Module 7: TBI Flashcards
(27 cards)
TBI Definition: acquired injury to the brain due to an ? that results in widespread ?
there is ? at the microscopic level resulting in?
not all tissue damage is detected via? however, diffuse damage affecting multiple structures is ?
applied force/ damage to cortical and subcortical structures
tearing and shearing / diffuse axonal injury
imaging / common
Incidence and prevalence: in the year 2013 … sustained a TBI in the united states resulting in ?
even greater numbers of injuries likely occurring without ?
prevalence: between approx. .. and.. people are currently living with varying degrees of permanent disability relative to brain injury
2.8 mill/ emergency department visits, hospitalization and death
documentation
3 and 5 million people
Risk factors:
increased risk
pre-existing medical conditions
heart
high
mental
substance
previous
additional risk factors:
…
have a low … status
etiologies:
blows to the
-
-motor
-.. wounds
…
…
abusive
blast
…lash
heart disease
high blood pressure
mental illness
substance abuse
previous head injury
homeless
have a low SES
blows to the head
falls
motor vehicle accident
gunshot wounds
hypoxia
anoxia
abusive head trauma
blast injury
whiplash
Pathophysiology:
focal: aka?
external force passes through?
results in
closed head injury AKA ?
-hit to head or ? that does not result in ?
diffuse:
diffuse axonal injury
severe ? cause axons to ? where cells ?
more likely in ? regions because of the skull
… and …
what often accompanies this
penetrating injury
skull and enters brain tissue
-brain tissue destruction from the foreign object itself as well as from resulting brain tissue movement
non-penetrating injury
movement of head / object passing through the skull to brain tissue
rotational forces during CHI/ tear and shearing / slide over one another
frontal and temporal regions
shaken baby syndrome and whiplash
-brain stem damage
related Trauma:
concussion: change in mental status caused by?
usually accompanied by ?
usually gets better without ?
intracranial hemorrhages: bleeding into
most often occurs in ? more in … than ..
trauma
-confusion, loss of memory and sometimes loss of consciousness
-long term affect
cranium
young adults and adolescents
-male than females
Mechanisms of injury:
occur at ?
related to instantaneous effects of ? acting on the skull and brain
Secondary mechanisms of injury:
injuries resulting from the ?
could be.. or .. later
chain reaction of events that follow the primary injuries. Includes:
increased ?
…
cerebral ?
…
other:
in comatose patients: pressures…, …, organ ..
time of trauma
acceleration/deceleration (transitional and rotational forces)
primary mechanisms but not occuring at the time of injury
-minutes or days later
intracranial pressure (main issue): herniation, shift of brain tissue, restricted blood supply
-hematomas
-cerebral edema
hemorrhage
-seizures, infections, pain
-pressure sores, pneumonia, organ failure
Mild TBI Diagnosis:
diagnosis is based on the initial ?
may experience loss of ? altered ? , .., .., .., .., double ?
may experience ?
all skill areas seem relatively ? however cognitive linguistic issues are still? and may go ?
neurological signs and symptoms at the time of the event
consciousness, altered mental status, amnesia, confusion, headache, fatigue, double vision
post-traumatic amnesia
intact/ present and may go undetected for years
Mild injury:
glasgow coma scale score:
>… min loss of consciousness
<… hours post traumatic amnesia
moderate injury:
GSC scale score of ?
>30 min - 24 hours loss of ?
.. days of PTA
Severe injury:
GSC score of ?
> 24 hours loss of ?
>7 days ?
13-15
30 min
24 hours
9-12
consciousness
1-7 days
3-8
consciousness
of PTA
Translational Forces: coup-contrecoup
….!!!
contusion at the site of ? and directly ?
inertia
impact/ opposite the site of impact
Rotational Forces:
occurs when vector of force does not pass through?
causes a ? around its center of gravity
because of structure of skull and meninges, cortex suffers damage due to ?
application of rotational force causes ? of skull while brain initially remains?
then brain surface catches on ? on inner surface of skill and is dragged along with ?
results in ripping of the ? with greatest damage in the?
object’s center of gravity
rotation of object around it’s center of gravity
shearing strain
angular acceleration of skull/ stationary due to inertia
angular acceleration / stationary due to inertia
bony protuberances/ movement of the skull
cortex/frontal and temporal regions
Impaired consciousness:
…
vegetative
persistent
permanent
minimally
coma
vegetative state
persistent vegetative state
permanent vegetative state
minimally conscious state
Level of Consciousness:
coma:
-eyes closed
may respond to ? via ?
no detectable ?
display only ?
respiratory ?
postural ?
facial ?
no …cycles
lasts for a max of ? then shift ?
all the time
painful stimuli via subcortical reflexes
signs of awareness
generalized responsed = whole body response
changes
responses
grimaces
sleep-wake cycles
2-3 weeks/ diagnosis
Levels of Consciosuness:
vegetative state:
appearence of ?
spontaneous ? doll’s eyes ? … reactions
return of ?
no emaningful ?
may vocalize but does not ?
poor ?
no evidence of ?
longer periods of vegetative state:
persistent vegetative state: vegetative state has persisted more than ?
permenanet vegetative state: vegetative state has persisted for more than ?
sleep-wake cycles
eye opening / phenomenon (eyes move when head moves) / pupillary reactions
reflexes - startle reflex ; postural responses
adaptive response to external environment
verbalize
habituation to stimuli
comm.
