms such as headache or dizziness.
Treated with a neuropyschological evaluation with multidisciplinary team and symptom focused.
Disorders of Consciousness occurs with injury to…
Injury to…
Reticular Activating System (Arousal)
Higher cortical areas in the cerebrum (awareness)
Awareness is regulated by…areas.
Awareness is the ability to use…information.
Awareness is required for…response.
Awareness is regulated by higher cortical areas.
Awareness is the ability to use sensory information to relate to outside world.
Awareness is required for voluntary response.
What are the medical management goals for Disorders of Consciousness? (3)
- Maintain physical stability
- Prevent medical complications
- Provide opportunities for stimulation to the neurological system
When does a coma usually resolve?
A coma is rarely a persistent condition.
Usually 2-4 weeks with the individual either passing away or resolving into vegetative state or minimally conscious state.
What are the signs of a coma? (5 signs)
No arousal/eye-opening No behavioral signs of awareness Impaired spontaneous breathing Impaired brainstem reflexes No vocalization >1hr
Coma characteristics:
Arousal
Awareness
Prevalence
Arousal: NO
Awareness NO
Prevalence: WEEKS
Vegetative State characteristics:
Arousal
Awareness
Prevalence
Arousal: YES
Awareness: NO
Prevalence: MONTHS TO YEARS
Minimally Conscious State characteristics:
Arousal
Awareness
Prevalence
Arousal: YES
Awareness: FLUCTUATES
Prevalence: MONTHS TO YEARS
What is the diagnostic criteria for a vegetative state? (4-5 signs)
Arousal/spontaneous or stimulus induced eye opening
May grimace to pain or localize sounds inconsistently
No behavioral signs of awareness
No purposeful behaviors
No language production
What is the diagnostic criteria for a minimally conscious state?
Eye-opening and arousal Fluctuating signs of awareness Response to a verbal directive Smiling or crying Object localization Sustained visual fixation Verbalizations Some communication
How to measure emerging from DOC?
At least one behavior must be present to meet criteria:
- communication (verbal or gestural)
- use of two or more objects
What causes Autonomic Dysfunction Syndrome? (ADS)
Cased by imbalance to the Autonomic nervous system (which is responsible for regulation of autonomic bodily functions - breathing, heart rate, respiratory rate)
The Autonomic Nervous System is located in the medulla oblongata and lower portion of the brainstem. Primary responsibility is the regulation of automatic bodily functions.
How often does Autonomic Dysfunction Syndrome occur? What %
15-33% of persons with severe TBI
How is Autonomic Dysfunction Syndrome managed?
Pharmacological Intervention and Environmental control
What is the Glasgow Coma Scale?
Neurobehavioral scale which provides assessment of coma or impaired consciousness.
A score of ___ to ___ correlates to mTBI on GCS.
A score of ___ to ___ correlates to moderate TBI on GCS.
A core below ___ correlates to severe TBI.
A score of 13 to 15 correlates to mTBI on GCS.
A score of 9 to 12 correlates to moderate TBI on GCS.
A score below 8 correlates to severe TBI.
Fatigue can persist for ___ after a moderate to severe injury.
years
What causes physiological fatigue?
Possible depletion of energy, hormones, neurotransmitters, or reduction in the number of neural connection.
Psychological fatigue is…
A state of weariness related to reduced motivation, prolonged mental activity or boredom that occurs with chronic stress, anxiety and depression.
What is primary fatigue?
Primary fatigue is fatigue resulting directly from injury or disease. It is the direct result from a diffuse axonal injury affecting brain centers which control arousal, attention, and response speed.
Primary fatigue includes injuries to…
the limbic system
basal ganglia
Reticular activating system
Middle frontal area
What is secondary fatigue?
Occurs from factors that exacerbate fatigue such as sleep disturbances, pain, stress, anxiety and depression.
What are four common sleep disorders?
Narcolepsy
Sleep Apnea Syndromes
Post-Traumatic Hypersomnia
Periodic Limb Movement Disorder
What is the most common physical symptom after TBI?
