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Flashcards in Exam 3 TBI Deck (82):

Cultural sensitivity (5 details on it)

  1. ~Check your baggage at the door
  2. ~Leave religious beliefs at the door
  3. ~They have the right to not believe in a type of treatment
  4. ~If you work at a hospital that is faith based, you can talk about faith
  5. Is ok to ask if there is anything that will offend them
  6. ~If its unsafe, then you can tell them not to do something


CTE- stands for

chronic traumatic encephalopathy


chronic traumatic encephalopathy:

what is it?

how old is it?


How long does it take?

What symptoms? (7)

  1. ~progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head
  2. ~has been known to affect boxers since the 1920s
  3. ~recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma
  4. ~trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau
  5. ~these changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement
  6. ~brain degeneration is associated with
    • memory loss,
    • confusion,
    • impaired judgment,
    • impulse control problems,
    • aggression,
    • depression, and,
    • eventually, progressive dementia


4 Different types of TBI

  1. ~traumatic
  2. ~atraumatic
  3. ~acquired brain injuries
  4. ~secondary injuries


Traumatic (2 types)

A trauma to the body (duh)

  • ~open
  • ~closed


Traumatic- closed (3 types)

  1. ~Coup-contra coup- injury-the inside of the skull is very sharp
    • ~what direction was the force, etc (twisting, head down, head up)
    • ~hard to figure out where the injury is 
  2. DAI (Diffuse Axonal Injury)
    • shear
    • all the microscopic injuries that could happen
    • on a scan everything might look fine, but the person still has deficits (can be emotional)
      • A lot of times emotions are not something that PT can train (but psych therapy might be able to help)
  3. Shaken Baby Syndrome


Traumatic- open (3 things to know)

  1. ~the head has to open
  2. ~you know where the injury is
  3. ~you can have a contra-coup as well


What is something you particularly need to look out for when you have an open traumatic injury?

INFECTION!- secondary problems from the cranial vault being opened up


 DAI (stand for)

diffused axonal injury


Traumatic- Closed, DAI (four things, and some possible examples)

  1. ~lots of micro trauma
  2. ~has little deficits
  3. ~everything else looks fine, but they have a few little problems/ some changes
  4. ~emotions are usually involved- changed
  5. Possible Examples
    • **Shaken baby (closed, acquired, anoxic)


Non traumatic (2 main types)

  1. ~Infection
  2. ~Anoxic


Non traumatic- some examples (3)

  1. Drowning,
  2. CO poisoning victim,
  3. strangulation

cancer?, stroke?


Non traumatic- anoxic (3 details)

  1. ~loss of oxygen
  2. ~pediatrics can happen a lot in peds
  3. ~affects every single cell in your brain- every cell is starting to die


Acquired brain injury

common in whom?

two examples

  1. ~a lot of peds
  2. ~When you have it at birth/ during the birthing process
  3. ~If you have the umbilical cord stuck on neck when coming out of the womb (deprived of O2)


Secondary injuries (4)

  1. ~Inflammation/ swelling
    • ~Need to watch closely for the 1st 24 hours to see if there are any changed in mental status
    • ~Uncal Herniation, herniation through the hole (you will keep the craniotomy open if there is increased pressure)~
      • **don’t walk them without the helmet
  2. Lack of Oxygen because of tearing of tissues from original tissue
  3. ~Infection
    • ~Cell mediators that can kill some brain tissues
  4. Hydrocephalus

    • the original injury may occlude the sinuses that usually drain CSF

    • One of the things that might show up in first 24 hours

~*when in doubt, go to the doctor


Secondary injuries- inflammation/ swelling details (3)


  1. ~can make the injury worse
  2. ~can create the bleed that was not there at first
  3. ~may have to do a craniotomy to prevent uncal herniation
    • do not walk them without thier helmet


What are the three severities of TBI?

  • ~mild
  • ~moderate/ severe
    • mod and severe mainly different because of length of time with loss of consciousness [LOC]


Differentiation- Mild defining

~Concussion/ LOC- less than 30 minutes


 Mild TBI is also called:



Post-Concussive Syndrome



Mild TBI: details (3)


  1. ~Over looked a lot- in sports/military a lot
  2. ~Can last longer, but these problems are most prominent the next day
  3. ~15% of these people will still have these symptoms in upwards of a year


TBI: Mild- Post-concussive symptom (15)


*the long term symptoms*

*A lot of the military comes home with these*

  1. ~Fatigue
  2. ~HA
  3. ~coup-contracoup
  4. ~balance
  5. ~vision
  6. ~attention
  7. ~sleep problems (all the time or they don’t need to sleep)
  8. ~irritability
  9. ~depression
  10. ~seizures (can last)
  11. ~nausea
  12. ~vomiting
  13. ~olfactory N- loss or sense of smell (decrease in appetite)
  14. ~slowness in thinking
  15. ~get lost


