Exam 3- TBI part 1

Question 1

Cultural sensitivity (some details on it)

Answer 1

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

Question 2

CTE- stands for

Answer 2

chronic traumatic encephalopathy

Question 3

chronic traumatic encephalopathy

Answer 3

~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
~has been known to affect boxers since the 1920s
~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
~trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau
~these changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement
~brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia

Question 4

Different types of TBI

Answer 4

~traumatic
~atraumatic
~acquired brain injuries
~secondary injuries

Question 5

Traumatic (type types)

Answer 5

A trauma to the body (duh)
~open
~closed

Question 6

Traumatic- closed

Answer 6

~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

Question 7

Traumatic- open

Answer 7

~the head has to open
~GWS, baseball bat, hit a stair and the skull comes open, a horse kicks you
~you know where the injury is
~you can have a contra-coup as well

Question 8

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

Answer 8

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

Question 9

Traumatic- Closed can lead to DAI (stand for)

Answer 9

diffused axonal injury

Question 10

Traumatic- Closed can lead to DAI

Answer 10

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

Question 11

Non traumatic (2 main types)

Answer 11

~Infection

~Anoxic

Question 12

Non traumatic- some examples

Answer 12

Drowning, CO victim, strangulation

Question 13

Non traumatic- anoxic details

Answer 13

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

Question 14

Acquired brain injury

Answer 14

~a lot of peds
~When you have it at birth/ during the birthing process
~If you have the cord stuck coming out of the wound (deprived of O2)

MB: Did you mean womb? Lol!

Question 15

Secondary injuries ((there’s lots of them))

Answer 15

~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
~Lack of oxygen- can create cell death
~Infection
~Cell mediators that can kill some brain tissues
~Hydrocephalus- can occlude our normal sinuous that can cause it
~*when in doubt, go to the doctor

Question 16

Secondary injuries- inflammation/ swelling details

Answer 16

~can make the injury worse
~can create the bleed that was not there at first
~we vasodialate to make better

Question 17

Differentiating concussions/ LOC

Answer 17

~mild

~moderate/ severe

Question 18

Differentiation- Mild defining

Answer 18

~Concussion/ LOC- less than 30 minutes

Question 19

Differentiation- Mild s/s

Answer 19

~Memory problem
~headaches
~attention deficits
~mood swings
~irritable
~a disconnect
~cant focus
~frustration

Question 20

Differentiation- Mild details

Answer 20

~Over looked a lot- in football a lot
~Can last, but these problems are most prominent the next day
~15% of these people will still have these symptoms in upwards of a year

Question 21

Differentiation- Mild- Post-concussive symptom

Answer 21

*the long term symptoms
*A lot of the military comes home with
~Fatigue
~HA
~coup-contracoup
~balance
~vision
~attention
~sleep problems (all the time or they don’t need to sleep)
~irritability
~depression
~seizures (can last)
~nausea
~vomiting
~olfactory N- loss or sense of smell (decrease in appetite)
~slowness in thinking
~get lost

Question 22

Moderate- defining

Answer 22

Concussion/ LOC- great than 30 to 6 hours

Question 23

Severe- defining

Answer 23

Concussion/ LOC greater than 6 hours

Question 24

Moderate/ Severe- cognitive s/s

Answer 24

**A lot more cognitive problems
~attention
~concentration
~memory
~distractibility
~processing speed
~confusion
~perseveration
~impulsiveness
~language processing
~executive functions