Dizziness and loss of balance
What is the % of individuals who have ongoing physical or neuromotor abnormalities at 2 year follow-up?
30% have ongoing physical abnormalities
What is a contracture?
An abnormal and usually permanent condition of a joint characterized by selection and fixation due to wasting away and abnormal shortening of muscle fibers and loss of skin elasticity
What are the 3 stages of Motor Learning?
Cognitive (What to do)
Associative (How to do)
Autonomous (How to succeed)
Acquired brain injury occurs…
after birth and includes injuries caused by external physical forces and internal insults to the brain.
an injury that is not hereditary, congenital, degenerative or induced by birth trauma
How does Acquired Brain Injury differ from Traumatic?
Traumatic is caused by external force. Acquired may be traumatic or nontraumatic.
Causes of acquired brain injury
stroke falls mva seizures gunshot wounds toxic exposure
How long is loss of consciousness in Mild LOC?
Mild LOC is brief or no loss of consciousness
How long is loss of consciousness in Moderate LOC?
Moderate LOC may last up to _______
Moderate LOC may last up to 24 hours
How long is loss of consciousness in Severe LOC?
Severe LOC may last greater than 24 hours
What are 5 risk factors for brain injury?
severity age of injury alcohol misuse domestic violence service in the military
Adults of this age suffer the highest rates of death from TBI (All Causes)
Adults 75 years or older
HIghest rates of death from TBI due to falls
Adults 75 years or older
Highest rates of death from TBI due to firearms
Adults 20-24
Adults 75 years or older
Highest rates of TBI due to falls by age group
Adults 65 yeras or older
What is meant by disease-causative and disease accelerative?
TBI is the beginning of a chronic process which impacts multiple organ systems, can cause disease & accelerate disease
Name 3 neurological conditions associated with brain injury
Epilepsy
Alzheimer’s Disease
Sleep Disturbance
List four functions of the Reticular Activating System
- modulates arousal
- modulates alertness
- modulates concentration
- modulates basic biological rhythms
What are two causes of early cardiopulmonary issues?
1) Direct trauma
2) Result from damage to the parts of the brain that control heart and lung function
Orthostatic Hypotension is…
low blood pressure when you stand up (aka postural hypotension)
What is a DVT?
When blood moves too slowly it can cause a clot.
When a clot forms in a vein deep within the body it causes a DVT.
What causes blood to move too slow (causing DVT?)
Limited movement
What causes the clustering of blood cells that leads to a clot?
Blood moves too slowly
What is a pulmonary embolism?
When part of a blockage (DVT) breaks free and moves to the lungs
What is dysautonomia?
Sometimes causes autonomic storming
Autonomic functions (heart & respiratory rates, blood pressure, temperature, perspiration) are disrupted.
Usually resolves in early recovery
What are musculoskeletal complications?
Neurologically-based changes / disruptions in neurologically based…in reflexes, sensory integration, range of motion, muscle tone, strength, endurance, spasticity, postural control and alignment
List 4 musculoskeletal complications
Contractures
Hyperreflexia
Spasticity
Heterotopic Ossification
What is hyperreflexia?
Involuntary exaggerated deep tendon reflexes
What are contractures?
Abnormal (usually permanent condition) of joints characterized by decreased range of motion (often in a flexed position)
What causes contractures?
Wasting away and shortening of muscle fibers and loss of skin elasticity
What is spasticity?
involuntary increases in muscle tone (rigidity)
a type of hypertonia (hypertonia is too much muscle tone)
What is heterotopic ossification? (HO)
Abnormal growth of bone in soft tissues adjacent to the joints
Management of musculoskeletal complications
exercise casting orthotic techniques ultrasound functional e-stim oral anti-spasticity medications Botox Surgically implanted baclofen pump
UTI intervention
maintain adequate hydration (minimize caffeine - bladder irritant)
timed voiding
use of absorbent briefs
condom caths
(avoid indwelling caths)
Signs of UTI
frequent/painful urination
fever
possible increased agitation
decreased level of alertness
What are the 4 systems responsible for regulation?
hypothalamus
parasympathetic system
sympathetic nerve systems
cortical functions
What is metabolism?
set of chemical reactions to convert food to energy
What happens with TBI and metabolism?
