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S6- Neuro 2 > Week 2- TBI > Flashcards

Week 2- TBI Flashcards

1
Q

PART 1: TBI INTRODUCTION

A

PART 1: TBI INTRODUCTION

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2
Q

What is a TBI and what can cause it?

A
  • A TBI is an injury that disrupts the normal function of the brain. It can be caused by a bump, blow, or jolt to the head or a penetrating head injury.
  • Explosive blasts can also cause TBI, particularly among those who serve in the U.S. military.
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3
Q
  • What is the mortality rate for severe TBI?

- What is the mortality rate for moderate TBI?

A
  • 30-50%

- 10-15%

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4
Q

What populations are more at risk for TBI?

A
  • Children
  • Older Adults
  • Men > Women 2:1
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5
Q

What are some additional groups that are at higher risk for a TBI?

A
  • Racial and ethnic minorities
  • Service members/veterans
  • Homeless
  • Incarcerated individuals
  • Domestic abuse
  • Rural areas
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6
Q

What are the (4) most common causes of TBI?

A
  • MVA
  • Falls
  • Acts of violence
  • Sports
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7
Q

What are the 2 categories in which our brain can be injured?

A
  • Traumatic Brain Injury (TBI)

- Acquired Brain Injury (ABI)

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8
Q

What are the mechanisms of TBI? (4)

A
  • Open head injury
  • Closed head injury
  • Deceleration injuries
  • Hemorrhage/Hematoma
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9
Q

What are the mechanisms of ABI? (4)

A
  • Chemical/toxic
  • Hypoxia
  • Tumor
  • Infections
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10
Q

What is the difference between open injuries and closed injuries?

A
  • Open injuries result from penetrating types of wounds where the skull is fractures or displaced or meninges are compromised.
  • Closed injuries result from impact to the head but the skill is not fractured. Only cortical neuronal tissue is damaged.
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11
Q
  • In which type of injury are meninges compromised?

- In which type of injury are cortical neuronal tissues damaged?

A
  • Open

- Closed

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12
Q

With open and closed injuries, ________ Brain Damage is a result of the mechanical issue at the time of trauma.

A

Primary

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13
Q

Within Primary Brain Damage, what are the 2 types of injuries?

A
  • Focal

- Diffuse

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14
Q

List the types of FOCAL injuries.

A
  • Hematomas (Epidural and Subdural)
  • Hemorrhages (Subarachnoid and Intracerebral)
  • Coup Lesion
  • Contrecoup Lesion
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15
Q

What is the difference between a hematoma and a hemorrhage?

A

A hematoma usually describes bleeding which has more or less clotted, whereas a hemorrhage signifies active, ongoing bleeding.

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16
Q
  • ________ Hematomas occur between the dura mater and the skull.
  • ________ Hematomas involve a rupture to the cortical bridging veins.
A
  • Epidural Hematoma (EDH)

- Subdural Hematoma (SDH)

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17
Q

What is the classic presentation often seen post Epidural Hematoma?

A
  • Unconscious, Alert, Deteriorate

- Patients lose consciousness, snap back and are with you, then rapidly start to deteriorate again.

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18
Q

What is the most common focal injury seen with geriatric population when they fall?

A

-Subdural Hematoma

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19
Q

What is the classic presentation often seen post Subdural Hematoma?

A

-Slow deterioration, little rattled after fall and may be ok after a couple of days. Family member usually notices that they are out of it.

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20
Q
  • _______ Hemorrhages occur between the arachnoid and brain tissue.
  • ________ Hemorrhages occur within the brain tissue itself.
A
  • Subarachnoid Hemorrhage (SAH)

- Intracerebral Hemorrhage (ICH)

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21
Q

How are hemorrhages from strokes and TBIs different?

A

-They are almost entirely the same and can occur intracerebrally or in the subarachnoid space.

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22
Q

What type of focal injury is most life threatening?

A
  • Subarachnoid Hemorrhage (SAH)

- 1/3 survive with good recovery, 1/3 survive with a disability, 1/3 will die

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23
Q

Does a bleed from a trauma or a rupture bleed faster?

A

-Trauma

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24
Q

What is a common sequela of SAH?

A

-vasospasm

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25
Q

What is a contusion?

A

-Bruising on the surface of the brain sustained at the time of impact. (small vessels on the surface of the brain hemorrhage)

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26
Q

What is the difference between a coup lesion and contrecoup lesion?

