Neuro II > Exam 3: TBI - Part 2 > Flashcards

Exam 3: TBI - Part 2 Flashcards

(76 cards)

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1
Q

What are the three criteria that are looked at when scaling the severity of an acute TBI

A

Glascow coma scale
Loss of consciousness
PTA

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2
Q

What is PTA

A

posttraumatic amnesia

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3
Q

What level of severity would a concussion be scaled at

A

mild

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4
Q

What is the definition of PTA

A

The time between the injury and the time to remember on going events

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5
Q

What is an easy way to tell the difference between a mild and moderate TBI

A

Impairments will go away and return to normal with a mild TBI, but they will not with a moderate TBI

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6
Q

True or False:

Impairments or loss of consciousness that occur with a moderate concussion has the potential to become permanent

A

true

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7
Q

What type of impairments will be seen in a mild TBI

A

Neuro or neuropsychological

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8
Q

What type of impairments might be seen in a moderate TBI

A

physical, cognitive, and/or behavioral changes

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9
Q

How long would you expect any physical, cognitive, and/or behavioral changes to last after a moderate TBI

A

months or even permanently

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10
Q

1/3 of patients with a (mild/moderate/severe) TBI will have extra cranial injuries or multi-trauma

A

severe

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11
Q

___ of patients with a severe TBI will have extra cranial injuries or multi-trauma

A

1/3

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12
Q

A (mild/moderate/severe) TBI is associated with acceleration/deceleration forces with any period of confusion, disorientation, or impaired consciousness

A

mild

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13
Q

How would a mild TBI be scaled

A

GCS: 13-15
Loss of consciousness: less than 30 min
PTA: 0-1 day

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14
Q

How would a moderate TBI be scaled

A

GCS: 9-12
Loss of consciousness: 30min-24 hours
PTA: 1-7 days

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15
Q

How would a severe TBI be scaled

A

GCS: 3-8
Loss of consciousness: over 24 hours
PTA: greater than 7 days

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16
Q

Which clinical rating scale is to be used at the acute level or in an emergency situation

A

Glascow coma scale

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17
Q

When do you use the GCS

A

at the acute level or in an emergency situation

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18
Q

Which clinical rating scale measures post traumatic amnesia

A

Galveston orientation and amnesia test

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19
Q

When do you use the GOAT

A

to test for PTA

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20
Q

Which clinical rating scale determines the overall prognosis of the patients

A

Glascow outcome scale

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21
Q

When do you use the GOS

A

at discharge from acute care and again at 6 months after the injury

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22
Q

Which clinical rating scale measures level of consciousness in the subacute phase or rehab phase

A

Ranchos

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23
Q

When do you use the Ranchos scale

A

During the subacute or rehab phase to measure level of conscious

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24
Q

Which clinical rating scale has a wide range of physical and cognitive function to truly capture where the patient is at in recovery