Question 25

Moderate/ Severe- Speak and language s/s

Answer 25

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

Question 26

Moderate/ Severe- Sensitivity s/s

Answer 26

Light touch/ pain/ etc can be gone

Question 27

Moderate/ Severe- Vision s/s

Answer 27

``` ~complete ~partial loss ~diplopia from weakness of muscles ~blurred vision ~depth perception ~nystagmus ~photophobia (light sensitivity) ```

Question 28

Moderate/ Severe- Hearing s/s

Answer 28

~complete loss or decrease or increase | ~tinnitus (ringing in the ear)

Question 29

Moderate/ Severe- Smell s/s

Answer 29

loss or diminished

Question 30

Moderate/ Severe- taste s/s

Answer 30

loss or diminished

Question 31

Moderate/ Severe- autonomic s/s

Answer 31

~temp issues ~B/B issues ~menstrual cycles ~seizures

Question 32

Moderate/ Severe- Physical changes s/s

Answer 32

~weakness ~flaccidly ~tone ~chronic P

Question 33

Moderate/ Severe- Social emotional s/s

Answer 33

``` ~dependent behavior ~childlike ~emotions(more/less/childlike/ etc) ~lack of motivation ~irritability ~aggression ~depression ~disinhibition ~denial ```

Question 34

what's a STORM

Answer 34

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

Question 35

Levels of conciseness

Answer 35

``` ~awake and alert ~Lethargic ~Obtunded ~stupor ~MSC (minimally conscious state) ~coma ```

Question 36

LOC: Awake and alert

Answer 36

~AAO x3, x4 | ~Awake attentive

Question 37

LOC: Lethargic

Answer 37

Drowsy

Question 38

LOC: Obtunded

Answer 38

~Sleeps often | ~Difficulty to arouse, actions largely non-productive, frequently confused when awake

Question 39

LOC: Stupor

Answer 39

~Unresponsive, but can be aroused with noxious stimulus ~You can do thing in this state ~Only respond to hard, strong noxious stimulus ~Sternal rub, pick the nail bad, nipple twist, thenar pinch

Question 40

LOC: MSC

Answer 40

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

Question 41

MSC stands for?

Answer 41

Minimally conscious state

Question 42

LOC: coma (2 types)

Answer 42

~Vegetative state | ~Persistence vegetative state

Question 43

LOC: coma- vegetative state

Answer 43

~No words, does not follow commands, does not make any response that is physiologically meaningful ~Intact eye opening, has wake and sleep cycles ~We don’t know if they ~Our job is to start to interact with the outside world- “emerge”

Question 44

LOC: coma- persistent vegetative state

Answer 44

~No meaningful motor or cognitive function ~Lasts for a year (a noxious brain injury only takes 3 months to get this title) ~Not on a vent, have a lot of their brain stem functions- will be on a peg tube to get

Question 45

some info on how to get pts better

Answer 45

~Stabilize the pt so that they live through the event ~Prevent secondary: Skin, DVT, contractures, infections, pneumonia ~Look at: How much can they interact with env; Equipment that they may need ~Do they need to go to a rehab, voc rehab ~Some of the things that will impact- mental, emotional, behavioral (emotional side issues- Don’t trigger the negative emotions) ~Behaviors: What was the premorbid behavior; The effects of the injury, phys, emotion, sec, etc ~Act of abuse, someone died in the injury, etc ~The nature of the env that you will be in during therapy- will it promote good/bad behavior ~Talk to family members if possible ~Disinhibition: Will be saying inappropriate things- don’t agree with them/ don’t laugh/ wear bigger scrubs

Question 46

Glascow Coma Scale: the levels

Answer 46

~mild ~moderate ~sever

Question 47

Glascow Coma Scale: Mild TBI

Answer 47

13-15

Question 48

Glascow Coma Scale: Moderate TBI

Answer 48

9-12

Question 49

Glascow Coma Scale: Sever TBI

Answer 49

3-8

Question 50

Rachos Los Amigos LoCF: levels

Answer 50

1- 8

Question 51

Rachos Los Amigos LoCF: name of 1

Answer 51

No response

Question 52

Rachos Los Amigos LoCF: name of 2

Answer 52

generalized response

Question 53

Rachos Los Amigos LoCF: name of 3

Answer 53

localized response

Question 54

Rachos Los Amigos LoCF: name of 4

Answer 54

confused- agitated

Question 55

Rachos Los Amigos LoCF: name of 5

Answer 55

confused inappropriate, non-agitated

Question 56

Rachos Los Amigos LoCF: name of 6

Answer 56

confused appropriate, non-agitated

Question 57

Rachos Los Amigos LoCF: name of 7

Answer 57

automatic appropriate

Question 58

Rachos Los Amigos LoCF: name of 8

Answer 58

purposeful appropriate

Question 59

Rachos Los Amigos LoCF: level 1 from book

Answer 59

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

Question 60

Rachos Los Amigos LoCF: level 1 from bringman

Answer 60

Pt appears to be in a deep sleep

Question 61

Rachos Los Amigos LoCF: level 1's therapy

Answer 61

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

Question 62

Rachos Los Amigos LoCF: Level 2 from book

Answer 62

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

Question 63

Rachos Los Amigos LoCF: level 2 from bringman

Answer 63

Non purposeful responses that Doesn’t change no matter the stimulus

Question 64

Rachos Los Amigos LoCF: level 2's therapy

Answer 64

~sensory deprivation ~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) ~will get them out of bed- stand to wheelchair, etc ~pre-feeding (good stimulus); decorate the pts room in everything that they like (pictures, tv, songs, etc)

Question 65

Rachos Los Amigos LoCF: level 3 from book

Answer 65

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

Question 66

Rachos Los Amigos LoCF: level 3 from bringman

Answer 66

Vague awareness of self; should be able to grab

Question 67

Rachos Los Amigos LoCF: level 3 therapy

Answer 67

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

Question 68

Rachos Los Amigos LoCF: level 4 from book

Answer 68

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

Question 69

Rachos Los Amigos LoCF: level 4 from bringman

Answer 69

Decrease ability or process info; confused/ agitated

Question 70

Rachos Los Amigos LoCF: level 4's therapy

Answer 70

