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10 - Rehabilitation > 10-05 Traumatic Brain Injury > Flashcards

10-05 Traumatic Brain Injury Flashcards

(51 cards)

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1
Q

General Terms

A
  • BI: Brain injury
  • TBI: Traumatic Brain Injury
  • CHI - Closed head imjury
  • HI: Head injury
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2
Q

Causes of death and disability in young adults

A
  • Leading cause of death/disability in young adults
  • Falls (32%)
  • MVA (19%)
  • Struck by/against events (18%)
  • Assaults (10%)
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3
Q

Most common age for TBI

A
  • Older adolescents/young adults
  • Under 4
  • Older than 65
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4
Q

External forces of TBI

A
  • Acceleration, deceleration, rotational forces relative to bony skull
  • Compression, strain, shearing, displacement of brain tissue
  • Penetrating object –> laceration and contusion of brain tissue
  • Glial cells vs neurons: rapid atmospheric pressure changes in blast-related injuries; neuron cells intact (resilient), glial cells (support for neurons) damaged and die - send out toxins that kill off neurons
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5
Q

Focal Injury

A
  • Localized to site of impact on skull
  • Typically sports injury/MVA
  • Causes hematomas, edema, contusion, laceration or combination
  • Coup/Countercoup injury: Blow –> injury under site of impact –> bouncing of brain off opposite side of skull (2 areas of impact directly opposite)
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6
Q

Diffuse Axonal Injury (DAI)

A
  • Widespread shearing of axons
  • Severe MVA - multiple forces acting on brain
  • Caused by acceleration, deceleration and rotational forces
  • Axons shear, retract and separate from neuron cell bodies
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7
Q

Hypoxic-Ischemic Injury (HII)

A
  • Lack of oxygenated blood flow to the brain
  • Global brain damage (poor cognitive function, low outcome expectations)
  • Caused by systemic hypotension (LBP due to arteriosclerosis), anoxia (drowning, suffocation, asthma/emphysema)
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8
Q

Increased Intracranial Pressure (ICP)

A
  • Caused by brain edema, abnormal CSF fluid dynamics, hematomas (epidural, subdural, intracerebral)
  • Normal ICP is 4-15 mmHg (greater = brain damage)
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9
Q

Blast-related injuries

A
  • Single or multiple (cumulative trauma) blasts
  • Combat, bombings, industrial accidents
  • Can range from mild to severe, primary to tertiary
  • Damage difficult to see on imaging
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10
Q

Mild blast-related injury

A
  • Loss of consciousness (LOC) less than 1 hour
  • Post-trauma amnesia (PTA) less than 24 hours
  • Might not have LOC (current research)
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11
Q

Moderate blast-related injury

A
  • LOC greater than hour, up to 24 hours

- PTA greater than day, no more than 7 days

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12
Q

Severe blast-related injury

A
  • LOC greater than 24 hours

- PTA greater than 7 days

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13
Q

Primary blast injury

A
  • Changes in atmospheric pressure
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14
Q

Secondary blast injury

A
  • Flying debris to head
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15
Q

Tertiary blast injury

A
  • Head hits solid object
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16
Q

Common symptoms of blast-related injuries

A
  • Severe headaches
  • Inability to sleep
  • Mood swings
  • Balance problems
  • Memory/concentration issues
  • Ringing in the ears
  • Irritability
  • Nausea
  • Vomiting
  • Sensitive to noise/light (common, esp. in mold injuries)
  • Tremors
  • Mild TBI symptoms similar to PTSD
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17
Q

Neuromuscular impairments

A
  • Abnormal tone
  • Primitive reflexes
  • Posturing (depends on amount of damage; seen in more severe cases): Decorticate or Decerebrate rigidity
  • Sensory impairments: Proprioception, Kinesthesia
  • Motor Control: Monoparesis, hemiparesis, tetraparesis; incoordination, timing, sequencing; balance
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18
Q