A
  • Coup Lesion is a contusion on the same side of the brain as the impact.
  • Contrecoup Lesion is surface hemorrhages on the opposite side of the brain trauma as a result of deceleration.
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27
Q
  • More often than not we have both Coup and Contrecoup Lesions at the same time. What is this called?
  • What are the most common structures involved?
A
  • Coup-Contrecoup Injuries

- Anterior poles, underside of temporal and frontal lobes

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28
Q

With Coup-Contrecoup injuries, the __________ injury is most often worse.

A

-Contrecoup

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29
Q
  • What is the main diffuse injury often seen with TBIs?

- What is the most common cause?

A
  • Diffuse Axonal Injury

- Acceleration/Deceleration such as MVA

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30
Q
  • Diffuse Axonal Injuries result in traumatic “______ ______” and have SIGNIFICANT __________ involvement.
  • What are the most affected areas?
A
  • “micro bleeds”, neurological

- corpus callosum, basal ganglia, brainstem, cerebellum

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31
Q

PART 2: SECONDARY INJURY AND ACUTE COMPLICATIONS

A

PART 2: SECONDARY INJURY AND ACUTE COMPLICATIONS

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32
Q

With open and closed injuries, ________ Brain Damage is caused by physiological responses to initial injury.

A

-Secondary

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33
Q

What are the 2 ways we can find ourselves in the Secondary Brain Damage?

A
  • Ongoing increases in ICP causing swelling and mass effect with more damage to brain and higher rates of herniation and death.
  • Acquired Brain Injuries
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34
Q

List some of the most common Acquired (non-traumatic) Brain Injuries.

A
  • Stroke
  • Infectious Disease
  • Seizure
  • Electric Shock
  • Tumors
  • Toxic Exposure
  • Metabolic Disorders
  • Neurotic Poisoning
  • Lack of Oxygen
  • Drug Overdose
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35
Q
  • What is THE most common causes of ABIs?

- What is the most common cause of Anoxic/Hypoxic Injuries?

A
  • Anoxic/Hypoxic Injury

- Cardiac Arrest

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36
Q
  • Anoxic/Hypoxic injuries typically result in _______ damage and is associated with poor prognosis for _________ function.
  • What are the more vulnerable areas with hypoxic/anoxic injuries?
A
  • global damage, poor prognosis for cognitive function

- hippocampus, cerebellum, basal ganglia

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37
Q

What are the (3) classifications of blast injuries?

A
  • Primary- Direct effect of blast overpressure on organs.
  • Secondary- Shrapnel injury.
  • Tertiary- Direct blow to head.
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38
Q

Acute Management of Brain Injury. (5)

A
  • Diagnostic Imaging (MRI, CT, PET, EEG)
  • Medication Management
  • Surgical Management
  • Secondary Complications
  • Trauma Management
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39
Q

When will an EEG scan be used with these patients?

A

-If seizures exist.

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40
Q

What are the ways medication is used to manage these patients?

A
  • ↓ BP and ICP
  • ↓ Intracranial bleeding
  • Anti-seizure
  • ↓ body temperature
  • ↓ infection rate
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41
Q

Why are hypothermic medications used?

A

-Due to hypothermia known neuroprotective effect.

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42
Q

What are some common secondary complications with these patients? (4)

A
  • Increased ICP
  • Post-Traumatic Seizures
  • Dysautonomia
  • Heterotropic Ossification
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43
Q

Increased ICP:

  • __% of patients with serious injuries have ↑ICP.
  • Increased pressure can compress brain tissue, decrease perfusion to brain tissues or possible herniation.
  • Normal ICP = __-__ mm Hg
  • Abnormal ICP + > __ mm Hg
A
  • 70%
  • 5-10mmHg
  • > 20 mmHg
44
Q

What are some activities that increase ICP?

A
  • Full supine or Trendelenburg
  • Cervical flexion
  • Percussion and vibration
  • Valsalva (coughing, sneezing, holding breath)
  • Exertional activities
45
Q

What are the S/Sx of increased ICP? (7)

A
  • Decreased responsiveness
  • impaired consciousness
  • severe HA
  • vomiting
  • irritability
  • papiledema
  • ↑ BP and ↓ HR
46
Q

If a patient has any ICP >___ mmHg do not touch them due to the risk.

A

-20mmHg

47
Q

What are some events that trigger seizures?