Moderate TBI - defining


Concussion/ LOC- great than 30 to 6 hours



TBI Severe- defining

Concussion/ LOC greater than 6 hours


TBI Moderate/ Severe- cognitive s/s (10)

**A lot more cognitive problems

  1. ~attention
  2. ~concentration
  3. ~memory
  4. ~distractibility
  5. ~processing speed
  6. ~confusion
  7. ~perseveration
  8. ~impulsiveness
  9. ~language processing
  10. ~executive functions

These are in addition to mild symptoms


TBI Moderate/ Severe- Speech and language s/s (4)

  1. ~Broca’s and Wernicke’s aphasia (and other aphasias)
  2. ~inability to form words
  3. ~speak fast/ slow
  4. ~foreign accent syndrome (change how you pronounce things)


TBI Moderate/ Severe- Sensitivity s/s

Light touch/ pain/ etc can be gone


TBI Moderate/ Severe- Vision s/s (7)

  1. ~complete
  2. ~partial loss
  3. ~diplopia from weakness of muscles
  4. ~blurred vision
  5. ~depth perception
  6. ~nystagmus
  7. ~photophobia (light sensitivity)


TBI Moderate/ Severe- Hearing s/s (4)

  1. ~complete loss or
  2. decrease or
  3. increase
  4. ~tinnitus (ringing in the ear)


TBI Moderate/ Severe- Smell s/s (2)

loss or diminished


TBI Moderate/ Severe- taste s/s (2)

loss or diminished


TBI Moderate/ Severe- autonomic s/s (4)

  1. ~temp issues
  2. ~B/B issues
  3. ~menstrual cycles
  4. ~seizures


Moderate/ Severe- Physical changes s/s (4)

  1. ~weakness
  2. ~flaccidly
  3. ~tone
  4. ~chronic P


TBI Moderate/ Severe- Social emotional s/s (9)

  1. ~dependent behavior
  2. ~childlike
  3. strange emotions(more/less/childlike/ etc)
  4. ~lack of motivation
  5. ~irritability
  6. ~aggression
  7. ~depression
  8. ~disinhibition
  9. ~denial


what's a STORM (7)

TBI Brain Storms (sensory storms)

  1. ~It’s the partner of autonomic dysreflexia in a brain injury
  2. ~Sweating a lot,
  3. tons of tone,
  4. get to end range that you normally cant get to
  5. ~Cant find the factor that caused it like in AD
  6. ~try and move them into other positions to stop the STORM
    • ~Try to get the brain to calm down
  7. ~Can be a life threatening situation, but normally not


Levels of conciseness (6-8)

  1. ~awake and alert
  2. ~Lethargic
  3. ~Obtunded
  4. ~stupor
  5. ~MSC (minimally conscious state)
  6. ~coma
    1. vegitative
    2. persistant vegitative


LOC: Awake and alert

~AAO x3, x4

~Awake attentive


LOC: Lethargic



LOC: Obtunded (4)

  1. ~Sleeps often
  2. ~Difficulty to arouse,
  3. actions largely non-productive,
  4. frequently confused when awake


LOC: Stupor

what is it?

what do they respond to? (4)

  1. ~Unresponsive, but can be aroused with noxious stimulus
  2. ~Only respond to hard, strong noxious stimulus
    1. ~Sternal rub,
    2. pick the nail bad,
    3. nipple twist,
    4. thenar pinch



  1. ~The person with make some purposeful movements
  2. ~Will open eyes up, reach for things, but wont know what to do with the objects then they get it


MCS stands for?

Minimally conscious state


LOC: coma (2 types)

~Vegetative state

~Persistence vegetative state


LOC: coma- vegetative state (8 things)

  1. ~does not speak,
  2. does not make any response that is physiologically meaningful
    1. does not follow commands,
  3. ~Intact eye opening,
  4. has wake and sleep cycles
  5. ~We don’t know if they are taking anything in
  6. ~Our job is to start to interact with the outside world- “emerge”


LOC: coma- persistent vegetative state


Characteristics (3)

A vegetative state that lasts 12 months for most TBIs

  • 3 months for hypoxic brain injury


  1. ~No meaningful motor or cognitive function
  2. ~Not on a vent,
  3. have a lot of their brain stem functions-
    • will be on a peg tube to get food


some info on how to get pts better

Initial (2, 5 subcategories for one)

concerns to address: (7 main)

two things about behaviors (2)

cause of injury concerns (2)

how to deal with disinhibition (3)

  1. ~Stabilize the pt so that they live through the event
  2. ~Prevent secondary:
    1. Skin,
    2. DVT,
    3. contractures,
    4. infections,
    5. pneumonia

~Look at:

