Neuromuscular: TBI

Question 0

Ranchos Los Amigos I

Answer 0

No Response

Deep sleep, completely unresponsive to any stimuli

Question 1

Open Injury

Answer 1

Location, depth, and pathway determine damage extent. GSW, sharp object, skull fragments, direct trauma.

Question 2

Ranchos Los Amigos II

Answer 2

Generalized Response
React inconsistently and non-purposefully to stimuli
Responses are limited and often same regardless of stimuli
Responses are physiological changes, gross body movements and/or vocalization

Question 3

Ranchos Los Amigos III

Answer 3

Localized Response
Reacts specifically but inconsistently
Responses are related to type of stimulus
Follow simple commands (close eyes, squeeze hand) delayed and inconsistently

Question 4

Ranchos Los Amigos IV

Answer 4

Confused-Agitated
Bizarre, non-purposeful behavior
Does not discriminate people or objects
Unable to directly cooperate
Verbalized incoherent and/or inappropriate
Possible confabulation
Gross attention very brief, specific attention nonexistent
No short/long term recall

Question 5

Ranchos Los Amigos V

Answer 5

Confused-Inappropriate
Respond to simple commands fairly consistently unless with complexity or no structure
Gross attention but highly distractible, cannot focus on one task
Converse short periods with structure
Verbalize inappropriately and confabulatory
Severe memory impairment
Inappropriate use of objects
Previously learned task with structure; no new learning

Question 6

Ranchos Los Amigos VI

Answer 6

Confused-Appropriate
Goal-directed behavior
Dependent on external input/direction
Simple commands consistently
Carryover for relearned tasks (self-care)
Responses may be incorrect due to memory issues
Appropriate to situation
Past memories more depth/detail than recent memory

Question 7

Ranchos Los Amigos VII

Answer 7

Automatic-Appropriate
Appropriate, oriented
Daily routine is automatic but robot-like
Shows min-no confusion
Shallow recall of activities
Carryover for new learning at decreased rate
Initiates social or recreational actives with structure
Judgement impaired

Question 8

Ranchos Los Amigos VIII

Answer 8

Purposeful-Appropriate
Recall, integrate past and recent events
Aware, responsive
Carryover for new learning, no supervision with learned tasks
May show decreased ability with premorbid activities, abstract reasoning, tolerance for stress, and judgement in emergencies
or unusual circumstances

Question 9

Coup Lesion

Answer 9

Direct lesion under point of impact

Question 10

Countrecoup Lesion

Answer 10

Lesion to opposite side of brain from rebound effect

Question 11

Coma

Answer 11

Unconsciousness

Un responsiveness to all stimuli

Question 12

Stupor

Answer 12

General unresponsiveness

Arousal from repeated stimuli

Question 13

Obtundity

Answer 13

State of consciousness characterized by:
Sleep
Reduced alertness to arousal
Delayed responses to stimuli

Question 14

Delirium

Answer 14

State of consciousness characterized by:
  Disorientation
  Confusion
  Agitation
  Loudness

Question 15

Clouding Of Consciousness

Answer 15

State of consciousness characterized by:
  Quiet behavior
  Confusion
  Poor attention
  Delayed responses

Question 16

Consciousness

Answer 16

Alertness
Awareness
Orientation
Memory

Question 17

Concussion

Answer 17

Damage to RAS allowing for immediate change in vital signs

Question 18

Grad 1 Concussion

Answer 18

No loss of consciousness
Transient confusion
Resolves within 15 min
Full memory of event
Return to sport after asymptomatic with 1 week of rest

Question 19

Grad 2 Concussion

Answer 19

Transient confusion
Longer than 15 min
Poor concentration
Retrograde and antegrade amnesia
Medical evaluation
CT scan if symptoms worsen
Return to sport after asymptomatic 2 weeks with rest and exertion

Question 20

Grad 3 Concussion

Answer 20

Diffuse axonal injury
Loss of consciousness
Transport to ER
Full neuro eval
Hospitalization if altered consciousness/mental status persists
Return to sport after asymptomatic with 1 month rest
Coma if severe

Question 21

Glasgow Coma Scale

Answer 21

Arousal and cerebral cortex function
Eye opening (1-4), motor response (1-6), verbal response (1-5), 3-15 Total
    0-8   Severe, 90% coma
   9-12  Moderate
  13-15 Mild

Question 22

Anterograde Memory

Answer 22

Inability to create new memory
Last to recover after comatose state
  Poor attention
  Distractibility
  Impaired perception of stimuli

Question 23

Retrograde Amnesia

Answer 23

Inability to remember events prior to injury

May progressively decrease with recovery

Question 24

Post-Traumatic Amnesia

Answer 24

Time between injury and when patient can recall recent events Cannot recall injury or events up until this point of the recovery Indicator of extent of damage