A
  • Stress
  • Poor nutrition
  • Electrolyte imbalance
  • Missed medication or drug use
  • Flickering lights
  • Infection
  • Fever
  • Anxiety
48
Q

What is the golden rule for treating patients with seizures?

A

-Patients need to be seizure free for 24 hours before mobilization is allowed.

49
Q

What is dysautonomia?

A

-Umbrella term for anything that goes wrong with autonomic system.

50
Q

-TBI survivors in the acute stages are at risk for PAID, what is this?

A
  • Paroxysmal Autonomic Instability and Dystonia (“Sympathetic Storming”)
  • Typically seen in severe TBI (GCS 3-8)
51
Q

PAID (“Sympathetic Storming”) involves alterations in level of __________, __________, dystonia, HTN, hyperthermia, tachyardia, tachypnea, diaphoresis, and agitation.

A

-consciousness, posturing

52
Q
  • How is PAID diagnosed?

- How is it managed?

A
  • Diagnosed via clinical observation.

- Managed via symptom management w/ medication “ride out the storm”.

53
Q
  • What is heterotopic ossification?

- Involved in __-__% of TBIs.

A
  • Formation of abnormal bone growth around joint tissue.

- 10-20%

54
Q

Heterotopic ossification onsets around __-__ weeks after brain injury and the cause is _______.

A
  • 4-12 weeks

- unknown

55
Q

What is the clinical presentation of patients with heterotopic ossification?

A
  • Initial signs are loss of ROM and pain in joint area.
  • Local erythema, pain with movement, swelling, warm to touch.
  • Severe HO may result in vascular and/or nerve compression.
56
Q

What PT interventions are utilized to help manage Heterotopic Ossification (HO)?

A

-PROM and stretching to maintain ROM and prevent further complications.

57
Q

HO is mainly treated with medication, however, after ~___ years after injury surgical excisions are performed.

A

-1.5 years (recurrence possible)

58
Q

Additional complications with TBI:

  • 50% _________ difficulties
  • 45% genitourinary deficits
  • 34% ________ problems
  • 32% ________ problems
  • 21% dermatological impairments
  • urinary and bowel incontinence
  • hydrocephalus
A
  • 50% GI difficulties
  • 34% respiratory problems
  • 32% CV problems
59
Q

PART 3: CLINICAL MANIFESTATIONS OF TBI

A

PART 3: CLINICAL MANIFESTATIONS OF TBI

60
Q

The extreme variability when treating patients with TBI has to do with what things?

A
  • Brain injury can occur anywhere in the head.
  • There are a bunch of types of brain injuries.
  • Additional level of high medical complications.
  • Next level of cognitive/behavioral considerations.
61
Q

There are a bunch of similarities between clinical presentation of _______ and TBI.

A

-stroke

62
Q

Clinical presentation of Frontal Lobe TBIs.

A
  • Initiation
  • Problem solving
  • Judgement
  • Inhibition of behavior
  • Planning/anticipation
  • Self-monitoring
  • Motor planning
  • Personality/emotions
  • Awareness of abilities/limitations
  • Organization
  • Attention/concentration
  • Mental flexibility
  • Speaking (expressive language)
63
Q

Clinical presentation of Temporal Lobe TBIs.

A
  • Memory
  • Hearing
  • Understanding language
  • Organization and sequencing
64
Q

Clinical presentation of Parietal Lobe TBIs.

A
  • Sense of touch
  • Differentiation (size/shape/color)
  • Spatial perception
  • Visual perception
65
Q

Clinical presentation of Brain Stem TBIs.

A
  • Breathing
  • Heart rate
  • Arousal/consciousness
  • Sleep/wake functions
  • Attention/concentration
66
Q

Clinical presentation of Occipital Lobe TBIs.

A

-Vision

67
Q

Clinical presentations of Cerebellum TBIs.

A
  • Balance
  • Coordination
  • Skilled motor activity
68
Q

_________ deficits often take the front seat with regards to disability with TBIs. Unlike strokes, TBI patients often do well recovering from neuromuscular deficits.

A

-Cognitive

69
Q
  • What is meant when talking about “Walkie-Talkie Patients”?

- These patients may fill in info with fabricated stories, what is this?

A
  • May be able to ambulate independently without an AD negotiating barriers but might not know their name or family members.
  • Confabulation
70
Q

What are the 5 categories of attention?

A
  • Focused
  • Sustained
  • Selective
  • Alternating
  • Divided
71
Q

S/Sx of impaired attention.