  1. How much can they interact with env;
  2. Equipment that they may need
  3. ~Do they need to go to a rehab, voc rehab
  4. ~Some of the things that will impact- mental, emotional, behavioral
    • (emotional side issues- Don’t trigger the negative emotions)
  5. ~Behaviors:
    1. What was the premorbid behavior; T
    2. he effects of the injury, phys, emotion, sec, etc
  6. Cause of injury:
    • ~Act of abuse, someone died in the injury, etc
    • ~The nature of the env that they will be discharged to after therapy- will it promote good/bad behavior
  7. ~Disinhibition: Will be saying inappropriate things-  
    • don’t agree with pt/
    • don’t laugh/
    • wear bigger scrubs
  8. ~Talk to family members about things if possible


Glascow Coma Scale: explain the levels and scoring

what three things are evaluated?


Scoring: 3 is as high as you can get, 15 is the highest you can get

  • Mild TBI: 13-15
  • Moderate: 9-12
  • Severe: 3-8 

Three things you are evaluating for glascow Coma

  1. Verbal
  2. Eye
  3. Motor


Glascow Coma Scale: Mild TBI



Glascow Coma Scale: Moderate TBI



Glascow Coma Scale: Sever TBI



Rachos Los Amigos LoCF:

How many levels

Name the levels

8 Levels:

  • I: No response
  • II: generalized response
  • III: localized response
  • IV: confused- agitated
  • V: confused inappropriate, non-agitated
  • VI: confused appropriate, non-agitated
  • VII: automatic appropriate
  • VIII: purposeful appropriate


Rachos Los Amigos LoCF: name of 1

No response


Rachos Los Amigos LoCF: level 1 from book

Pts appear to be in a deep sleep and is completely unresponsive to any stimuli


Rachos Los Amigos LoCF: level 1 from bringman

Pt appears to be in a deep sleep


Rachos Los Amigos LoCF: level 1's therapy (5)

  1. brain is still trying to heal;
  2. ~5-15 mins for a couple seasons a day
  3. ~prevent sensory deprivation, don’t overload, but keep sensory going in (if we don’t, the body will stop looking for sensory)
    • tactile, auditory, olfactory stimulation
  4. ~ROM (and teach family)
  5. ~may do splinting/ serial casting
    • (DF can cause constant stimulation)
      • ~watch out for wound


Rachos Los Amigos LoCF: name of 2

generalized response


Rachos Los Amigos LoCF: Level 2 from book (3)

  1. Pts react inconsistently and nonpurposefully to stimuli in a nonspecific manner;
  2. responses are limited and often the same regardless of stimulus presented;
  3. responses may be physiological changes, gross body movements, and/or vocalization


Rachos Los Amigos LoCF: level 2 from bringman

Non purposeful responses that

  • don't change no matter the stimulus


Rachos Los Amigos LoCF: level 2's therapy (5)

  1. ~sensory deprivation
  2. ~try and link a response to a stimulus and have a certain response to a response (pattern will show that there is a connection forming)
  3. ~will get them out of bed- stand to wheelchair, etc
    1. stimulating all sensory (including vestibular and weight bearing). putting them in dependent position
  4. ~pre-feeding (good stimulus);
  5. decorate the pts room in everything that they like (pictures, tv, songs, etc)


Rachos Los Amigos LoCF: name of 3

localized response


Rachos Los Amigos LoCF: level 3 from book (3)

  1. Pt reacts specifically but inconsistently to stimuli;
  2. reposes are directly related to the type of stimulus presented;
  3. may follow simple commands such as closing eyes or squeezing hand in an inconsistent, delayed manner


Rachos Los Amigos LoCF: level 3 from bringman (2)

  1. Vague awareness of self;
  2. should be able to grab


Rachos Los Amigos LoCF: level 3 therapy (6)

  1. ~try and get other type of response and decrease the time from the stimulus to the response
  2. ~improve grabs (can throw soft object to them, and see if they try to block it)
  3. ~as little distraction as possible
  4. ~1 step task with 2 choices
    • (red and blue card- pick the red)
  5. ~may have to tick them off to get a response
  6. ~bathing and showering
    • (pt wont be able to do much, but they have a happy response)


Rachos Los Amigos LoCF: name of 4

confused- agitated


Rachos Los Amigos LoCF: level 4 from book (9)

  1. Pt is in a heightened state of activity;
  2. behavior is bizarre and nonpurposeful relative to immediate env;
  3. does not discriminate among persons or obj;
  4. is unable to cooperate directly with treatment efforts;
  5. verbalizations frequently are incoherent and/or inappropriate to the env;
  6. confabulation* may be present;
  7. gross attention to env is very brief;
  8. selective attention is often nonexistent;
  9. pt lacks short- and long-term recall

* Confabulation: In psychology, confabulation (verb: confabulate) is a memory disturbance, defined as the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive.


