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Neurologic PT > Brain Injury > Flashcards

Brain Injury Flashcards

1
Q

List 2 characteristics of a traumatic brain injury.

A
  1. Damage is caused by an external force

2. Can be open or closed

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2
Q

List 2 characteristics of a non-traumatic brain injury.

A
  1. Not caused by an external force

2. Sometimes called Acquired Brain Injury

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3
Q

List 4 primary mechanisms of traumatic brain injury.

A
  1. Coup and contrecoup
  2. Diffuse Axonal Injury
  3. Open head injury: skull facture
  4. Bleeding
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4
Q

List 4 characteristics of coup and contrecoup injuries.

A
  1. Coup: occurs at the site of impact
  2. Contre coup: occurs opposite of the impact site
  3. Causes cerebral contusion (bruising)
  4. Considered a focal injury
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5
Q

Diffuse axonal injury occurs with _____ and _____ to the brain leading to _______ injury.

A

Shearing
Tensile stress
Widespread injury

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6
Q

List 4 types of bleeding that can affect the brain.

A
  1. Epidural
  2. Subdural
  3. Subarachnoid
  4. Intraparenchymal
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7
Q

List 8 secondary mechanisms of TBI.

A
  1. Ischemia
  2. Hypoxia
  3. Hypotension
  4. Cerebral edema
  5. Increased intracranial pressure
  6. Hypercapnia
  7. Acidosis
  8. Excitotoxicity
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8
Q

Describe 2 types of encephalopathy.

A
  1. Toxic – due to exposure to toxic substances

2. Metabolic – due to abnormalities in fluid levels, electrolytes, and overall brain chemistry

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9
Q

List the 2 most alarming signs and symptoms of increasing intracranial pressure (ICP).

A
  1. Decreased level of consciousness

2. Cushing’s Triad (Increased SBP, bradycardia, and abnormal respiration (Cheyne stokes/Biot)

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10
Q

What are 3 symptoms to look for in patients that may have a DVT.

A
  1. Warmth
  2. Redness
  3. Swelling
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11
Q

Following a TBI, especially with a GSW/Skull fracture, the risk of _____ greatly increases.

A

Seizures

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12
Q

What are the 4 most common spots for heterotopic ossification to develop?

A

Shoulders
Elbows
Hips
Knees

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13
Q

PT will notice heterotopic ossification as the patient will present with a sudden decrease in _____ with a ____ end feel.

A
  1. ROM

2. Hard end feel

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14
Q

List 2 interventions used to treat heterotopic ossification. What intervention should be avoided?

A
  1. Calcium modulating drugs
  2. Gentle PROM

Avoid surgical interventions

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15
Q

What is the different between anterograde and retrograde amnesia?

A
  1. Anterograde – inability to form new memories following brain injury
  2. Retrograde – inability to recall old memories prior to brain injury
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16
Q

A ______ is used to track amnesia. A score of ___ on ___ consecutive days indicates emergence from post-traumatic amnesia.

A

Orientation Log
25/30
3 consecutive days

17
Q

The ____ scale is useful when assess patients with consciousness disorders.

A

Coma Recovery Scale (CRS)

18
Q

List 4 classifications of consciousness under the coma recovery scale.

A
  1. Coma: no signs of wakefulness or purposeful movement
  2. Vegetative/Unresponsive Wakefulness: wakefulness returns; no purposeful, consistent, or measurable response to stimuli or environment
  3. Minimally Conscious – response to stimuli and inconsistent ability to follow commands
  4. Emerged – consistent ability to follow commands (when structured appropriately), communication, functional object use
19
Q

List 5 outcome measures used to assess memory and executive function.

A
  1. Mini Mental State Exam
  2. GOAT
  3. MoCA
  4. Confusion Assessment Protocol
  5. Cog-Log
20
Q

Describe level 1 Coma of Rancho Los Amigos levels. Where are these patients typically found?

A

No sleep/wake cycles or purposeful response to external stimuli

Found in ICU

21
Q

List 3 PT interventions used to treat patients in the Level 1 Coma stage.

