TBI Flashcards
(189 cards)
1
Q
Males are often more affected by TBI than females (true/false)
A
true
2
Q
Which cause of TBI is the most common?
a. MVA
b. Sports
c. falls
d. other collisions
A
falls
3
Q
This mechanism of injury in TBI causes more susceptibility to brain damage, infection and rupture of blood vessels
a. open head injury
b. high velocity injury
c. closed head injury
d. low velocity injury
A
open head injury
4
Q
This mechanism of injury in TBI is more perforation or depressed fracture with diffused axonal damage
a. low-velocity injury
b. high-velocity injury
c. penetration
d. hypoxia
A
high velocity injury
5
Q
This mechanism of injury in TBI is more linear with fracture contusion at side of impact and possible tear or blood vessels
a. low-velocity injury
b. hypoxia
c. penetration
d. high-velocity injury
A
low velocity injury
6
Q
What are potential mechanisms of injury with TBI?
A
fractures
direct blow without fracture
penetrating
loss of blood supply from neck injury
7
Q
A direct blow without fracture will have brain damage due to
A
anoxia
8
Q
What are the types of primary damage in TBI?
A
focal injury
diffuse axonal injury
9
Q
This type of TBI is shown as damage to the exact area where hit, with any severity and more severe neurological signs
A
focal injury
10
Q
This primary damage is acceleration, deceleration and/or rotational damage to the brain
A
diffuse axonal injury
11
Q
this type of damage may not show signs initially but it will get more severe with edema over time
A
diffuse axonal injury
12
Q
What is secondary damage with TBI?
A
increased intracranial pressure hypoxic-ischemic damage infection seizures electrolyte imbalance
13
Q
Increased intracranial pressure can be due to
A
herniation
hematomas
14
Q
increased intracranial pressure is related to
A
poorer outcomes
increased mortality rates
15
Q
A direct blow to the head is a cause of diffuse axonal injury (true/false)
A
false
16
Q
A bruise directly at site of impact is called
a. open head injury
b. closed head injury
c. coup
d. contrecoup
A
coup
17
Q
As the brain is jolted back, it can hit the skull on the opposite side, this is defined as
a. open head injury
b. closed head injury
c. coup
d. contrecoup
A
countercoup
18
Q
All of the following are secondary damage to TBI except
a. hypoxic-ischemic damage
b. diffuse axonal injury
c. infection
d. seizure
A
diffuse axonal injury
19
Q
This type of imaging is good for showing fractures in the skull
a. CT
b. MRI
c. x-ray
d. PET
A
x-ray
20
Q
Which neurological imaging is good for nonresponsive patients in order to see brain activity?
a. CT
b. PET
c. EEG
d. fMRI
A
EEG
21
Q
This type of imaging shows mass lesions and brain shifting from acute injury after TBI
a. CT
b. MRI
c. x-ray
d. PET
A
CT
22
Q
_ is more sensitive than CT
A
MRI
23
Q
This type of imaging shows disturbances in cerebral metabolism that may not show on other
a. CT
b. MRI
c. x-ray
d. PET
A
PET
24
Q
This type of imaging shows cognitive dynamics and overall neuroplasticity
a. CT
b. MRI
c. fMRI
d. PET
A
fMRI
25
What autonomic nervous system changes are seen with TBI?
```
changes in pulse and respiratory rates
temperature elevations
blood pressure changes
excessive sweating, salivation, tearing
dilated pupils
vomiting
```
26
All of the following include changes in the autonomic nervous system except
a. temperature elevations
b. constricted pupils
c. vomiting
d. changes in pulse
constricted pupils
27
All of the following include changes in the autonomic nervous system except
a. dilated pupils
b. changes in pulse and respiratory
c. temperature decreased
d. vomiting
temperature decreased
28
What are the neuromuscular changes that occur?
```
sensory impairments
abnormal tone
motor function impairments
impaired balance
loss of bowel or bladder control
CN involvement
locked-in syndrome
```
29
What sensory impairments can occur with TBI?
changes in primary sensation light touch, deep touch, position sense
30
What abnormal tone is seen with TBI?
a. low tone
b. high tone
c. normal tone
d. full spectrum
full spectrum possible
31
A patient's LE is in extension and UE in flexion this describes
a. low tone
b. decorticate
c. rigidity
d. decerebrate
decorticate
32
All of the extremities are in an extension posture, this describes
a. low tone
b. decorticate
c. rigidity
d. decerebrate
decerebrate
33
All of the extremities are in an _ posture = decerebrate
extension
34
Decorticate position
a. LE in flexion and UE in flexion
b. LE in extension and UE in flexion
c. LE in extension and UE in extension
d. none of the above
LE in extension and UE in flexion
35
What are the motor function impairments possible with TBI?
