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529 Neuro 2 > L3 TBI POC > Flashcards

L3 TBI POC Flashcards

(52 cards)

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1
Q

new research on mTBI shows imbalance between _______ and _________- contribute to pathophys

A

microvascular supply and metabolic demand

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2
Q

standing recommendation for post concussion syndrome

A

symptoms based approach
treatment should address lingering symptoms, patient specific

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3
Q

rest period after mTBI: timeline

A

24-48 hours

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4
Q

after initial rest period, how should patients modify activity for mTBI?

A

symptoms based (headache, fatigue)
limit physical and cognitive activity
reduce exposure to symptom aggravating stim (noise, light, electronics)
avoid activity with risk for another concussion
pt education on reducing symptoms and symptom aggravating factors
try to increase activity like reading by 5 min each day

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5
Q

what should mTBI pts AVOID?

A

another blow to head
computer
texting
television
cognitive activites

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6
Q

What can mTBI pts MAYBE do with clearance from doctor?

A

drive
bike ride
sports
use heavy equipment

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7
Q

medications after mTBI?

A

pt should only take what dr allows, including OTC meds
not shown to help recovery, just for symptoms

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8
Q

highest risk sports for mTBI

A

men: football, rugby, hockey soccer
women: soccer, basketball

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9
Q

When after a concussion are you most likely to get another?

A

in the first 10 days

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10
Q

signs of mTBI

A

signs:
ocular - reading, visual deficits
vest - cervical/ocular deficits, walking/turning head/driving impairments
posture - loss of balance, dynamic balance

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11
Q

symptoms of mTBI

A

symptoms:
attention - unable to perform school or work related activities, difficulty focusing, fatigue, memory loss
emotion - irritability, depression, sleep disturbance, less engaged in activity
enviro - emotion, attention, sleep, noise, light, screen time

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12
Q

VOR deficits in mTBI

A

dizziness, reading difficulty, vertigo, unsteadiness, eye fatigue

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13
Q

vestibular postural system functionV

A

assists in postural stability an body orientation in space
generate postural tone
in TBI need practice with this through sit to stand, leg extension activating reflex pathway

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14
Q

VOR testing in mTBI

A

VOMS
dynamic visual acuity test

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15
Q

VOR and eye cranial nerves: how do they adjust eye position with head movement

A

when head turns left, eyes move right to maintain gaze
do this by feedback from semicircular canals sensing head rotation, triggers eyes to move in opposite rotational direction as the neck

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16
Q

how does mTBI affect ocular pathway?

A

oculomotor system connected to medial longitudinal fascilculus and to oculomotor/vestibular nuclei + semicircular canal
timing of this connection (inhibition/activation pattern) of 3 cranial nerves and vestibular system disrupted

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17
Q

working memory loss in mTBI caused by damage to what structures?

A

medial prefrontal cortex has disruption of excitation/inhibition

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18
Q

other structures involved in memory after mTBI?

A

amygdala: interferes with hippocampus by creating emotional priority of memories
amygdala and hippocampus connected to frontal lobe by unicinate fasciculus that is vulnerable to twisting injury

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19
Q

tests for coordination in mTBI exam

A

ruler drop test: measure reaction time by dropping ruler and measure distance caught
cerebellar exams

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20
Q

endurance exams for mTBI

A

buffalo concussion treadmill stress test
also walking/run/bike and measure RPE/symptoms

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21
Q

buffalo concussion stress test

Study These Flashcards
A

monitor RPE, HR, and symptom severity
pt walks on treadmill with incline and speed increasing over time
record HR, RPE, symptoms each minute
stop test when pt experiences HDNF symptoms or is exhausted/RPE 17+

22
Q

framework of vestibular system reflexes/VOR

Study These Flashcards
A

input from otoliths for linear motion and semicircular canals for angular motion - inputs from auditory, visual, proprioceptive, and somatosensory
vestibular inputs go to cerebellum and all go to vestibular nuclei
vestibular nuclei contols VOR with extraocular muscles to get gaze stability
also vestibular spinal and colic reflexes to move head with moving body

23
Q

why are seated exercises easier for vestibular?

