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Neuro Exam 2 > TBI > Flashcards

TBI Flashcards

(73 cards)

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1
Q

Name the 2 categories of TBI

A
  1. penetrating head injury (skull is fractured and meninges are torn) aka open head injury
  2. non-penetrating head injury (skull and meninges stay intact) aka closed head injury
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2
Q

What is the most common cause of a TBI?

A
  • falls (28%)
  • other (21%)
  • MVA (20%)
  • struck by… (19%)
  • assault (11%)
  • suicide (1%)
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3
Q

T/F 90% of OHIs are caused by falls, MVAs, and assaults

A

false, 90% of CHI

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4
Q

T/F TBI is leading cause of neurologic disability in persons under age 50

A

true

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5
Q

Risk factors of TBI

A
  • intoxication
  • poor academic performance
  • SES
  • type A personalities
  • participation in high-risk sports
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6
Q

2 categories of penetrating brain injuries

A
  • high and low velocity
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7
Q

Adults who survive penetrating head injuries are almost always left with…

A

physical, cognitive and linguistic impairments

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8
Q

High velocity

A

rifle bullets, military projectiles

- perforates the skiull and tunnels through the brain before exiting through the skull opposite the point of entry

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9
Q

Low velocity

A

bullets from handguns, shrapnel

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10
Q

T/F low velocity injuries are often less fatal than high velocity injuries

A

true

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11
Q

2 categories of non-penetrating injuries

A

acceleration and non-acceleration injuries

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12
Q

Acceleration injuries are…

A

moving-head trauma
- caused by sudden acceleration or deceleration of the head, brain, and brainstem causing diffuse damage due to movement inside the skull

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13
Q

What are the 2 forms of acceleration injury

A
  1. linear acceleration injuries (coup and countercoup)

2. angular acceleration injuries

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14
Q

Linear acceleration injuries occur when…

A

the head is struck by a force aligned with the center axis of the head

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15
Q

Provide circumstances in which linear acceleration injuries could occur

A
  • shaken baby syndrome

- whiplash injuries in MVAs

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16
Q

T/F linear acceleration injuries cause diffuse damage to meninges and brain tissue

A

false; focal damage

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17
Q

Angular acceleration injuries are caused by…

A

blows that strike the head off-center, causing it to rotate and move at an angle away from the point of impact

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18
Q

Non-acceleration injuries aka?

A

fixed-head trauma

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19
Q

T/F Non-acceleration injuries usually cause less severe BI than acceleration injuries

A

true

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20
Q

Blows to a moveable head are up to ____ times more devastating than blows to a fixed head

A

20

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21
Q

Consequence of non-acc injuries is…?

A

deformation of the skull by the impact of the object striking the skull

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22
Q

T/F Acc BIs may stretch nerve-cell axons throughout the brain and brainstem– “diffuse axonal injury” and is common in acc injuries

A

true

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23
Q

Severe diffuse axonal injury may lead to vegetative state and is sign of severe damage to…

A

cortical and subcortical tissues

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24
Q

Cuts, bruises, twisting, and shearing forces in the brain cause ______ (bleeding) and _______ (accumulations of blood)