```
motor control and learning impairments
loss of selective motor control
impairments in coordination, timing, sequencing
paresis
abnormal reflexes
```
36
TBI patients have a loss of bowel or bladder control (true/false)
true
37
What are the cognitive changes seen with TBI?
```
coma/altered level of consciousness
memory loss
altered orientation
attentional deficits
impaired insight and safety awareness
problem-solving
preservation
impaired executive functioning
```
38
Learning is not affected with memory loss (true/false)
false
39
This is referred to as the time between injury and then the ability to remember ongoing events
PTA
40
Orientation includes
person
place
time
situation
41
This is defined as an inability to stay on task, concentrate or focus and inhibit distraction
a. impaired executive functioning
b. perservation
c. attentional deficit
d. problem-solving impairment
attentional deficit
42
This is usually when they are stuck on one idea and it is all they think about
a. impaired executive functioning
b. perservation
c. attentional deficit
d. problem-solving impairment
persevation
43
What visual changes occur with TBI?
cortical blindness
| hemianopsia
44
Awareness of body parts, position of body in relationship to environment is defined as
a. body image
b. right left discrimination
c. spatial relations disorder
d. body scheme
body scheme
45
Dont recognize visual, auditory, or tactile
a. somatoagnosia
b. finger agnosia
c. unilateral neglect
d. agnosia
agnosia
46
Denial or lack of awareness of the problem on one side of the body
a. apraxia
b. agnosia
c. anosognisa
d. somatoagnosia
anosognisa
47
Impairment in scheme, inability to correctly identify or orient the parts of one's body or the body of another
a. apraxia
b. agnosia
c. anosognisa
d. somatoagnosia
somatoagnosia
48
Ability to perceive self in relation to other objects
a. spatial relations disorder
b. figure-ground discrimination
c. form discrimination
d. body scheme
spatial relations disorder
49
Ability to distinguish foreground from background
a. spatial relations disorder
b. figure-ground discrimination
c. form discrimination
d. body scheme
figure ground discrimination
50
Ability to understand concepts like over, under, around, above and below
a. spatial relations disorder
b. position in space
c. body scheme
d. topographic disorientation
position in space
51
Ability to find ones way from one place to another
a. spatial relations disorder
b. position in space
c. body scheme
d. topographic disorientation
topographic disorientation
52
What are the behavioral deficits seen in TBI?
```
disinhibition
impulsiveness
physical and verbal aggressiveness
apathy
lability
sexual inappropriateness
irritability
egocentricity
```
53
What are communication deficits seen in TBI?
```
receptive aphasia
expressive aphasia
dysarthria
auditory deficits
impaired reading comprehension
impaired writing expression
impaired pragmatics
```
54
TBI patients can have dysphagia (true/false)
true
55
List the secondary impairments
```
contractures
skin breakdown
DVT
heterotrophic ossification
decreased bone density
muscle atrophy
decreased endurance
infection
pneumonia
```
56
The Glascow coma scale is used primarily to measure severity of TBI in which setting?
a. Outpatient rehab
b. Acute
c. ICU
d. Home health
Acute
57
Posttraumatic amnesia is defined as
a. Time between injury and ability to motor recovery
b. Time between injury and ability to come out of coma
c. Time between injury and ability to remember ongoing events
Time between injury and ability to remember ongoing events
58
A mild TBI is considered a concussion (true/false)
true
59
Which stage of severity of TBI considers physical, cognitive and behavioral impairments for months that could become permanent
a. Mild
b. Moderate
c. Severe
Moderate
60
Which clinical rating scales can be used to measure employability?
a. GCS and GOS
b. GOAT and GOS
c. DRS and FIM
d. DRS and FAM
DRS and FAM
61
Which category in the ICF table would FAM fit under?
a. Body function/impairment
b. Participation
c. Activity
d. Environment internal
Participation
62
Which category in the ICF table would DRS fit under?
a. Body function/impairment
b. Participation
c. Activity
d. Environment internal
Participation
63
Which clinical rating scale is used at discharge and then 6 months after injury?
a. GCS
b. GOAT
c. GOS
d. Rancho
GOS
64
Which clinical rating scale is used in the subacute stage measuring consciousness?
a. GCS
b. GOAT
c. GOS
d. Rancho
Rancho
65
The glascow coma scale measures what activities?
