Midterm

Question 1

TBI definition

Answer 1

alteration in brain fx or other pathology caused by external force; not congenital or degenerative

Question 2

leading causes of TBI

Answer 2

falls (35%), MVA (17%), struck by/against (17). Blasts for military. 2.2 million ER visits a year

Question 3

why is TBI underreported?

Answer 3

have to lose consciousness to count?; coding by dr/ER; don’t go to ER

Question 4

TBI ages

Answer 4

15-24; under 5 and over 75

Question 5

primary injuries

Answer 5

localized brain injury (OHI); polar damage (CHI, contracoup); diffuse injury (DAI)

Question 6

localized head injury/open-head injury

Answer 6

penetrating or missile injuries producing focal damage (less tissue involved); acts of violence; localized can also be CHI; OHI has better outcome due to less intracranial pressure

Question 7

diffuse/polar damage/closed head injury

Answer 7

acceleration/deceleration (MVA); linear/translation vs. angular/rotational; coup/countrecoup; more brain tissue involved; often front and back

Question 8

coup/contrecoup

Answer 8

coup= site of impact/front, contrecoup = side opposite injury/back

Question 9

diffuse axonal injury (DAI)

Answer 9

shearing of nerve tissue b/c of ridges of cranium= white matter injured; key to prognosis; damage to white matter, corpus callosum, internal capsule (everything passes through here!), grey matter, brain stem tracts

Question 10

midline shift

Answer 10

ventricles moved over after impact

Question 11

systemic TBI issues: concomitant injuries

Answer 11

hypoxemia (02); hypotension (BP); anemia, hyponatremia (sodium–action potential), infection

Question 12

hyponatremia and dysphagia =

Answer 12

pontine injury b/c salt converted too quickly

Question 13

hematoma

Answer 13

bleeding out: epidural (solid, clotted blood separating dura mater and skull), subdural (clotted blood between inner surface and dura), intracerebral (blood thinners first)

Question 14

intracranial pressure

Answer 14

edema (with blood) and hydrocephalus (CSF–VP shunt); ventricles may be enlarged when losing brain tissue; craniectomy may be done to relieve pressure (cut skull); Richmond bolts can monitor ICR pressure

Question 15

other intracranial concerns

Answer 15

infections (meningitis, encephalitis, abscess); epilepsy (anti-seizure meds can also be cognitively dulling); vasospasm (constriction in arteries)

Question 16

coma

Answer 16

after CNS damage or depression; state without eye opening, obeying commands, uttering words

Question 17

Glasgow Coma Scale

Answer 17

subjective assessment of consciousness related to E (eye opening) + M (motor response) + V (verbal response); severe = 8 or below; mod = 9-12; mild =13-15; also used for predictions of outcome; eyes out of 4, motor out of 6, verbal out of 5

Question 18

likelihood for a second or more TBI?

Answer 18

3-4 x more likely

Question 19

coma scales

Answer 19

Disability Rating Scale; Glasgow Outcome Scale; Sickness Impact Profile; Katz Adjustment Scale; Galveston Orientation and Amnesia Test

Question 20

decorticate vs. decerebrate

Answer 20

flexion (body inward) vs. extension (body outward)

Question 21

neuro eval early stages

Answer 21

consciousness, motor response (decorticate vs. decerebrate), muscle tone (spastic/flaccid), orbicularis reflex (tap on head and blink), pupil size, resting eye position, other ocular

Question 22

neuro eval later stages

Answer 22

smell and taste, visual acuity and fields, facial symmetry and mvm’t, motor function (body), hearing, phonation and swallow, gait and balance, cognition

Question 23

psychosocial considerations

Answer 23

premorbid factors (personality, hx, substance), impaired cog. fx. (memory and attention), emotional status (depression), environmental responses

Question 24

Reitan and Wolfson Model of Cog Fx

Answer 24

sensory input–attention, concentration, memory–lang. and visuospatial skills–concept formation, reasoning, logic

Question 25

neurpsych eval components

Answer 25

general neuropsych function, intellectual and academic, attention and concentration, memory, processing speed, visual-spatial and perceptual motor, sensory perceptual and motor, problem solving and abstract reasoning

Question 26

ancillary testing

Answer 26

personality, mood, psychosocial measures such as intelligence (Wechsler, Peabody)

Question 27

attention components

Answer 27

must be alert, need capacity to attend to multiple, need selection (selective attention--i.d. most imp. piece of info.)

