12% Medical and Physical Issues (EBIG chapters 5, 6, 7, and 9)

Question 1

What is autonomic storming?

Answer 1

Dysautonomia- autonomic functions such as heart, blood pressure, temp, etc are disrupted
also can present as muscle over activity (dystonia)

Question 2

DVT/PE

Answer 2

Deep vein thrombosis causes a pulmonary embolism when the clots break off, travel up to the lungs and get stuck in the arteries, creating a blockage

Question 3

What are some physical issues?

Answer 3

Spasticity, hyperreflexia, contractures, HO

Question 4

Describe contractures

Answer 4

Abnormal usually permanent contracted joints (flexed position) due to shortening of muscle fibers and loss of skin elasticity

Question 5

Describe hyperrflexia

Answer 5

Involuntary exaggerated deep tendon reflexes

Question 6

Describe spasticity (city = city)

Answer 6

involuntary abnormal motoric patterns due to velocity-dependent increase in muscle tone

Question 7

Describe HO

Answer 7

O= ossification
Abnormal growth of bone in soft tissues adjacent to the joints

Question 8

Characterize bladder issues with brain injury (BI)

Answer 8

When injured, the regulatory systems in eliminating (using the bathroom) may be disturbed resulting in inconsistence or accidents.
How to help: bladder training (timed breaks), maintaining adequate hydration

Question 9

Describe aspiration

Answer 9

When food/drink enters the airway. Swallowing is a difficult process and dysfunction can lead to aspiration in phase 1 of swallowing (oral stage)

Question 10

Describe pressure sores

Answer 10

Pressure sores develop when a person lies on a bed or sits in a wheelchair for long periods of time without repositioning. Usually form at bony areas.

Question 11

What are some risk factors for pressure sores?

Answer 11

Incontinence, poor nutrition, contractures, use of casts/splints.

Question 12

Describe seizures

Answer 12

Seizures are caused by an abnormal discharge of electrical activity in the nerve cells of the brain.

Question 13

What are some complications of seizures?

Answer 13

Early post-traumatic seizures (EPTS)
Late post-traumatic seizures (LPTS)

Question 14

What is the mortality rate for seizures & TBI

Answer 14

After TBI individuals are 37x more likely to die of a seizure disorder as compared to the general population.
Status epilepticus also carries a high mortality risk (seizures lasting longer than 5 minutes)

Question 15

Describe pain after brain injury

Answer 15

Pain can be subjective and can be acute or chronic. Pain can disrupt the rehabilitation process. Over time neuropathic pain like nerve injuries, and tendinitis may emerge due to spasticity.

Question 16

The most common pain pathways for non-headache pain?

Answer 16

Nociceptive and Neuropathic

Question 17

Nocioceptive

Answer 17

Pain related to the peripheral nerve fibers
Treatment: opioids, acetaminophen

Question 18

Neuropathic

Answer 18

Pain asssociatied with primary lesion of dysfunction of the nervous system
Treatment: trigger point injections, antidepressants

Question 19

Types of headaches

Answer 19

Tension type headache (TTH)- Tight pressing (like a clamp)
Cervicogenic- head pain generated from the cervical spine
Cranio-mandibular- headache associated with temporal mandibular joint
Migraine- Usually located on one side of the head

Question 20

Migraine phases

Answer 20

Prodrome–> Aura –> Headache –> Postdrome

Question 21

TBI & spinal cord overlap

Answer 21

TBI is present in 60% of individuals with spinal cord injury

Question 22

What are some symptoms of cranial nerve damage?

Answer 22

Visual disturbance
Facial drooping
Postural instability
Dysphagia
Autonomic dysregulation

Question 23

What are some perceptual (hint: perception how you view yourself) deficits?

Answer 23

Body scheme/Body image disorders
Spatial relation disorders
Agnosia
Apraxia

Question 24

What are the three types of apraxia?

Answer 24

Ideomotor apraxia- cannot perform tasks on command
Ideational apraxia- cannot perform tasks automatically

Question 25

What are the three types of apraxia?

Answer 25

Ideomotor apraxia- cannot perform tasks on command
Ideational apraxia- cannot perform tasks automatically and on command
Buccofacial apraxia- limitations on movements of the lips, cheeks, tongue, larynx, & pharynx

Question 26

What is the prevalence and types of disorders of consciousness (DOC)

Answer 26

3 levels of DOC- coma, vegetative state, minimally conscious.
Vegetative state= 4,200 per year
DOC= 315,000 persons living with

Question 27

Prognosis of DOC (disorders of consciousness)

Answer 27

Neuroimaging has lead to
better understanding of
DOC
Arousal, Awareness, Prevalence

Question 28

Medical management of DOC

Answer 28

Keep skin healthy- watch for skin irritation
Keep lungs and airway clear- trach tube
Keep bladder and bowel healthy- Infection

Question 29

Why is the autonomic nervous system important?

Answer 29

it controls the bodies automatic body processes such as blood pressure & breathing

Question 30

Causes of sleep and fatigue disorders?

Answer 30

imbalance in the availability, utilization, and or/ restoration of resources needed to perform activity.

Question 31

How do you measure sleep and fatigue disorders?

Answer 31

Visual analogue scale (VAS-F)
Fatigue severity scale (FSS)
Barrow Neurological fatigue scale (BNI Fatigue scale)
Global fatigue index (GFI)
Causes of fatigue questionnaire (COF)
Epworth Sleepiness Scale
Pittsburgh Sleep Quality Index
Polysomnography
Multiple Sleep Latency Test

Question 32

What is the persistence of fatigue and sleep disorders?

Answer 32

Persists for years after a
moderate to severe injury

Question 33

Treatments of sleep and fatigue disorders?

Answer 33

No well-established treatments for fatigue.
Lifestyle modifications, relaxation training, OTC medication, and CPAP devices for sleep disorders.

Question 34

Fatigue vs sleep disturbances?

Answer 34

Sleep disorders are diagnosed through sleep history. Fatigue is the awareness of a decreased capacity for physical and or/mental activity.

Question 35

What is psychological fatigue?

Answer 35

Is a state of weariness related to reduced motivation, prolonged, mental activity, or boredom that occurs with chronic stress, anxiety, or depression.