ABI Flashcards
Types of ABI
Concussion - mild TBI caused by an impact to the head or whiplash
Contusion - blood under skin due to trauma causing a bruise
Coup countrecoup - contusion present at both the site of impact and the exact opposite end of the impact
Diffuse axonal injury - similar to concussion, though the brain is shake much more violently
Primary vs. secondary ABI damage
Primary
- skull laceration
- skull fracture
- contusions
- cerebral lacerations
- intracranial hemorrhage
- diffuse axonal injury
Secondary: due to
- increased intracranial pressure
- hypoxia
- hypotension
- hypothermia
- electrolyte disturbances
- toxic amino acids
- oxygen radicals
Medical issues to be aware of with ABI
Stabilize: prevent secondary injury
- Deal with associated injuries, often fractures
Seizures
- sometimes they will go away
ICU environment
- may have specific protocols
Helmet
- if the skull fx area is bigger than 5x5, must wear helmet
BP – pulse
ICP
- Pupillary changes
- Diaphoresis
- Vomiting
- Behavioral changes
How to measure severity of ABI
Structural imaging
- Brain mapping
- Will tell you normal or abnormal
Loss of consciousness
- < 30 min= mild
- 30 min to 24 hours= moderate
- >24 hours severe
Post Traumatic Amnesia
- 0-1 day- mild
- 1-7 days moderate
- More than 7 days severe
Glasgow Coma Scale
Glasgow Coma Scale
Initially semiconscious or unconscious
Looks at:
- Motor
- Verbal response
- Eye opening
Scores:
- 3-15, higher the better
- 8 or below has poor outcome
Performed 2-7 days after injury
Ranchos Los Amigos Scale
Level of awareness and cognitive function
Used partially for assessment and to guide you in therapy tasks
Levels 1-3: total assist
Level 4 and 5: max assist; can’t leave them alone
Level 6: mod assist
Level 7: min assist
Level 8 and 9: SBA
Level 10: mod ind; not normal
What does ABI look like?
Decorticate posture
Decerebrate posture
Abnormal tone
Primitive reflexes
Muscle weakness
Decreased endurance
Ataxia
Limits of joint motion
Loss of sensation
Dysphagia
Change in cognitive status
- Attention
- Memory
- Initiation and termination
- Poor safety and judgment
- Delayed processing
- Impaired executive function
Visual
Perceptual
Psychosocial factors
- Loss of job, ADL, social
- High divorce rate
Interventions for ABI
Positioning
Wheelchair
ROM
Orthotics
Attention/Cognition
Sensory stimulation
Vision and perception
Cognition
Agitation/self awareness
- Family impact
Functional training
Focal vs. Multifocal or diffuse injury
focal - one area
multifocal - multiple areas
FORs used for ABI
Sensorimotor
MOHO
Rehabilitative
OA
Task-oriented
Motor learning
Biomechanical
NDT – specifically for CNS
PNF
Brunnstrom
Rood
Assessment and intervention for severe ABI
Assessments
- Coma recovery scale
- modified ashworth
- assessment of static head control
- pain
- skin integrity
- seating and positioning
- assistive technology
- possible home assessment
Intervention
- promote sensory stimulation, pain and/or motor responses
- positioning
- muscle reeducation
- family/caregiver training
- home modifications
- equipment trials
Assessment and intervention for moderate ABI
Assessment
- motor observation
- ROM
- Ranchos Los Amigos
- modified ashworth
- pain
- skin integrity
- ADLs
- FIM
- custom seating and positioning assessment
- assistive technology needs
- behavioral agitation scale
- depression
- equipment needs
- home assessment
Intervention
- target basic ADLs
- cognition, physical, psychosocial, and behavioral goals
- equipment trials
- family/caregiver training
- home modifications
Assessment and intervention for mild ABI
Assessment
- motor
- cognitive assessment aimed at memory
- IADLs
- FIM
- executive functioning
- self-awareness
- pain
- depression
- behavior
- preinjury behavior
- home assessment
- equipment needs
Intervention
- target areas with IADLs
- higher cognitive skills
- family/caregiver training
- return to work, driving, and sports
Decerebrate and decorticate postures
