Unit 4 Traumatic Brain Injury Flashcards
Define traumatic brain injury
Trauma in the brain. It can be based on the severity:
-Open brain injury or closed brain injury
What are 5 types of impairments you will expect to see in someone following a TBI?
- Long-term functional problems
- Altered or declined LOC
- Motor, perception and cognitive functions
- Behaviour and emotional changes
Explain coup and contrecoup
- Coup: injury occurs under the site of impact with an object
- Contrecoup: injury occurs on the side opposite the area that was hit
What are the 4 pathophysiological processes?
- Disruption of synapses
- Functional, but not structural damages
- Contusion on surface of brain
- Due to rupture of small blood vessels
- Could be on same side or opposite site
- Frontal and temporal lobes most affected
- Diffuse axonal injury
- Axons stretched and rotated
- Hemorrhaging –> Hematomas
- Epidural *Subarachnoid
- Subdural *Intracerebral
What is diffuse axonal injury (DAI) and explain how it happens?
- Cause
- High velocity
- Result in stretching and shearing forces
- And strong rotational forces (twisting)
- Pathophysiology
- Micro-bleeding
- Chemical changes in brain
- Effect
- Can cause widespread brain damage
- Affects central areas of brain
What are 4 complications that could occur following traumatic brain injury?
- LOC
- Seizures
- Infection
- Increased intracranial pressure
- Can be life-threatening
- Can occur immediately, within days, or up to months later
Describe the mechanisms of closed TBI?
- Blow to head –> the head accelerates
- Head suddenly stops –> the head decelerates and then accelerates back the other way
- Brain movement without skull impact but movement of brain inside the skull.
Explain why traumatic brain injuries results in such varied impairments
Due to coup and contrecoup affects and it depends on where the area of the brain is affected.
True or false: Seizures are only a concern immediately following a traumatic brain injury?
False. 80% of seizures can develop within first 2 years.
- approx. 30% of people with TBI develop post-traumatic seizures
- more common with open head injuries, subdural hematoma and older adults
What should you do if your patient starts to have seizure?
- Don’t try to stop it
- Transfer to floor
- Position on side
What are the 3 ways to assess severity of brain injury?
- Glasgow Coma Scale
- Post-traumatic amnesia (PTA)
- Level of Consciousness (LOC)
What does the Glasgow Coma Scale do?
- Considers 3 responses of stimulation
- Eye opening, movement and speech in response to stimulation
- Indicates
- Level of arousal
- Function of cerebral cortex
True or false: A person with a severe brain injury will have a Glasgow Coma Scale of 13 when they come to the hospital.
False, scores of less than 8, indicates coma, severe brain injury
- Scores range from 3-15
- The higher the score, the less severe the brain damage
What does PTA stand for and describe
- Stand for: Post-Traumatic Amnesia
- It is use in period of confusion when come out of coma
Individuals are:
- Disoriented
- Inattentive
- Have difficulty learning new things
- Have significantly decreased short-term memory
- Not remember since injury
- Maybe agitated
What does MTBI stand for?
Mild Traumatic Brain Injury
The other name for MTBI is ________
Concussion
What are five symptoms for mild brain injury?
Acute
- Headache - mild or moderate
- Dizziness
- Nausea
- Blurred vision
- Sensitive to light
Later
- Trouble with thinking, memory or concentrating
- Ringing in ears (tinnitus)
- Decreased energy
- Changes in sleep patterns
- Drowsiness
Do the upper or lower limbs tend to have a greater increase in extensor tone?
LE: rigidly in full extension
What are 4 common cognitive impairments following severe brain injury?
- Short-term memory loss
- Lack of attention
- Insight
- Orientation
What are 4 common behavioral impairments following severe brain injury?
- Impulsive
- Disinhibition
- Inflexibility
- Emotional lability
Describe the development of spasticity following TBI
- Often develops quickly
- LE: increase extensor tone
- UE: can be extension or flexion
- One side may be more affected than the other
- Often increase extensor tone of back and neck
What is the difference between decerebrate and decorticate positioning?
- Decerebrate position: Body held rigidly in full extension, including arms, legs, and neck ( Most serious)
- Decorticate position: Arms are held rigidly in flexion. Legs held rigidly in full extension
True or False: People wake up from a coma quickly
False
Define head Injury, brain injury, and acquired brain injury
Head injury:
- trauma to the head
- may or may not include injury to brain
Brain injury:
- generally synonymous with ABI
- can have brain injury without skull injury
ABI:
-any brain damage that occurs after birth