A

Passive Range of Motion
Positioning
Spasticity Management (serial casting, splinting)

22
Q

Describe level 2 Vegetative State of Rancho Los Amigos levels (3). Where are these patients typically found?

A
  1. Generalized Response
  2. Clear sleep/wake cycles return
  3. No purposeful, consistent, or measurable response to stimuli or environment

Found in acute rehab

23
Q

List 4 PT interventions used to treat patients in the Level 2 Vegetative state.

A
  1. Passive Range of Motion
  2. Mobilization may begin – tilt table, standing frame
  3. Positioning
  4. Spasticity Management (serial casting, splinting)
24
Q

Describe level 3 Minimally Conscious of Rancho Los Amigos (2)

A
  1. Purposeful Response

2. Inconsistent ability to follow commands

25
Q

What are the 3 criteria for emergence?

A
  1. Consistent ability to follow commands (with appropriate setup)
  2. Communication (can be verbal or non-verbal)
  3. Functional Object Use
26
Q

List 5 PT interventions used to treat patients in level 3 minimally conscious state.

A
  1. Mobilization continues– tilt table, standing frame
  2. More “traditional” PT interventions may begin – early gait training
  3. Passive Range of Motion
  4. Positioning
  5. Spasticity Management (serial casting, splinting)
27
Q

Describe 5 characteristics of level 4 confused/agitated of Rancho Los Amigos.

A
  1. Bizarre, non-purposeful, incoherent or inappropriate behaviors
  2. No short-term recall
  3. Attention is short and non-selective
  4. Agitation/Frustration compounded by lack of impulse control – patient may become aggressive at times.
  5. Motorically restless
28
Q

List 7 PT interventions used to manage patients in level 4 confused/agitated stage.

A
  1. Behavior Management – work in conjunction with medical team and neuropsychologist
  2. Gait training
  3. Environmental control
  4. Choose activities that are repetitive, automatic, and functional to reduce frustration
  5. Set up a reward system
  6. Provide choices
  7. DO NOT MAKE FALSE PROMISES
29
Q

What is level 5 of the Rancho Los Amigos classification?

A

Confused and Inappropriate (similar to level 4 but less agitation and aggression)

30
Q

List 2 characteristics of level 6 confused/appropriate of Rancho Los Amigos

A
  1. Patient is not consistently oriented to person /place/time/situation, but is more easily re-directed
  2. Responses to stimuli are more appropriate
31
Q

List 3 PT interventions used to treat level 6 confused and appropriate stage.

A
  1. Encourage use of external cues to guide patient
  2. Facilitate recall
  3. Introduce new skills and transfer of old skills
32
Q

List 4 characteristics of level 7 Automatic and Purposeful of Rancho Los Amigos.

A
  1. Appropriate behavior in familiar settings
  2. Performs daily routine automatically
  3. Carries over new learning at a slower rate
  4. Judgment remains impaired
33
Q

List 2 characteristics of level 8 Purposeful and appropriate of Rancho Los Amigos.

A
  1. Oriented and responds to environment appropriately

2. Abstract reasoning is still impaired compared to pre-morbid baseline

34
Q

List 4 PT interventions used to treat levels 7-8 automatic and purposeful stage.

A
  1. Support residual cognitive deficits via remediation or adaptation
  2. Emphasis on safety awareness
  3. Improve mental flexibility
  4. Manage stress
35
Q

____ is the primary cause of mild TBI (mTBI) in older adults. Mortality rate is ____.

A

Primary Cause = Falls

HIGH mortality rate

36
Q

List the 8 levels of the Rancho Los Amigos Scale.

A 
Level I: No Response
Level II: Generalized Response
Level III: Localized Response
Level IV: Confused-agitated
Level V: Confused-inappropriate
Level VI: Confused-appropriate
Level VII: Automatic-appropriate
Level VIII: Purposeful-appropriate

Neurologic PT (11 decks)

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