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

10-05 Traumatic Brain Injury Flashcards

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

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

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

A
  • Unresponsive state

- Aroused briefly with vigorous, repeated sensory stimulation

24
Q

Obtunded

A
  • Sleeps often

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

25
Q

Delirium

A
  • Disorientation
  • Confusion
  • Agitation
  • Loudness
26
Q

Clouding of consciousness

A
  • Quiet behavior
  • Confusion
  • Poor attention
  • Delayed processing
  • Does not interact a lot, not sure what is going, or where they are
27
Q

Consciousness

A
  • Alert and aware
  • Oriented
  • Memory intact
28
Q

Cog Impair: Orientation/Memory

A
  • 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
Q

Cog Impair: Attention

A
  • Hyperactivity
  • Impulsiveness
  • Decreased attention span
  • Decreased safety awareness
30
Q

Cog Impair: Executive Function

A
  • Decreased safety awareness
  • Voltion
  • Planning - Trouble planning the order of how things go
  • Purposive action
  • Effective performance
31
Q

Behavioral impairments

A
  • 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
Q

Communication impairments

A
  • Dysarthria (motor skill disorder)
  • Expressive aphasia
  • Receptive aphasia
  • Reading comprehension
  • Written expression of communication
  • Language skill deficits
33
Q

Visual- Perceptual impairments

A
  • 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
Q

Swallowing impairments

A
  • Dysphagia
35
Q

Clinical rating scales (outcome measures)

A
  • 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
Q

Glasgow Coma Scale (GCS)

A
  • 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
Q

Rancho Los Amigos LOCF

A
  • 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
Q

Functional Independence Measure (FIM)

A
  • 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
Q

Modified Ashworth Scale for grading spasticity

A
  • 0-4 point scale
40
Q

Compensation vs. Recovery: Considerations

A
  • 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
Q

Rancho Level I, II, III (Decreased or low-level response)

A
  • 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
Q

Rancho Level IV (Confused-Agitated)

A
  • 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
Q

Rancho Level IV Intervention

A
  • 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
Q

Rancho V, VI (Confused-Inappropriate and Confused-Appropriate)

A
  • 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
Q

Rancho V, VI Interventions

A
  • 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
Q

Rancho VII, VIII (Appropriate response)

A
  • 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
Q

Rancho VII, VIII Interventions

A
  • 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
Q

Mild Traumatic Brain Injury (mTBI)

A
  • 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
Q

mTBI Management (Intervention depends on pt deficit)

A
  • 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
Q

Dual Task Intervention

A
  • Perform physical task (ex: walking) simultaneously with cognitive task (ex: talking)
  • Should match task patient wants to return to
51
Q

Rehab Technology

A
  • 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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