A

Rappaport’s disability rating scale

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25
What are the two clinical rating scales that measures participation
DRS and FAM
26
When do you use the DRS
when you need to truly test where the patient is physically and/or cognitively in their recovery
27
True or False: The FIM is no longer used clinically
true
28
What is the difference between the FIM and FAM
The FAM is the FIM, but with 12 additional measurement items that target TBI patients
29
Which clinical rating scales have employable scoring on them
FAM and DRS
30
What are the three activities that are looked at on the GCS
eye opening motor response verbal response
31
When is a patient no longer in a coma
when their eyes open, even if it is spontaneous eye opening
32
True or False: A patient in a coma is still responsive to stimulus
False, they are not responsive. only to reflexes
33
True or False: A patient in a coma is still responsive to reflex testing
true
34
What severity of TBI would a patient classify as with a GCS score of 15
mild
35
What severity of TBI would a patient classify as with a GCS score of 11
moderate
36
What severity of TBI would a patient classify as with a GCS score of 9
moderate
37
What severity of TBI would a patient classify as with a GCS score of 3
severe
38
What severity of TBI would a patient classify as with a GCS score of 7
severe
39
What are the four levels on the GOS
vegetative severely disabled moderately disabled good recovery
40
Describe a patient in the vegetative stage of the GOS
The patient will persistently be unresponsive. They may have some eye opening, yawning, localized motor response
41
Describe a patient in the severely disabled stage of the GOS
The patient has some consciousness but need 24 hour care
42
Describe a patient in the moderately disabled stage of the GOS
The patient has some independence. Can complete self care skills and most ADL's independently but still have some varying other disablements
43
Describe a patient in the good recovery stage of the GOS
Still have some sequela, but is able to integrate back into social and work life
44
The categories of the GOS are (directly/indirectly) related to prognosis
directly, the longer the coma or PTA the poorer the outcome
45
To receive a prognosis of moderate to severe for cognitive functioning, the patient must have what criteria
Been in a coma for greater than two weeks and/or Have PTA greater than 12 weeks
46
To receive a prognosis of moderate disability to good recovery for cognitive functioning, the patient must have what criteria
Been in a coma less than a week and/or Have TPA less than 4 weeks
47
Is it better to have a patient with cognitive impairments and normal physical function, or a patient with normal cognition, and physical impairments
Better for normal cognitive and physical impairments. It will be easier to integrate into every day life.
48
What are the 8 levels of the ranchos scale
1. No response 2. Generalized response 3. Localized response 4. Confused- agitated 5. Confused - inappropriate 6. Confused- appropriate 7. Automatic- appropriate 8. Purposeful - appropriate
49
What is the lowest level on the ranchos scale that a modified MMT can be done for testing
5: confused and inappropriate
50
What levels on the ranchos scale make it appropriate to assess the patients posture and alingment
1-8
51
There are several factors that influence patient outcomes after a TBI. Examples of these can be either static or dynamic. Explain what this means
static factors do not change over time, dynamic factors will change with good therapy
52
What is the lowest level of ability that is measured on the DRS
eye opening
53
What is the main goal of medical/emergency management of a patient that just sustained a TBI
To monitor ICP
54
What are the precautions for monitoring ICP
keep the head elevated at least to 30 degrees, NO LOWER to ensure that the ventricles drain properly
55
Which rancho scale level is appropriate to gather patient history
all levels
56
Which rancho scale level is appropriate to gather a systems review
all levels
57
Which rancho scale level is appropriate to determine a cognitive status
all levels
58
Which rancho scale level is appropriate to gather skin integrity
all levels
59
Which rancho scale level is appropriate to gather the patients ability to feel sensation
Unable to do formal testing 1-4 Modified testing can be done at 5 and 6 Normal testing done at 7 and 8
60
True or False: When we test for sensation, visual fields and auditory functions are included
true
61
Which rancho scale level is appropriate to gather a motor exam Ex: reflexes, spasticity, movement patterns and quality of movement, posture, coordination, and balance
all levels but will be modified with levels 1-6
62
before performing a MMT, what should the PT make sure of first
that the patient can follow instructions
63
Which rancho scale level is appropriate to test a patient's balance
7 or higher
64
Which rancho scale level is appropriate to perform timed tests for coordination
Can just observe coordination in levels 3-4 or formally by levels 7 or higher
65
What is lowest level at which coordination can be tested
3 if observing | 7 if doing timed testing
66
Which rancho scale level is appropriate to gather information regarding fatigability
level 4 and higher
67
What is diadokokinesia
rapid alternating movements
68
Which rancho scale level is appropriate to gather a functional status
4 if observing 5-6 if modified 7 or higher if for outcome measures
69
At what level can we perform the full set of outcome measurements on a TBI patient
7 at the very very lowest, some not until level 8
70
What are the core set of movement tasks for an adult that can be done by observing
``` sitting/standing sit to stand/stand to sit walking step up/down reach, grasp, and manipulation ```
71
What are the core set of movements tasks for pediatrics that can be done by observing
floor to stand/stand to floor | floor mobility
72
True or False: Rancho levels have nothing to do with physical abilities/performance and are only cognitive related
true
73
True or False: Movement system diagnoses are about cognitive function and not physical function
False, it is physical
74
What is the most likely movement system diagnosis for TBI
Anything goes here
75
What are the best functional outcome measures
DRS and the FIM/FAM
76
Would the DRS or FIM/FAM be better for inpatient rehab
FIM/FAM

Neuro II (3 decks)

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