Rachos Los Amigos LoCF: level 4 from bringman (4)

  1. confused/ agitated!!!
  2. Heightened state of activity
  3. Decreased ability to process information
  4. This is the person who will swing on you


Rachos Los Amigos LoCF: level 4's therapy (7)

  1. ~need a quiet env
  2. ~don’t demand activities
  3. ~more ball throwing
  4. ~work on simple gross motor skills
  5. ~provide lots of compliments
    • ~don’t bring up the negative
    • ~end therapy on a positive note
  6. ~the more you can explain, the less likely they will get agitated
  7. Simple iPad games (smack the ant)


Rachos Los Amigos LoCF: name of 5

confused inappropriate, non-agitated


Rachos Los Amigos LoCF: level 5 from book (5)

  1. Pt is able to respond to simple commands fairly consistently.
  2. However, with increased complexity of commands or lack of ay external structure, responses are non-purposeful, random, or fragmented.
  3. Demonstrates gross attention to the env but is highly distractible and lacks ability to focus attention on a specific task.
  4. With structure, may be able to converse on a social automatic level for short periods of time.
    • Verbalization is often inappropriate and confabulatory.
  5. Memory is severely impaired;
    • often shows inappropriate use of objects;
    • may perform previously learned tasks w structure but unable to learn new info


Rachos Los Amigos LoCF: level 5 from bringman (5)

  1. highly distractible
  2. family might be coming to visit more
  3. working towards self care, feeding, ADLS
  4. Typically establish a morning routine
  5. Inappropriate: a lot of the inhibition will start to come out now.
    • If we are not careful, this is where we can become very inappropriate.


Rachos Los Amigos LoCF: level 5's therapy (7)

  1. ~establish a morning routine,
  2. working towards ADL, step by step activities
  3. ~things that take a little bit longer attention span
  4. more fine motor skills
  5. OT may do~crafts,
    1. stand up and do connect four
      1. okay if they do not know to put four in a row
  6. Weakness, can start to do more structured strength training
    1. may be able to do 10 reps of an exercise (they will be able to pay attention long enough and understand the instruction)
  7. ~bring people together and doing group activities as long as they can be more appropriate than inappropriate


Rachos Los Amigos LoCF: name of 6

confused appropriate, non-agitated


Rachos Los Amigos LoCF: level 6 from book (4)

  1. Pt shows goal-directed behavior but is dependent on external input or direct.
  2. Follows simple directions consistently and shows carryover for relearned tasks such as self care.
  3. Responses may be incorrect due to memory problems, but they are appropriate to the situation.
  4. Past memories show more depth and details than recent memory


Rachos Los Amigos LoCF: level 6 from bringman (3)

  1. Very dependent on order;
  2. short term memory still affected;
  3. time is a difficult thing


Rachos Los Amigos LoCF: level 6's therapy (3)

  1. ~increase group activity increase complexity of task
  2. ~make a daily log on what they need to do
  3. ~working toward being more independent in tasks


Rachos Los Amigos LoCF: name of 7

automatic appropriate


Rachos Los Amigos LoCF: level 7 from book (6)

  1. Pt appears appropriate and oriented within the hospital and home setting;
  2. does through daily routine automatically, but frequently robot-like.
  3. Pt shows minimal to no confusion and has shallow recall of activities.
  4. Show carryover for new learning but at a decrease rate.
  5. With structure is able to initiate social or recreational activities;
  6. judgement remains impaired


Rachos Los Amigos LoCF: level 7 from bringman (4)

  1. ~Appears app and oriented in a safe known env
  2. ~they can do things automatically
  3. ~don’t need as much cuing, but a lack of awareness for future planning
  4. ~what are the pts goals? (start to bring the pt in to making own decisions)


Rachos Los Amigos LoCF: level 7's therapy (6)

  1. ~memory
  2. ~abstract skills
  3. ~function independent
  4. ~voc rehab
  5. Working on getting community skills
    • ~take the pts out into the outside world- see how they react when things don’t go their way
  6. ~safety awareness and emergency skills


Rachos Los Amigos LoCF: name of 8

purposeful appropriate


Rachos Los Amigos LoCF: level 8 from book (3)

  1. Pt is able to recall and integrate past and recent events and is aware of and responsive to env.
  2. Shows carryover for new learning and needs no supervision once activities are learned.
  3. May continue to show a decrease ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgment in emergencies or unusual circumstance.


Rachos Los Amigos LoCF: level 8 from bringman

  1. Pt is independent in home and community;
  2. may still have some deficits compared to where they were before


Rachos Los Amigos LoCF: level 8's therapy

push towards being as close to as they were before (cogn, motor, etc) so that they can work toward being more apart of society