1 month with no functional changes
1 year with no functional changes
Levels of Consciousness:
minimally conscious state
individuals in this state are also called?
inconsistent control of ?
must demonstrate at least one of the following:
single limb
intermittent
visual ?
inconsistent
inconsistent
comm. via
…
contingent movement or ?
Locked-in syndrome:
similar to other levels of ? but treated ?
patient may be ? but unable to ?
may be able to ?
minimally responsive or slow to recover
voluntary movements or behaviors
withdrawal to stimulus
localization
tracking
grasping of objects
following of commands
yes/no verbal or gestural responses
verbalization
emotional responses
consciousness but treated differently
conscious / move or speak
move eyes
Other disorders of consciousness:
clouding of consciousness is a very mild form of altered mental status in which the pt has?
confusional state: is a more profound deficit that includes ?
lethargy: consists of severe ? in which the pt can be aroused by ? then ?
obtundation: is a state similar to lethargy in which the pt has a lessened interest in ? slowed ? and tends to sleep more than ? with … in between sleep states
stupor: means that only .. stimuli will arouse the individual and when left undisturbed, the pt will immediately lapse back to ?
inattention and reduced wakefulness
disorientation, bewilderment, and diff. following commands
drowsiness / moderate stimuli/ drift back to sleep
environment/ responses to stimulation/ normal;/ drowsiness
vigorous and repeated/ unresponsive state
When does loss of consciousness occur:
the most common disorder associated with loss of consciousness is ?
TBI
What is our role as SLP”
coma stimulation: help with
assessment: identify when its
education: educate family on ?
emergence from coma
appropriate to assess
patient’s level
deficits following TBI:
it all depends on ?
but it’s not always ?
often … damage
where or the extent of primary injury occurs
easy to tell
diffuse damage
Deficits in TBI:
orientation:
refers to understanding and awareness of ?
can be evaluated ?
orientation to person and situation likely return ? and deficits may persist
attention:
impacts all areas of ?
attention deficits common regardless of ?
lack of ? and poor?
attention deficits in people with TBI are likely to interfere with ?
person, place, time and situation
daily or multiple times
last/ well into injury recovery
attention
injury severity
attentional flexibility/ working memory
recovery and rehabilitative outcomes
Deficits in TBI continued:
memory deficits
as many as .. people with TBI report some form of memory loss following injury
… and … memory
…. memory
most individuals with TBI have diff. with storing and retrieving ? information as opposed to ?
75%
short and long term memory
declarative, procedural, visual and verbal memory
declarative information/ nondeclarative
executive functioning deficits:
a group of cog. processes that facilitate
two general categories of exec functioning impairments in individuals with TBI
… impairments
… impairments
example exec functioning impairments: setting ?… ? monitoring and adapting to ?
developing and executing ?
developing alternative ?
often impacts their ability to return to ?
goal-directed behavior
initiation impairments
inhibition impairments
reaosnable goals, planning, org. , monitoring and adapting to situation
a plan to manage their new deficits
possibilities and possible consequences
work or school even if they have awareness
Awareness and theory of mind:
researchers have reported that up to 97% of individuals with TBI demonstrate ?
however more common in ?
impaired self-awareness may be related to ?
mild; acknowledge disability but feel
moderateL acknowledge but underestimate the ?
severe: deny ?
claim to perform activities clearly ?
self-awareness deficits (anosognosia)
RHD
theory of mind deficits
indifferent
severity or minimize effects
major disabilities
beyond abiltiies
Psycho-social behavioral:
social-behavioral issues are present due to ?
may also depend on the extent of ?
changes in … may occur
…,… have difficulties both ? friendships
issues include .. language but extend to other areas such as:
…. in social circumstances
managing ? environments
interpreting?
psycho-social behavioral issues can manifest as
poor?
impulsive ?
…
lack of ?
poor? and ?
amoral ?
executive dysfunction
primary lesion
personality
awkward, blunt, have diff. maintaining and forming friendships
pragmatic language
-monitoring, adapting, and problem solving in social circumstances
managing noisy and highly stimulating environments
interpreting social contexts
poor emotional regulation
-poor tolerance
-agitation
-lability
impulsive agression
compulsivity
lack of empathy
poor judgment and decision making
amoral impulses
Comm. deficits:
approx. … % of individuals who cannot speak initially following injury will regain speech during ?
indiv. with TBI also often experience .. impairments resulting from deficits in underlying ?
common language diff.:
wernicke and broca are ?
anomia on the other hand is ? because it can be caused by injuries in alot of ?
motor speech control can be also a problem depending on?
common speech impairments:
50-60% / middle stages of recovery
comm. imapirments/ cogntiive processes
aphasia, word finding deficits, processing
-uncommon
common/ different braina reas
location of injury
apraxia, dysarthria, mutism
