Ch 9: Physical Complications

Question 1

What amount of individuals with severe TBI will have ongoing physical or neuromotor abnormalities at the two year time point?

Answer 1

1/3

Question 2

Hydrocephalus

Answer 2

Abnormal accumulation of CSF within the ventricles

Occurs in 2/3 of mid-severe brain injury

Question 3

Obstructive or noncommunicating hydrocephalus

Answer 3

Obstruction of the flow of CSF around the brain after trauma

Question 4

Hydrocephalus ex-vacuo

Answer 4

Occurs after TBI

brain tissue that has been damaged will cause neuronal loss and shrinking of the brain tissue which will lead to a look of ventricular enlargement

Normal pressure hydrocephalus may develop

Question 5

Tx for hydrocephalus

Answer 5

Shunt system placement

Shunt, catheter, valve

Catheter placed into ventricle and valve controls one way flow of CSF into abdominal cavity

Question 6

Symptoms of over and under draining (hydrocephalus)

Answer 6

Over: Headache or even cause development of hemorrhage from tearing of blood vessels

Under: reoccurrence of hydrocephalus symptoms

**watch for fever, neck stiffness or soreness, or changes in level of alertness - require immediate medical attention

Question 7

Heterotopic ossification

Answer 7

Formation of new bone around joints causing decreased ROM and presents with redness and swelling

**11-77% of TBI Incidence

Prevalence of clinically significant HO in TBI is typically reported as 10% to 20%

Hips are most common, then shoulders and elbows

Occurs on the same side of the body where spasticity is worst

Surgical Treatment should wait until the individual has achieved max motor recovery

Question 8

Vascular thrombus/ emboli (VTE)

Answer 8

Individuals with multisystem or major trauma have a VTE risk exceeding 50%

**and in this population PE is the third leading cause of death

Question 9

s/s of DVT

Answer 9

Redness in an extremity
Swelling
Pain
Fever

Question 10

Thrombus

Answer 10

Mass of platelets and/or fibrin that forms in a clot vessel (ie: blood clot)

Question 11

Embolus

Answer 11

Piece of thrombus that has broken free and circulates within the bloodstream

Question 12

What is the prevalence of chronic pain in persons with brain injury?

Answer 12

58%

More prevalent among mTBI vs mod/severe

Effects:
Mood, participation, concentration, and sleep quality

Question 13

Silent Aspiration occurs in what percent of severe TBI?

Answer 13

Nearly 50%

Question 14

What percent of TBI’s present with significant balance impairments?

Answer 14

75%

Question 15

Photophobia is associated with which visual impairment?

Answer 15

Binocular impairments (ie: double vision)

**treating diplopia can reduce light sensitivity

Question 16

Ideomotor apraxia

Answer 16

Inability to perform a task on command or imitate gestures.

Question 17

Ideational apraxia

Answer 17

Inability to perform a task automatically and on command. These individuals may do better in a familiar home environment vs clinic

Question 18

Buccofacial apraxia

Answer 18

Limitations in performing purposeful movement of the lips, cheeks, tongue, larynx, and pharynx.

Automatic expressions are easier compared to sequencing more complex language

Question 19

Labyrinthine concussion (unilateral vestibular hypofunction)

Answer 19

Typically from a bleed in the trauma into the labyrinth. Symptoms include dizziness or loss of balance with head turns, the stag mess present to one side, oscillopsia with head turns, postural instability.

Nearly 95% improve within six months

Question 20

Post traumatic Ménière’s disease

Answer 20

Often comes from hydrops (area of scarring and intermittent fluid buildup that impacts pressure within the endolymphatic system) and can occur early or later after injury; may result in low tone hearing loss, with or without dizziness.

Intermittent symptoms of dizziness; can worsen over time without therapy as the pt will limit use of the vestibular system

Question 21

Basilar skull fx

Answer 21

Symptoms Frequently include bleeding or CSF leakage in that year at the time of the injury, severe in balance, or symptoms of dizziness.

Question 22

Vestibular migraine

Answer 22

Episodic spinning dizziness lasting a few minutes to or three times per month.

Symptoms also may include photophobia, hearing loss, and tonight us, and may or may not be associated with a headache.

Physical and diagnostic exams are normal

Question 23

Perilymphatic fistula

Answer 23

Abnormal communication between the inner and middle ear

Question 24

Benign paroxysmal positional vertigo (BPPV)

Answer 24

Sensation of spinning with particular movements which may include rolling in one direction, bending over, and position change in bed, with no loss of hearing involved.

Question 25

Bilateral vestibular hypofunction

Answer 25

Because it affects both sides, individuals rarely complain of nausea/vertigo.

Posture and gait abnormalities and difficulty focusing with head movements are often seen.

These individuals often have permanent deficits and require an AD/compensatory strategies

Question 26

Central vertigo

Answer 26

Can come from trauma to the a Ferent inputs in the cervical spine or from a vertebrobasilar insufficiency (VBI).