  • Unable to engage on relevant or functional information.
  • Unable to sustain attention to task.
  • Unable to switch to ____ task.
  • Unable to resist __________.
  • Unable to _________.
  • Unable to manipulate mental information while maintaining overarching goal in mind.
A
  • new
  • distraction
  • multitask
72
Q

What are 3 additional cognitive impairments seen with TBIs?

A
  • Memory
  • Executive Function
  • Language
73
Q

Memory Deficits:

  • _________ and/or ________ amnesia.
  • _____ term > ______ term memory deficits.
  • _________ and ________ memory often both difficult.
A
  • retrograde and/or anterograde amnesia
  • short-term > long-term
  • Declarative and procedural
74
Q
  • Language deficits are generally ___-______ in nature and related to _________ impairment.
  • What are some common language deficits seen with TBI patients?
A
  • non-aphasic, cognitive
  • Disorganized and tangential oral and written communication, imprecise language, word-retrieval difficulties, disinhibited language.
75
Q
  • What is the most enduring and socially disabling of impairments after TBI?
  • These issues are very prominent in patients classified as having Rancho ___ and ____ brain injuries.
A
  • Behavioral Issues

- Rancho IV and V

76
Q

Frontal Lobe Syndromes are also known as “__________ Syndrome”.

A

-Dysexecutive Syndrome

77
Q

What are the 2 commonly presenting dysexecutive syndromes?

A
  • Orbitofrontal Lobe Syndrome

- Frontal Convexity Syndrome

78
Q

These symptoms describe which Dysexecutive Syndrome?

  • Impulsive
  • Inappropriate jocular affect, euphoria
  • Emotional lability
  • Poor judgement and insight
  • Distractibility
A

-Orbitofrontal Lobe Syndrome

79
Q

These symptoms describe which Dysexecutive Syndrome?

  • Apathy
  • Indifference
  • Psychomotor retardation
  • Motor perseveration and impersistence
  • Stimulus-bound behavior
  • Motor programming deficits
  • Poor word list generation
A

-Frontal Convexity Syndrome

80
Q

What are some motor and sensory impairments we can see with TBIs?

A
  • Strength deficits
  • Tone Abnormalities
  • Sensory deficits
81
Q

In regards to strength deficits, more _____ lesions result in hemiparesis/hemiplegia while ______ lesions are more characterized by motor control and coordination deficits over true strength deficits.

A
  • focal

- diffuse

82
Q
  • In regards to tone abnormalities, posturing results from injury to the ________.
  • __________ Rigidity = LE ext/UE flex
  • __________ Rigidity = LE and UE ext
A
  • brain stem
  • Decorticate
  • Decerebrate
83
Q

With sensory deficits, ________ and __________ deficits are most common.

A

-Proprioceptive and Kinesthetic

84
Q

What structures are also in the brainstem and are important to test if we have a TBI?

A

-Cranial Nerves

85
Q
  • CN__ is damaged in 7% of all TBIs.

- Intact pupillary response indicates injury is above level of ________.

A
  • CN1

- brainstem

86
Q
  • Conjugate gaze palsy = CNS or PNS?
  • Unilateral gaze palsy = CNS or PNS?
  • Tonic downward gaze = injury to ______, ______, or ____.
  • Tonic upward gaze = injury to both ________.
  • Rapid horizontal eye movement = _______ activity.
A
  • Conjugate gaze palsy = CNS
  • Unilateral gaze palsy = PNS
  • thalamus, midbrain, or pons
  • both hemispheres
  • seizure activity
87
Q
  • Damage to what cranial nerve results in loss of sensation to the nose, eyebrow, and forehead.
  • Damage what cranial nerve causes muscle weakness, loss of tear production, decreased saliva secretion, and taste.
A
  • CN5 (trigeminal)

- CN7 (facial)

88
Q

As many as 50% of people who have a TBI report signs of what?

A

-Vestibular Dysfunction (dizziness and imbalance)

89
Q

Vestibular rehabilitation may take up to ___ as long as those without a TBI.

A

-3x

90
Q
  • What is a “Labyrinthine Concussion”?

- It is often related to the development of _______.

A
  • Damage to the inner ear due to head trauma with no well-defined injury or skull fracture, resulting in sensorineural hearing loss with or without vestibular symptoms.
  • BPPV
91
Q

Autonomic dysfunction is common post TBI. What are some common ANS symptoms seen with TBI?