Cognitive impairments

A
  • Altered level of consciousness
  • Altered consciousness states: minimally conscious, vegetative, persistent vegetative
  • Altered consciousness: stupor, obtunded
  • The LONGER altered state persists, the LESS CHANCE of functional recovery
  • Orientation/memory
  • Attention
  • Executive function
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19
Q

Levels of Consciousness

A
  • Coma: MCS, VS, PVS
  • Stupor
  • Obtunded
  • Delirium
  • Clouding of consciousness
  • Consciousness
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20
Q

Vegetative state

A
  • Decreased level of awareness
  • Intact eye opening
  • Intact sleep-wake cycles
  • Unable to follow commands
  • Unable to speak
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21
Q

Persistent vegetative state

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A
  • No meaningful motor function
  • No meaningful cognitive motion (ex: reflex withdrawal from noxious stimulus)
  • Absence of awareness of self or environment
22
Q

Minimally conscious state

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A
  • Different from vegetative state
  • Severely altered consciousness
  • Minimal, but definite awareness of self or environment
  • Reproducible cog-meditated behavior
  • Sustained behavior (different from reflex)
  • Ex: localized orient to noxious stimulus, reaches for objects
23
Q

Stupor

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A
  • Unresponsive state

- Aroused briefly with vigorous, repeated sensory stimulation

24
Q

Obtunded

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A
  • Sleeps often

- Aroused = Decreased alertness, decreases interest in environment, delayed reactions