Metabolism increases significantly following a moderate or severe BI
How many stages of pressure ulcers are there?
6 stages ranging from stage 1-4, unstageable, deep tissue injury
What are 6 risk factors for pressure sores?
incontinence poor nutritional status contractures spasticity use of casts and/or splints sensory impairment
Name 6 common infections in BI
Meningitis Respiratory infections UTI Surgical site infections Cellulitis Urosepsis
After TBI, individuals are ___ times more likely to die of seizure disorder.
22% more likely to die of seizure disorder
What causes seizures?
An abnormal, disorderly discharge of electrical activity in the nerve cells of the brain
What are immediate post traumatic convulsions (IPTC)?
Events that involve loss of consciousness and movement seconds after impact
Non-epilectic events
Early post-traumatic seizures (EPTS)
a strong risk factor for the development of late post-traumatic seizures (LPTS)
Late post-traumatic seizures (LPTS) are less frequently seen in ________.
children
Late post-traumatic seizures (LPTS) are more frequently seen in ______.
people >65 years of age
What is the strongest risk factors for LPTS (late post-traumatic seizures)?
missle wounds
bilateral or multiple contusions
multiple craniotomies
What is the most common sleep complaint after TBI?
insomnia
What is status epilepticus?
more than 30 minutes of continuous seizure activity
or
two or more sequential seizures without full recovery of consciousness between seizures
What is anti-epileptic prophylaxis?
Anti-seizure medications
For adult patients with severe TBI, prophylaxis with phenytoin for 7 days decreases the risk of early post-traumatic seizures.
Continuing beyond 1 week is not effective in reducing risk of LPTS
The most common pain pathways in perons with TBI are …
nocioceptive
neuropathic
What is the nocioceptive pain pathway?
pain related to the peripheral nerve fibers
What is the neuropathic pain pathway?
pain associated with primary lesions of dysfunction of the nervous system
What is post-traumatic headache? (PTH)
Headache that commences within 14 days of consciousness. May resolve over the next 6 months or symptoms can persist to be chronic
Post-traumatic headache (PTH) is more prevalent in
mild TBI
How many people with mild PTH report post-traumatic headache pain compared to mod-severe TBI?
95% mild TBI
22% moderate to severe TBI
What is a chronic headache?
One that occurs at least 15 days per month for at least 3 months
What is a primary headache?
Has no specific cause
What is a secondary headache?
May have an identifiable cause
What is a tension headache?
bilateral head pain of pressing quality, much like that of a tight hand or vice clamping across the head
Do not get worse with physical activity
No other symptoms (no light sensitivity, etc.)
What is a cervicogenic headache?
Head pain generated from the cervical spine
nerve injections
What is a craniomandibular headache?
subtype of tension type headache associated with the temporal mandibular joint
What is the clinical presentation of a migraine?
Located on one side of thead
Patients complain the head is throbbing, stabbing/sharp, worsened by heat, bright light, excessive physical activity
can cause nausea or vomitting
tend to have a peak of severity within 24 hours of onset but range 4-72 hours
What are the four phases of the migraine?
Prodrome (early)
Aura
Headache
Postdrome
What is an acquired brain injury?
a ABI is an umbrella definition for injuries caused by external physical forces and internal insults to the brain
Traumatic Impact is a contact injury (head struck by or against an object) - can be…
closed or open head injuries.
closed = likely focal or diffuse open = focal
Traumatic Inertial is a non-contact injury when…
the brain moves within the skull
diffuse or multifocal
Non-traumatic injury is…
an internal insult
focal or diffuse
What are four common closed (non-penetrating) traumatic head injuries?
brain contusions
brain lacerations
intracerebral hemorrhage
diffuse axonal injury
What are five causes of closed (non-penetrating_ traumatic head injuries?
blast related assaults falls vehicular accidents sports accidents
what are four common causes of open (penetrating) traumatic head injuries?
epidural hematoma
subdural hematoma
intracerebral hemorrhage
infection
What are five causes of open (penetrating traumatic head injuries?
gunshot stabbing falls vehicular accidents sports
What are three common rotational/angular forces traumatic inertial head injuries?