Study These Flashcards
A

vestibular system is not controlling the LE and has less input to manage
safer for falls

24
Q

VOR cancellation

Study These Flashcards
A

higher level activity as more processing and coordination is require to cancel out the movement sensation from the vestibular system

25
benefits of aerobic exercise after mTBI
impaired temperature and cardio regulation exercise to point of symptoms, not pushing through them 70-80% HRmax
26
How does aerobic exercise aid TBI recovery?
exercise increases BDNF leading to: increased neuroplasticity/neuroprotection decreased neuroinflammation, apoptosis modulate dopamine and more all these lead to improved cognitive recovery
27
treatment for convergence insufficiency
brock string exercise
28
can you exercise too soon after TBI?
yes, premature exercise can be harmful due to ANS effects blunting cardiopulm response to exercise
29
primary damage in mod/severe TBI
DAI - axonal swelling membrane mechanooperation disrupted, Ca accumulates and increases excitotoxicity acute ischemia - cellular acidosis
30
secondary damage after mod/severe TBI
apoptosis microglia activation secondary axon damage demyelination secondary ischemia these cause neurodegeneration - leading to beta amyloid plaques and tau tangles
31
areas involved in memory loss of mod/severe TBI?
ACC: attention control in frontal lobe Brocas and Wernicke's parietal lobe: perception occipital lobe: visuospatial damage to any of these can interfere with the ability to process and store memories with the hippocampus
32
examination mod/severe TBI: orientation
to self, place, time, family, long term/short term
33
examination mod/severe TBI: arousability
arouses to: verbal visual tactile pain
34
examination mod/severe TBI: attention level
time following one or two step commands dual tasking emotional disruptions
35
examination mod/severe TBI: sensitivity
light sound visual
36
examination mod/severe TBI: bx
aggressive perseverating distracted judgment/safety
37
examination mod/severe TBI: neuro
muscle performance: synergy, ataxia, motor planning, weakness tone: hyper/hypo, spasticity, DTR, rigidity CN: visual, vestibular, dysphagia sensation: proprioception, somatosensory, perception balance: sitting, standing, righting responses
38
types of motor control impairments in TBI
loss of selective motor control: unable to dissociation joints of a limb synergistic motion hemi/quadriplegia ataxia poor motor planning (parietal, cerebellar)
39
general parameters of intervention for TBI
should be task based related to personal and functional goals allow rest breaks reduced distractions and complexity use body weight, task, environment to incduce muscular changes/muscular firing
40
impact of sensory system on gait dynamics
input from sensory system goes to the central rhythm generator as well as interneurons, which both feed into motor neurons CRG drives motor patterns of motor neuron firing
41
NDT: neurodevelopmental theory
therapist decides what the patient will do and helps them do it with cuing like tactile, etc
42
task based training vs NDT
task based requires more thinking on the patient's part engages entire NS to follow normal patterns human brain uses for movement brain encodes tasks in environment bc they're planned in the brain requires goal setting and planning with posterior sensory cortex, perfrontal cortex, premotor cortex to sequence motor cortex actions
43
benefits of task based activity
develop selective visual attention facilitate weight shifting
44
NDT handling priorities
1. handle core, head, and trunk alignment first 2. handle lower limb connection to trunk next 3. motor learning with task 4. dual tasking
45
benefit of aerobic activity for TBI
reduxe cognitive fatigue decrese irritability increase BDNF: increased neuroplasticity and neuroprotection reduce depression increase self worth brain uses 20% of body's oxygen, so improving CV control and nutrient supply (blood flow) improves cognitive function
46
dosing of aerobic activity for TBI
12 weeks 3x week 30 min 70-80% THR
47
strategies for TBI patients motor learning and memory
sequence activities with numbered steps and provide pictures memory book for daily activities and STM issues calendars with crossed out dates to orient pt and calm anxiety
48
most common behavioral impairment in TBI
29-71% have irritability/aggression/physical outbursts worsens with environmental distraction, inability to express onself/communication/ unable to reach goals
49
how to reduce irritability in TBI pts
attend to excess enviro stim remain calm with level emotion know triggers (light, sound, enviro) if pt is irritable, allow rest give pt cues to stop session if they want like blink/hand signal to give them anxiety relief plan for aggressive outbursts reorient patient to their situation provide pt with choice
50
patient strategies to self relieve irritation
breathing exercises give communication methods relaxation self time out when needed for emotional regulation benzos if needed communicate their anger
51
strategies for distractible patient
clear gym, go to quiet area choose time when pt is rested simple activtiies limit verbal feedback show vs tell one-two step directions provide rest breaks
52
way finding
being able to navigate through an unknown area using memory, vestibular, vision, knowledge of velocity integration of senses to orient self in space based on head movement

529 Neuro 2 (16 decks)

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