``` ~need a quiet env ~don’t demand activities ~more ball throwing ~simple gross motor skills ~lots of compliments ~don’t bring up the negative ~end therapy on a positive note ~the more you can explain, the less likely they will get agitated ```

Question 71

Rachos Los Amigos LoCF: level 5 from book

Answer 71

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

Question 72

Rachos Los Amigos LoCF: level 5 from bringman

Answer 72

Highly distractible; will bring friends and family in more; working towards ADL, disinhibition will come out more

Question 73

Rachos Los Amigos LoCF: level 5's therapy

Answer 73

~establish a morning routine, working towards ADL, step by step ~crafts, stand up and do connect four ~more fine motor skills ~is able to attend long enough for strength training ~bring people together and doing group activities as long as they can be more appropriate than inappropriate

Question 74

Rachos Los Amigos LoCF: level 6 from book

Answer 74

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

Question 75

Rachos Los Amigos LoCF: level 6 from bringman

Answer 75

Very dependent on order; short term memory still affected; time is a difficult thing

Question 76

Rachos Los Amigos LoCF: level 6's therapy

Answer 76

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

Question 77

Rachos Los Amigos LoCF: level 7 from book

Answer 77

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

Question 78

Rachos Los Amigos LoCF: level 7 from bringman

Answer 78

~Appears app and oriented in a safe known env ~they can do things automatically ~don’t need as much queuing, but a lack of awareness for future planning ~what are the pts goals

Question 79

Rachos Los Amigos LoCF: level 7's therapy

Answer 79

``` ~memory ~abstract skills ~function independent ~voc rehab ~take the pts out into the outside world- see how they react when things don’t go their way ~safety awareness and emergency skills ```

Question 80

Rachos Los Amigos LoCF: level 8 from book

Answer 80

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

Question 81

Rachos Los Amigos LoCF: level 8 from bringman

Answer 81

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

Question 82

Rachos Los Amigos LoCF: level 8's therapy

Answer 82

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

Question 83

Name the Rancho los Amigos levels and names:

Answer 83

``` 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 ```