(brain moves within skull)
diffuse axonal injury
white matter lesions
hemorrhage
What are three common causes of common rotational/angular forces traumatic inertial injuries?
falls
vehicular accidents
sports accidents
What are five causes of non-traumatic head injury?
stroke poisoning hypoxia/anoxia ischemia infection tumors
Acceleration-deceleration forces can result in coup-contrecoup injuries and is an example of a traumatic _______ injury
inertial
What is the primary injury?
The initial injury to the brain defines the injury as either traumatic or non-traumatic. Helps determine severity
3 levels of brain injury severity
Mild TBI - brief or no loss of consciousness. Dizziness, poor memory of event, lethargy, vomitting
Moderate TBI - unconsciouss for any period of time up to 24 hours. Will have neurologic signs of brain trauma
Severe TBI - loss of consciousness >24 hours
What is the primary and secondary cascade of events?
The primary injury causes a cascade of adverse events leading to secondary brain injury
The primary event leads to the secondary events (all of the adverse events after). Secondary events when the injury process extends past the point of time of the initial injury
(hypoxia, anemia, metabolic abnormalities, hydrocephalus, hypertension, hemorrhagic activity)
What is a concussion?
a trauma-induced alteration in mental status (dazed, disoriented, confused)
What % of TBIs each year are mild TBI?
75% mild TBI
How many people sustain a TBI each year?
2.5 million
TBI is the ____ most prevalent disability in the US?
2nd
How many people are living with BI?
13.5 million
What are some risk factors for BI?
Age of injury alcohol misuse domestic violence service in the military participation insports injury severity
15-19 years old brain injury likely to be caused by…
MVA
20-24 brain injuries likely to be caused by…
firearms
65-75+ brain injuries likely to be caused by…
by falls and firearms
What age has the highest rates of hospitalization and death in BI?
age 75+
Risk of a 2nd BI is ___x greater after 1st.
3 times greater
Risk of a 3rd BI is ___xgreater after 2nd
8 times greater
What age group has the highest rates of death in TBI (all causes)?
75+
What age groups have the highest rates of death from firearms?
20-24
75+
What age group has highest rates of death from TBI due to falls?
75+
What age group has highest % of TBI from physical abuse?
children 0-4
what age group has hest rates of TBI from MVA?
20-24
Non-accidental trauma accounts for ___% of deahs from head trauma in children under 2
80%
What is the leading cause of serious injury in women between 15-44?
intimate abuse
What % of women victims of domestic violence have symptoms of BI?
67% of women who are victims of domestic violence
What % of inmates have brain injury?
up to 87%
In 1999 the Supreme Court ruled The Olmstead Decision which said…
individuals must be granted the option to live in the community in the most integrated setting appropriate.
When was the Brain Injury Association of America (BIAA) founded?
1995 (before that it was the National Head Injury Foundation starting in 1980)
How many state affiliates are in the BIAA?
26 state affiliates
What is the TBI Model Systems of Care? (TBIMS)
Developed in 1987 to conduct prospective longitudinal research on TBI outcomes at 16 centers for standardized national database of analysis of treatment outcomes
TBI reduces life expectancy by ___ years
7 years
What is the leading causes of death in TBI?
aspiration pneumonia (leading) 49x
seizures 37x
circulatory problems 29x
septicemia
Name secondary aspects to BI after the primary injury
hypoxia anemia metabolic abnormalities hydrocephalus hypertension hemorrhagic activity
Who has higher rates (at any age) of TBI related deaths? males or females?
males
What % of women victims of domestic violence also had symptoms associated with brain injury?