25
Delirium
- Disorientation - Confusion - Agitation - Loudness
26
Clouding of consciousness
- Quiet behavior - Confusion - Poor attention - Delayed processing - Does not interact a lot, not sure what is going, or where they are
27
Consciousness
- Alert and aware - Oriented - Memory intact
28
Cog Impair: Orientation/Memory
- Disorientation - Memory deficits: STM, LTM (recall failure) - Post-traumatic amnesia (PTA) (storage failure) - PTA = Time between injury and when pt again remembers ongoing events
29
Cog Impair: Attention
- Hyperactivity - Impulsiveness - Decreased attention span - Decreased safety awareness
30
Cog Impair: Executive Function
- Decreased safety awareness - Voltion - Planning - Trouble planning the order of how things go - Purposive action - Effective performance
31
Behavioral impairments
- Long-term changes: affects social skills, re-integration into society - Sexual dis-inhibition - Emotional dis-inhibition - Apathy - Aggressive dis-inhibition - Low frustration tolerance - Depression
32
Communication impairments
- Dysarthria (motor skill disorder) - Expressive aphasia - Receptive aphasia - Reading comprehension - Written expression of communication - Language skill deficits
33
Visual- Perceptual impairments
- CN or occipital lobe damage - Visual acuity impairments - Hemianopsia: blocking one side of visual field - Cortical blindness - Perceptual awareness - Spatial neglect - Apraxia: inability to perform purposeful movements - Spatial relationships - R/L discrimination
34
Swallowing impairments
- Dysphagia
35
Clinical rating scales (outcome measures)
- Glasgow Coma Scale (GCS) - Rancho Los Amigos Level of Cognitive Functioning (LOCF) - Functional Independence Measure (FIM) - Modified Ashworth Scale for Grading Spasticity - Coma Recovery Scale Revised - Disorders of Consciousness Sale
36
Glasgow Coma Scale (GCS)
- Measure of level of consciousness: scene of accident --> ER --> During initial recovery - 3 areas: Eye-opening, motor response, verbal response - Scores 3-15 - Com = < 8 --> severe TBI - Modeate TBI = 9-12 - Mild TBI = 13-15
37
Rancho Los Amigos LOCF
- Stages I, II, III: Decreased or low-level response - Stages IV: Confused-Agitated (Most challenging stage) - Stages V, VI: Confused-inappropriate and confused-appropriate - Stages VII, VIII: Appropriate response (Automatic and Purposeful)
38
Functional Independence Measure (FIM)
- Measure functional mobility and ADL function - Each skill rated on 7-point scale - 1 = Dependent - 2 = Max A - 3 = Mod A - 4 = Min A (or CGA) - 5 = Supervision (or SBA) - 6 = Modified independent - 7 = Independent
39
Modified Ashworth Scale for grading spasticity
- 0-4 point scale
40
Compensation vs. Recovery: Considerations
- Severity of sensorimotor deficits - Severity of secondary complications/co-morbidities (i.e., fractures) - Is motor recovery feasible? - Chronic vs. acute: Recovery occurs more in acute - Strength/weakness of patient: Ability to learn new tasks - Severity of cognitive, behavioral or medical barriers - Funding: Limited $$$ = compensation - Discharge destination
41
Rancho Level I, II, III (Decreased or low-level response)
- Preventing indirect impairments: positioning (contractures, decubiti, pneumonia, DVT, Heterotrophic Ossification) - Improving arousal through sensory stimulation - Family Education (important part of POC) - Spasticity management - Early transition to sitting posture (upright sitting, head support, co-treatments, guided techniques for ADL - Stretching, Serial casting
42
Rancho Level IV (Confused-Agitated)
- Pt. emerging: Most challenging stage; acute post-traumatic agitation, confusion, amnesia, disorientation, agitation, aggression - Interventions: Creative, flexible, work near pt level and improve endurance rather than progress - Use positive reinforcement
43
Rancho Level IV Intervention
- Consistency - Expect no carryover: Be very thorough in documentation - Model calm behavior - Expect egocentricity - Flexibility/options: Limited attention span; If can't redirect pt, change tasks; treat age-appropriate; Give control if appropriate, btwn two options - Safety - Pt and family education
44
Rancho V, VI (Confused-Inappropriate and Confused-Appropriate)
- Confused, but with structure, can follow simple commands - Goals: Functional task, meaningful task, shape task to pt ability, optimize success, increase complexity and task demand progressively - Same behavioral strategies as Level IV, may carryover into level V - Practice, practice, practice
45
Rancho V, VI Interventions
- Monitor for fatigue: physical and mental - BWSTT - CIMT - Developmental sequence - Facilitation techniques - Combination of treatment approaches - Pt education - may improve mobility skills but lack insight into safety awareness
46
Rancho VII, VIII (Appropriate response)
- Late confused-appropriate; early stage automatic-appropriate - Often d/c from inpatient rehab: Wean from external structure of rehab hospital - Comprehensive day treatment program: Interdiscipinary; PT, OT, ST, Recreational; Community re-entry; Return to work or school; Address cog, behavioral, psycho social issues
47
Rancho VII, VIII Interventions
- Goal: Integrate into community - cognitive, physical, emotionally: judgement, problem-solving, planning, self-awareness, health/wellness, social interaction - Treatment simulates or integrates "real world" community skills, social skills, daily living skills - Pt included in decision making - has some insight - Pt and family education: coping with residual deficits
48
Mild Traumatic Brain Injury (mTBI)
- Sports-related, military - Post-concussion syndrome - LOC: None or up to 30 min - PTA or altered mental state: Up to 24 hours - Recover in 3 months; 10-20% have lingering symptoms
49
mTBI Management (Intervention depends on pt deficit)
- Pt education - Activity intolerance - Vestibular dysfunction - High-level balance dysfunction - Post-traumatic headache (almost presents as migraine) - TMJ disorder - Attention and Dual-task performance - Participate in exercise
50
Dual Task Intervention
- Perform physical task (ex: walking) simultaneously with cognitive task (ex: talking) - Should match task patient wants to return to
51
Rehab Technology
- Imagination is the limit - Adaptive equipment - Environmental Control Unit (ECU) - Computer-augmented communication systems - Pocket computers - Wheelchair

10 - Rehabilitation (25 decks)

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