a. Cognitive status and postural control
b. Cognitive status, motor response and verbal response
c. Eye opening and vegetative state
d. Eye opening, best motor response and verbal response
Eye opening, best motor response and verbal response
66
The purpose of the GOS is to measure
a. Outcome
b. Prognosis
c. Current state of cognition
d. Motor response
Prognosis
67
If a patient is in a coma more than 2 weeks the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate to severe on GOS at 1 year
68
If a patient is in a coma less than 1 week, the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate to good recovery on GOS
69
If a patient is PTA is measured more than 12 weeks, the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate to severe on GOS
70
If a patient PTA is measured less than 4 weeks, the prognosis for cognitive function is
a. Moderate to good recovery on GOS
b. Moderate to severe on GOS at 1 year
c. Moderate disability to good recovery
d. Moderate to severe on GOS
Moderate disability to good recovery
71
A patient scores a 14 on the GCS, their loss of consciousness was less than 30 minutes and PTA was 12 hours. What level of severity should they be categorized under?
a. moderate
b. severe
c. mild
mild
72
A patient scores 10 on the GCS, loss of consciousness for 10 hours and 4 days of PTA. What is their TBI severity level?
a. moderate
b. severe
c. mild
moderate
73
A patient scores a 4 on the GCS, loss of consciousness for 42 hours and has PTA for 14 days. What is their TBI severity level?
a. moderate
b. severe
c. mild
severe
74
GCS of 13-15
loss of consciousness <30 min
PTA 0-1 day
what is the severity level?
mild
75
GCS of 9-12
loss of consciousness 30 minutes-24 hours
>1 to <7 days
what is the severity level?
moderate
76
GCS of 3-8
loss of consciousness >24 hours
PTA > 7 days
what is the severity level?
severe
77
Blunt trauma or acceleration/deceleration with confusion, disorientation or impaired consciousness
a. moderate
b. severe
c. mild
mild
78
Confusion for days or weeks, physical, cognitive and behavioral impairments for months that could become permanent
a. moderate
b. severe
c. mild
moderate
79
Which clinical rating scale measures post-traumatic amnesia?
a. GOS
b. GCS
c. GOAT
d. DRS
GOAT
80
This clinical rating scale is used at discharge in acute care and then 6 months later
a. GOS
b. GCS
c. GOAT
d. DRS
GOS
81
What levels fall under GOS?
vegetative
severely disabled
moderately disabled
good recovery
82
The patient is persistently unresponsive, may have eye-opening, sucking, yawning, localized motor response. Which level of the GOS does this fit?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
vegetative
83
Patient is conscious but needs 24 hour care. Which level of the GOS does this fit?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
severely disabled
84
Patient is independent and can do self care skills, varying with other deficits. What level of the GOS?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
moderately disabled
85
Able to reintegrate into social and work life. Which level of the GOS?
a. severely disabled
b. good recovery
c. vegetative
d. moderately disabled
good recovery
86
This clinical rating scale starts with eye opening and has a wide range of scoring, gives measure of employability and overall disability scale.
a. Rancho
b. GOS
c. DRS
d. GCS
DRS
87
What are the highly recommended clinical rating scales?
Rancho
| FIM
88
What are pre-injury characteristics that influence outcomes?
cognitive
behavioral
social
physical
89
What are the post injury chacteristics?
static
| dynamic
90
What are the static post injury factors?
trauma
cognitive
physical
91
What are the dynamic postinjury factors?
```
trauma
cognitive
behavioral
social
physical
environmental
```
92
What does the DRS measure?
arousability, awareness, and responsivity
the cognitive ability for self-care
dependence on others
psychosocial adaptability
93
PT management is based on physical deficits which is influenced by _ function
cognitive
94
cognitive function is not relevant to PT management (true/false)
false
95
A history and complete chart review should be completed for which levels?
all levels
96
systems review should be completed for which levels?
all levels
97
Cognitive status should be completed for which levels?
all levels
98
What is the clinical rating scale that should be used for cognitive status?
Moss Attention Rating Scale
99
This scale measures their ability to pay attention
Moss Attention Rating
100
ROM should be examined for which levels?
all levels
101
Sensation testing should be done at what levels?
formal testing I-IV
| modified V-VI
102
Skin integrity should be examined at what levels?
all levels
103
Motor examination should be tested at what levels?
all but may be modified in levels I-VI depending on cognition
104
What do you need to test with the motor examination?
spasticity
| reflexes
105
What reflexes should be tested?
superficial cutaneous reflex
| primitive and tonic reflexes
106
What are the primitive and tonic reflexes that should be tested?