67% of women victims of domestic violence also have symptoms associated with brain injury
What does the TBI Model Systems develop and maintain?
The TBI Model Systems develop a model system of care and maintain a standardized national database for analysis of treatment and outcomes.
What does neuroprotective compound or strategy limit?
A neuroprotective compond or strategy limits neuronal death following injury and/or enhances recovery.
Name examples of neuroprotective compounds or strategies
Magnesium (Mg)
What is neuroplasticity?
The ability of the nervous system to change itself and form new connections, creat new neurons in order to compensate for injury
When does excitotoxicity occur?
When an neuron cannot maintain its resting potential, resulting in its repeated firing. This creates toxic levels of sodium and calcium ions, leading to cell death.
What is Transcranial Magnetic Stimulation (TMS?)
TMS is a non-invasive method of stimulating the brain using electromagnetic induction.
It is a treatment modality for depression, stroke, migrains, dystonia, tinnitus and Parkinson’s Disease
The combination of _____ and ______ may prove to be the best treatment strategy for TBI.
Neuroprotection (the preservation of neuronal functioning & structure( and neuroplasticity (the brains ability to change its function & structures)
Who is at the greatest risk for second-impact syndrome if they returned to play while still neurologically at risk?
Athletes under the age of 24
What is second impact syndrome?
Rare but potentially fatal condition in sports a player who returns to play while neurologically at risk is vulnerable to particular metabolic problems
What are the primary causes of mTBI?
Acceleration-deceleration movements striking the head against a hard surface, the head being struck by an object and blasts or explosions
A rapid progressive headache immediately following a head injury may be indicative of what?
A more significant injury process
What is the most common complaint after mTBI?
headaches
What is Chronic Traumatic Encephalopathy (CTE)?
Rare progressive degenerative condition of the central nervous system.
Typically seen after repetitive brain trauma
Releases of proteins
Some atheletes with this problem go on to develop ALS and focal seizures due to chronic inflammation
How many extra calories will a person need after brain injury?
A person will require at least 40% more calories than he or she needed before the injury
What is metabolic syndrome?
A combination of medical disorders that increase the risk for both cardiovascular disease and diabetes. Common in aging adults, metabolic syndrome is marked by abdominal obesity, insulin resistance, high blood pressure
What leads to MRSA infections?
Typically a product of poor hygiene, including poor handwashing by care providers and use of soiled clothing
When do Early Post Traumatic Convulsions (EPTS) occur?
EPTS occur within 7 days following the injury.
WHy do Early Post Traumatic Convulsions (EPTS) occur?
As a direct result of the trauma, with 50% occurring within 24 hours of impact. Strong risk factor of late post-traumatic seizures
What are the risk factors for Persistent Post Concussive Symptoms (PPCS?
Risk Factors for PPCS Over age 40 Female Traumatically injured Low socioeconomic status History of substance abuse Positive mental health history
List 5 diagnostic criteria for a Coma (1st level of DOC)
- No arousal or eye opening
- No behavioral signs or awareness
- Impaired brainstem reflexes
- No vocalizations for over 1 hour
- Impaired spontaneous breathing
List 5 diagnostic criteria for Vegetative State (2nd level of DOC)
- Some arousal and spontaneous/stimulus induced eye opening
- No behavioral signs of awareness
- Preserved brainstem reflexes
- No language production or comprehension
- May grimace in pain or localize to sounds inconsistently
List 5 diagnostic criteria for Minimally Conscious State (3rd level of DOC)
- Arousal and spontaneous eye opening
- Fluctuating but reproducible behavioral signs of awareness
- Response to verbal directives
- Verbalizations
- Intentional but unreliable communication
List 5 symptoms of Autonomic Dysfunction Syndrome (ADS occurs in individuals with a DOC)
- Dystonia (abnormal muscle tone)
- Agitation
- Tachycardia (rapid heart rate)
- Hyperthermia (elevated temperature
- Hypertension (elevated blood pressure)