Question 28

memory

Answer 28

first need attention (30 sec.), then short-term for 30 sec. -2 min., then long-term forever (this includes episodic, semantic (declarative), procedural, non-declarative)

Question 29

attention deficits after TBI

Answer 29

selective attention, perseveration, vigilance, hemi-inattention or neglect

Question 30

retrograde amnesia vs. anterograde

Answer 30

remember before onset vs. ability with new learning

Question 31

post tramautic amnesia ( PTA)

Answer 31

one of best predictors of cog. outcome: from moment of injury till continuous memory returns; 1-2 or even up to 5 yrs. till can ascertain status and recovery potential

Question 32

cog-lang connection

Answer 32

impaired attention, memory, perception; inflexible, impulsive, disorganized; inefficient info. processing; difficulty processing abstract, learning new info, inefficient retrieval, impaired problem solving and judgment, inappropriate social behavior, impaired exec fx

Question 33

Rancho stages

Answer 33

early=1-3; mid = 4-6; late = 6-8/10; based on level of fx and cooperation behaviors

Question 34

TBI evals

Answer 34

lower: Rancho scale, Comm. Abilities Record, BRIEF Test of Head Injury; mid: SCATBI, RIPA, Ross Test of Higher Cognitive Fx, CLQT (for lang. BASA, WAB, CADL)

Question 35

motor speech deficits

Answer 35

impairment (strucure/fx); disability (activity); handicap (participation)

Question 36

initiation/planning disorders

Answer 36

persistent veg state; locked-in syndrome; apraxia ; apraxia and dysarthria often comorbid (volitional v. spontaneous); limb apraxia and verbal always follows (wait till limb resolves)

Question 37

apraxia

Answer 37

numerous phon. errors, inconsistency, difficulty initiating, increased error with length/complexity, discrepancy b/w production and perception, increased diff. with words carrying little meaning

Question 38

testing apraxia

Answer 38

informal; Apraxia Battery for Adults; automatized speech or singing

Question 39

apraxia tx

Answer 39

PACER (pacing board/tap); Rosenbeck Continuum for Apraxia; MIT

Question 40

dysarthria

Answer 40

test with AIDS/CAIDS or Frenchay and oral peripheral; consistent but slow, weak, imprecise, uncoordinated; occurs in 75-80% of severe TBI; DAB checklist

Question 41

dysarthria components

Answer 41

artic, resonance, respiration, largyneal fx, prosody

Question 42

dysarthria types

Answer 42

spastic, flaccid, ataxic, hyperkinetic, hypokinetic, mixed (TBI usually here)

Question 43

swallow phases

Answer 43

oral prep, oral, pharyngeal, esophageal

Question 44

oral prep disorders

Answer 44

primitive/pathological reflexes (rooting, biting, munchy chewing), abnormal muscle tone, sensation, movement disorders

Question 45

oral phase deficits

Answer 45

tone, sensation, movement, munch or suckle-swallow, premature spillage, inadequate buccal/labial tension

Question 46

pharyngeal issues

Answer 46

delayed swallow, absent (20 sec. or more), inadequate V-P closure, reduced hyol. excursion, reduced airway protection

Question 47

esophageal issues

Answer 47

cricopharyngeal dysfunction, distal esophageal issues

Question 48

dysphagia assessment

Answer 48

history/feedings, BSE, MBS, FEES