A

Hemorrhages and hematomas

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25
What is the most common cause of a traumatic hemorrhage?
auto accidents followed by falls, and sports injuries
26
Magnitude of symptoms depends on...
extent on the location of the hemorrhage
27
Most common tx for traumatic hemorrhage?
surgical removal
28
T/F subdural hematomas are twice as common and twice as deadly as epidural hematomas
true
29
What is the most common cause of SDH?
MVA
30
Increasing pressure and displacement of brain tissue by expanding hematoma may lead to...
coma and death within a few hours
31
T/F A patient may go for years without overt symptoms of a subarachnoid hematoma
true
32
Secondary consequences of TBI (5)
- cerebral edema - traumatic hydrocephalus - elevated intracranial pressure - ischemic brain damage - alteration in blood-brain barrier
33
T/F primary consequences of TBI are often more devastating than secondary consequences
false; secondary consequences are often more devastating than primary consequences
34
Cerebral edema is caused by...
accumulation of fluid due to trauma, anoxia, infection, inflammation
35
Where does the fluid accumulate for cerebral edema?
between brain & skull, ventricles, brain tissues
36
Cerebral edema is a common consequence of what type of injury?
diffuse injuries
37
How does elevated intracranial pressure differ from other types of intracranial pressures?
it is the most dramatic and deadly consequence of TBI and is the most frequent cause of death from TBI
38
T/F Most BI pts sustain ischemic brain damage
true
39
How does a BI disrupt the regulation of the blood-brain barrier?
allows normally excluded substances (e.g. proteins, neurotransmitter chemicals) to enter brain tissue
40
Passage of normally excluded substances into the BBB may contribute to...
accumulation of fluid and swelling of brain tissues (cerebral edema)
41
Rating severity of concussions: Grade 1
1:Transient confusion, no loss of consciousness; concussion symptoms or mental status abnormalities resolve in less than 15 minutes
42
Rating severity of concussions: Grade 2
Transient confusion, no loss of consciousness; concussion symptoms or mental status abnormalities last more than 15 minutes
43
Rating severity of concussions: Grade 3
Any loss of consciousness, whether brief (seconds) or prolonged (minutes)
44
What is post concussive syndrome? (PCS)
physical, psychological, and cognitive effects of BI that persist for weeks or months after what appears at onset to be a typical concussion
45
What are the symptoms of a concussion?
headache, nausea, vomiting, memory loss, dizziness, double vision, blurred vision, emotional lability, sleep disturbances
46
Relatively good physiologic recovery usually occurs due to _____
neuroplasticity
47
Moderate TBI is...
diffuse axonal damage spread throughout the brain and brainstem
48
Examples of moderate TBI
lacerations/contusions on surface of the brain destroy brain tissue, creating focal lesions
49
Severe TBI is...
extensive axonal damage through brain/brainstem
50
Duration of posttraumatic amnesia is defined as...
the time following a coma during which the pt is unable to store new info and experiences in memory
51
T/F Duration of posttraumatic amnesia is directly related to a pt's eventual level of recovery from TBI
false; it is inversely related
52
Review Rancho Los Amigos (RLAS) Levels of Cognitive Functioning
see page 467-470 in text
53
T/F Most pts do progress through RLAS levels
true
54
T/F Five lowest RLAS levels are more sensitive to language impairments than the five highest levels
false; 5 highest are more sensitive than 5 lowest
55
Risk factors for hemorrhages
- age - substance abuse - education - intelligence - SES - premorbid personality
56
How is the pattern of recovery for TBI different from CVA?
TBI follows a fairly predictable stair-step pattern
57
Treating cognition at Rancho levels: 1-3
- interdisciplinary collaboration among staff | - sensory stimulation to increase responsiveness to environment and encourage return to consciousness (aka "coma stim")
58
Treating cognition at Rancho levels: What are the different types of stimulation?
- acoustic, visual, tactile, olfactory, kinesthetic, intense
59
Treating cognition at Rancho levels: How do you track responses from stimulation?
with rating scale (i.e. Rappaport)
60
Treating cognition at Rancho levels: 4-5
environmental controls- consistent, predictable routines to decrease confusion
61
Treating cognition at Rancho levels: orientation training
- use of environmental prompts in the form of visual cues - verbal orientation cues, drills - passive orientation vs. active orientation - behavior management vs. impact of positive or negative setting events
62
Approaches to tx of cognition RLAS 5 and above (2)
- restorative or remedial interventions | - compensatory interventions (adaptive)
63
Approaches to tx of cognition RLAS 5 and above: Restorative/remedial interventions
process specific drills (aka 'mental muscle building') | - consistent with medical model or impairment based approach
64
Approaches to tx of cognition RLAS 5 and above: Compensatory interventions
- train practical skills for adaptive behavior
65
Approaches to tx of cognition RLAS 5 and above: What is best practice?
a combination of restorative and compensatory interventions
66
Improvement of attentional skills: Attention process training is a...
structured program targeting each aspect of attention
67
Improvements of memory skills
'muscle building' approach with repetitive drills
68
Improvements of memory skills: Compensatory approaches
internal vs. external strategies like day planner
69
Improvement of reasoning: paper pencil activities
done as homework vs. in session
70
Improvement of problem solving
paper pencil vs. individual's actual issues for life - hypothetical situations - real situations
71
Role of SLP: concussion
- ID and monitor students with concussions who are demonstrating difficulty with communicating/interacting with others - administer assessments - determine and provide classroom strategies/modifications - direct services to a particular student
72
School-based SLPs: medical model treats ____ deficits
mild
73
educational model works with students who are...
not successful in general ed

Neuro Exam 2 (4 decks)

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