A
  • HR variability
  • RR variability
  • Elevated body temp
  • BP changes
  • Excessive sweating, salivation, tearing
  • Dilated pupils
  • Vomiting
  • Anxiety, panic disorder, and PTSD all tied to autonomic system imbalance
92
Q

___% of individuals with TBI will have other injuries which increase the complexity of the rehabilitation program.

A

-40%

93
Q

PART 4: OUTCOME MEASURES AND PROGNOSIS

A

PART 4: OUTCOME MEASURES AND PROGNOSIS

94
Q

What are the 2 things our TBI outcome measures revolve around?

A

-Arousal and Cognition

95
Q

What are the main outcome measures used for arousal and cognition? (7)

A
  • Glasgow Coma Scale (GCS)
  • Ranchos Los Amigos Levels of Cognitive Function (LOCF)
  • Rappaport’s Disability Rating Scale (DRS)
  • Glasgow Outcome Scale (GOS)
  • Galveston Orientation and Amnesia Test (GOAT) and Orientation Log (O-Log)
  • Coma Recovery Scale (CRS-R)
  • Disorders of Consciousness Scale (DOCS)
96
Q

What are the (3) things that GCS measures?

A
  • Pupillary Response
  • Motor Activity
  • Ability to Verbalize
97
Q

How is the GCS scored?

A
  • 3-8 = severe
  • 9-12 = moderate
  • 13-15 = mild
98
Q

GCS Scoring- Mild

  • GCS = __-__
  • LOC = _____
  • _______ alteration of consciousness
  • Post traumatic amnesia
A
  • GCS = 13-15
  • LOC = 0-30 minutes
  • Brief (<24hrs) alteration of consciousness
  • Post traumatic amnesia <1 day
  • Imaging = normal
99
Q

GCS Scoring- Moderate

  • GCS = __-__
  • LOC = _____
  • Alteration of consciousness >_____
  • Post traumatic amnesia _______
  • Imaging = _______
A
  • GCS = 9-12
  • LOC = >30 minutes but < than 24hrs
  • Alteration of consciousness > 24hrs
  • Post traumatic amnesia >1 day but <7 days
  • Imaging = normal or abnormal
100
Q

GCS Scoring- Severe

  • GCS = __-__
  • LOC = _____
  • Alteration of consciousness >_____
  • Post traumatic amnesia >_______
  • Imaging = _______
A
  • GCS = 3-8
  • LOC = >24hrs
  • Alteration of consciousness > 24hrs
  • Post traumatic amnesia >7 days
  • Imaging = normal or abnormal
101
Q
  • The DRS is a ___ point scale that tracks progress for patients in a coma through community integration phase and can predict return to work.
  • What is the scoring?
A
  • 30 point scale

- Higher scores = higher level of disability

102
Q

The DRS evaluates 8 areas of function in what 4 categories?

A
  • Consciousness (eye opening, verbal, motor)
  • Cognitive ability (feeding, toileting and grooming)
  • Independence/ dependence level of function
  • Employability
103
Q

The GOS is a 8 level global scale for functional outcome that rates patient status into what 5 categories?

A
  • Dead
  • Vegetative State
  • Severe Disability
  • Moderate Disability
  • Good Recovery
104
Q

List some prognostic indicators for TBI.

A
  • Age/gender
  • GCS score
  • Length of PTA (post-traumatic amnesia)
  • Traumatic over acquired (vascular/anoxic)
  • Higher education level/pre-injury IQ
  • Early use of neurostimulants
  • Presence of pre-injury psychological issues or substance abuse
  • GOS: Level 1-3
105
Q

What are the (4) aspects of community integration?

A
  • Assimilation
  • Social Support
  • Occupation
  • Independent Living
106
Q

TBI Residual Impairments:

  • Decreased ________ inhibitions (lack of filter)
  • Impaired ______ control
  • Impaired ________, ______, sequencing and high level problem solving
  • Perseveration or word finding issues
  • Impaired ______
  • Impaired _______ or calculating ability
  • ________ impairments (return to driving issues)
  • _______/routing issues
  • _______ issues/incoordination
A
  • Decreased social inhibitions (ie. Lack of filter)
  • Impaired motor control
  • Impaired attention, memory, sequencing & high level problem solving
  • Perseveration or word finding issues
  • Impaired speech
  • Impaired writing or calculating ability
  • Vision impairments (return to driving issues, etc)
  • Topographic/ routing issues
  • Balance issues, incoordination

S6- Neuro 2 (18 decks)

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