TBI

Question 1

Causes of TBI

Answer 1

-Transportation (#1)-Falls-Firearms-Other Assaults-Other/Unknown

Question 2

Common ages for TBI

Answer 2

• 15-24 (risky behavior/transportation)

- 75+ (falls)

Question 3

TBI Classifications

Answer 3

• Open
• Closed
• Coup
• Contracoup
• Focal
• Diffuse
• Hypoxic
• Ischemic
• Hematomas

Question 4

Coup-Contracoup Injury

Answer 4

• Brain hits one part of skull and bounces back to other part
• Tend to involve antero-inferior temporal lobes and prefrontal cortex

Question 5

Closed TBI

Answer 5

• aceleration deceleration forces

- doesn’t penetrate skull

Question 6

Open TBI

Answer 6

• Penetrating injury

- Skull penetrated

Question 7

Focal TBI

Answer 7

• Localized area of injury
• can cause hematoma, edema, contusion, or laceration
• Edema can cause herniation of brainstem–>death

Question 8

Diffuse TBI

Answer 8

• Shearing and retraction of axons-can cause coma–>poor outcome
• DAI may not show up on imaging (imaging can’t show axon shearing)

Question 9

Hypoxic-Ischemic TBI

Answer 9

• due to systemic hypotension, anoxia, vascular damage

- can lead to global damage

Question 10

Hematoma TBI

Answer 10

• bleeding in brain can cause pressure in some areas

- TYPES: epidural, subdural, intracranial

Question 11

DAI

Answer 11

Diffuse axonal injury

Question 12

Epidural Hematoma

Answer 12

-between skull and dura mater-often arterial (rapid but not necessarily immediately)-period of normal functioning–>N/V & UMN signs

Question 13

Subdural Hematoma

Answer 13

• Venous-Develop slowly over time

- UMN signs and confusion-Elderly on blood thinners

Question 14

Intracranial Hematoma

Answer 14

In the brain

Question 15

Secondary Damage

Answer 15

• increased ICP
• Infection from open wounds
• Seizures (immediately or up to 6mo-2years to forever; can lead to more damage)

Question 16

Normal ICP

Answer 16

4-15mmHg-can increase from PT (trendelenburg positions, isometrics, exercise)

Question 17

Imaging/Diagnostics

Answer 17

• CT: may not detect soon after
• MRI: better resolution than CT
• Neuropsychological Testing (cognitive testing)

Question 18

Treatment

Answer 18

• Resuscitation/stabilization
• ER
• Eval, neuro exam, diagnostics
• Surgery
• ICP monitoring
• Rehab

Question 19

Glasgow Coma Scale

Answer 19

• Eye responses
• Verbal responses
• Motor responses
• for comatose pts or emerging from coma
• predictive of long term outcomes

Question 20

Ranchos Los Amigos Scale Levels

Answer 20

• Scale for cognitive functioning levels-broad scale of appropriateness
• Levels I-VIII

Question 21

Goals for Levels I-III

Answer 21

• increase alertness-prevent 2* impairments-Improve motor control
• facilitate normal tone
• increase tolerance of positions/activities
• edu family
• coord care among team/family

Question 22

Sensory Stimulation

Answer 22

• To increase arousal and elicit movement

- various stimulus types-need to document everything

Question 23

Goals of Level IV

Answer 23

• Prevent outbursts of agitation
• patient safety
• edu family
• mntn/increase physical activity tolerance
• prevent 2* impairments-coordinate care with team/family

Question 24

Goals of Level V-VI

Answer 24

• increase function/balance/ADL
• motor control-safety-participation
• behave appropriately
• improve impairments (strength/ROM)

Question 25

Goals of Level VII-VIII

Answer 25

• increase task/ADL perfromance, community functioning, work reintegration, leisure
• improve functional capabilities
• pt manage symptoms
• decreased need for supervision
• increased safety in diff environments
• family member edu