Module 9

Question 0

What is the range for age of onset of TBI?

Answer 0

15-24

Question 1

What is the definition of traumatic brain injury (TBI)?

Answer 1

An insult to the brain that is caused by an external force. Symptoms resulting from TBI may be temporary or permanent depending upon the extent of the neurological damage.

Question 2

What is the gender influence of TBIs?

Answer 2

Males 2:1

Question 3

What is the prevalence of TBIs?

Answer 3

2.5-6.5 million

Question 4

What is the average mortality rate of TBIs?

Answer 4

50,000

Question 5

What are the diagnostic procedures of TBIs?

Answer 5

Computerized tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
Single-photon emission computerized tomography (SPECT)
Functional magnetic resonance imaging (fMRI)
Diffusion tensor imaging (DTI)- can see diffuse axon injury breaks in the axons.

Question 6

What are the primary injuries caused by a TBI?

Answer 6

Facial injury-blunt trauma

Diffuse axonal injury (DAI)

Question 7

What are the secondary injuries of a TBI?

Answer 7

Hypoxic-ischemic injury-cell death
Intracranial hematoma-blood causing compression
Open wounds
Soft tissue injuries
Fractures
Spinal cord injury
Peripheral nerve injury
Internal organ injury

Question 8

What are the three different levels of the Glasgow coma scale?

Answer 8

Severe=<8 points
Moderate=9-12 points
Mild=13-15 points

Question 9

What are the different levels of the Glasgow outcome scale?

Answer 9

Dead
Vegetative
Degree of disability (severely disabled, moderately disabled, good recovery)

Question 10

What are the levels of consciousness?

Answer 10

Concussion
Stupor
Coma
Persistent vegetative state

Question 11

What are the ten levels of the rancho Los amigos cognitive functioning?

Answer 11

1-no response 
2-generalized response
3- localized response
4- confused-agitated
5- confused-inappropriate 
6-confused-appropriate
7-automatic-appropriate
8- purposeful-appropriate 
9- PA stand by assist (request)
10- PA modified independent

Question 12

What levels of the rancho Los amigos cognitive functioning scale are total assist?

Answer 12

Levels 1-3

Question 13

What levels of the rancho Los amigos cognitive functioning scale are max assist?

Answer 13

Level 4-5

Question 14

What level of the rancho Los amigos cognitive functioning scale is moderate assist?

Answer 14

Level 6

Question 15

What level of the rancho Los amigos cognitive functioning scale is minimal assist ADL?

Answer 15

Level 7

Question 16

What levels of the rancho Los amigos cognitive functioning scale are stand by assist?

Answer 16

Levels 8-9

Question 17

What level of the rancho Los amigos cognitive functioning scale is modified independence?

Answer 17

Level 10

Question 18

What are the factors influencing rehabilitation?

Answer 18

Pre-morbid status including previous sizable neuronal loss secondary to brain injury, disease, or age result in a worse brain injury.

Question 19

What are the drugs associated with TBIs?

Answer 19

Seizures- Dilantin 
Spasticity- Baclofen 
Antipsychotics- haldol
Arousal-sinemet
Disinhibited behavior- atenolol
Pain- Vicodin 
Insomnia- ambien
Depression- Paxil
Nausea/gastric stasis- reglan

Question 20

What’s part of the rehabilitation process for TBI?

Answer 20

Participation/communication
Family support
Medically stable
Functional recovery potential
Guide to physical therapist practice (strength impairments, sensory and perceptual impairments, coordination impairments, balance impairments, functional impairments)

Question 21

What are the implications for O and P for TBIs?

Answer 21

Hypertonicity
Contractures
Heterotopic ossification-joints get irritated and form bone and freeze up. Need stretching and ROM.
Amputations
Flaccidity-low tone
Fractures/walking boots-axial resist AFOs
TLSO, halo

Question 22

When working with patients who are levels 4 or 5 in the rancho Los amigos scale what should you remember to do?

Answer 22

Keep hands in front of you