```
flexor withdrawl
tonic neck
crossed extension
grasp
associated reactions
```
107
An absent reflex would be scored _
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
0
108
A reflex of tone change, slight, transient with no movement of extremities would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
1+
109
A visible movement of extremities (normal) would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
2+
110
An exaggerated, full movement of extremities (brisk) would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
3+
111
An obligatory and sustained movement, lasting for more than 30 seconds would be scored
a. 0
b. 1+
c. 2+
d. 3+
e. 4+
4+
112
What motor components need to be examined?
quality of movement
variability
movement patterns
balance
113
Quality of movement can be examined at what levels?
up to levels 5 and 6 cannot do formalized
114
What levels are appropriate to measure balance?
level 7 or higher
115
Posture and alignment should be measured at what levels
all levels
116
coordination should be measured at what levels
observation 3-4
| formal 7 or higher
117
What level can you measure diadokokinesia?
any level
118
What level can you measure fatigability?
level 4 or higher
119
Functional status can be measured at what levels?
level 4 observation
| modify levels 5 and 6
120
When can you use outcome measures for functional tasks?
level 5 and 6
121
At what level can you expect to do a full set of Core Measures?
level VII at the lowest, maybe not until level VIII
122
What neuromuscular movement system diagnoses are possible for a TBI patient?
all
123
The FAM is designed to be applicable in which setting?
inpatient rehab
124
increase in intracranial pressure is a (primary/secondary) effect
secondary
125
Which is the most common primary deficit after TBI?
a. cognitive
b. perceptual
c. behavioral
d. visual
visual
126
Which is the most common primary deficit after TBI?
a. cognitive
b. perceptual
c. behavioral
d. visual
visual
127
Unilateral neglect is commonly caused by damage to the _ lobe
a. frontal
b. parietal
c. temporal
d. occipital
parietal
128
somatoagnosia is a (body scheme/body image) disorder
body scheme
129
inability to recognize objects
visual agnosia
130
inability to recognize objects
visual agnosia
131
inability to identify objects through touch
tactile agnosia
132
What is the determinant that a pt is no longer in a coma?
spontaneous eye-opening
133
What are the four main acute care goals?
maintain pulmonary hygiene
maintain/improve motor skills and ROM for function
functional mobility
cognitive reorientation
134
How can you treat to improve motor skills and ROM in acute care?
ROM
casting
positioning
facilitation of normal movement patterns
135
What should be included for treatment in functional mobility in acute care?
```
mobility training
wt bearing
trunk rotation
proximal stability with distal mobility
WC upright
```
136
How do you treat cognitive reorientation in acute care?
stimulation
structured environment
family/team involvement
137
Goals of LOCF I-III should include:
```
increase alertness and function
reduce risk of secondary impairmetns
improve postural and motor control
manage tone
increase tolerance and endurance
```
138
```
These goals are appropriate for which LOCF level (level 1-3, 4, 5-6, 7-up)
increase alertness and function
reduce risk of secondary impairments
improve postural and motor control
manage tone
increase tolerance and endurance
```
LOCF I-III
139
What does management of LOCF I-III look like?
decrease abnormal posturing and primitive reflexes
position upright and transition to sitting/standing
sensory stimulation
management of tone
facilitation of movement
140
managing which level of LOCF
decrease abnormal posturing and primitive reflexes
position upright and transition to sitting/standing
sensory stimulation
management of tone
facilitation of movement
LOCF I-III
141
What stage focuses on positioning, and posturing the most?
LOCF I-III
142
Examination is (passive/active/structured/observational) at level IV
observational
143
Exam for LOCF IV should include
```
cognitive status
functional mobility/balance
ROM
motor function
sensation
tone
reflexes
skin integrity
```
144
Goals for LOCF IV should include
increase endurance
prevent secondary impairments
increase activity tolerance
prevent outbursts, assist to control behavior
145
these goals are indicated for which level
increase endurance
prevent secondary impairments
increase activity tolerance
prevent outbursts, assist to control behavior
level IV
146
What does a structured program look like?
```
consistency
expect no carry over
model calm behavior
flexibility
safety
family education
```
147
A concussion is a _ type of TBI
a. direct blow without fracture
b. penetrating
c. direct fracture
d. diffuse axonal injury
diffuse axonal injury
148
sports injuries are the most common cause of a concussion (true/false)
false
| falls are!!!
149
Who has the highest death rate due to concussions?
a. 0-4 year old
b. 15-25 year old males
c. 65+ year old females
65+ year old females
150
What level is focused on impairment and strategy pillars?
level V and VI
151
```
What level is this
performance of functional mobility and ADL
improved gait, mobility, balance
increased postural and motor control
prevent secondary problems
increased strength and endurance
improve safety in ADL's and mobility
improve tolerance mobility
```
level V and VI
152
What does intervention in level V and VI look like
```
structured distributed practice
restorative
constraint-induced
work directly on impairments and motor function
compensatory strategies
```
153
Which type of practice should be used in levels V and VI?
a. random
b. blocked
c. distributed
d. any type of practice
structured distributed
154
At what level can restorative training begin?
a. level 3
b. level 1-8
c. level 4
d. level 5-6
level 5-6
155
What does restorative training include?
task oriented training
aerobic training
gait training
156
What gait training should be used for TBI level 5 and 6?
a. BW support
b. non BW support
c. treadmill or overgound
d. a and d
BW support
| treadmill or overground
157
At what level can constraint-induced therapy begin?
a. level 3
b. level 1-8
c. level 4
d. level 5-6
level 5 and 6
158
At what level can all pillars be addressed?
level 7 and up
159
What level is this
safety improved
improved ADL, community and re-integration
improved functional mobility
motor control, motor learning and postural control improved
self-management of symptoms increased
level 7 and up
160
At what level can you give responsibility to the patient?
a. level 4
b. level 5
c. level 6
d. level 7 and up
level 7 and up
161
At what level do you expect a patient to be able to reenter the community?
level 7 and up
162
males are at a higher risk for a sports related concussion (true/false)
false
163
this is a head injury that is usually sufficient enough to result in a loss of consciousness after which 3-8 symptoms arise within 4 weeks
a. post-concussive syndrome
b. persistent post-concussive syndrome
c. diffuse axonal injury
d. head fracture with a concussion
post-concussive syndrome
164
Somatic, cognitive, behavioral, and or emotional symptoms that last longer than ones peers
a. post-concussive syndrome
b. persistent post-concussive syndrome
c. diffuse axonal injury
d. head fracture with a concussion
persistent post-concussion syndrome
165
Meds should be limited to the first _-_ days post concussion and stopped by _ weeks post
2-10 days
| 2 weeks
166
Who makes the final determination to return back to life?
physician
167
Return to work/school/life is based on
symptoms
routine activity
graduated exertion
168
Why is relative rest important in the acute phase?
demand of brain energy exceeds supply
169
When an individual (typically athlete) sustains a second or subsequent before first head injury has been cleared
second impact syndrome
170
Compromised metabolic state can persist for weeks or months (true/false)
true
171
Symptoms of cervicogenic headache are not the same as concussion symptoms (true/false)
false
172
What can be the source of head pain related to cervicogenic components of concussion?
occipital nerve roots
| joint complexes
173
cervical spine symptoms are (unilateral/bilateral)
unilateral
174
What tests are used for serious neck pathology
Vertebral Artery Test
Alar ligament
Transverse ligament
175
deconjugate horizontal eye movements that allow binocular fixation and stereopsis of visual targets at different viewing distances is defined as
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
vergence
176
eyes moving symmetrically in the same direction is defined as
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
version
177
adjustment of the optics of the eye to keep an object in focus on the retina as the distance from the eye varies
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
accomdation
178
rapid ballistic movement of eye that abruptly change point of fixation is defined as
a. version
b. vergence
c. alignment
d. accommodation
e. saccades
saccades
179
What can cause a post concussion headache?
occulomotor dysfunction
180
seizures can cause additional damage due to high _ and _ requirements
oxygen
| glucose
181
This hematoma is a tearing of meningeal vessels results in blood collecting between skull and dura
a. subdural
b. intracerebral
c. epidural
epidural
182
This hematoma is blood accumulating in the subdural space
a. subdural
b. intracerebral
c. epidural
subdural
183
This hematoma causes hypoxia to tissues fed by hemorrhaging blood vessels and adds pressure and distortion to brain tissue
a. subdural
b. intracerebral
c. epidural
intracerebral
184
What are the functional outcome measures you would use?
DRS
| FIM/FAM
185
Hypoxic ischmeia can be (primary/secondary/both) and affects (cognitive/physical/both) function
both - secondary more common
| both
186
Which imaging is looking for a mass lesion and brain shifting?
CT
187
Which imaging shows differences in metabolism?
PET or SPECT
188
Which imaging shows cognitive dynamics and overall neuroplasticity?
fMRI
189
cortical blindness can be due to
coup-countercoup
