TBI Flashcards
1
Q
Why do we classify a brain injury
A
to determine prognosis for recovery for an individual who has experienced a TBI
2
Q
How do we classify a brain injury (4)
A
chronicity
etiology of injury
level of arousal
cognitive function
3
Q
regarding chronicity, the rate of recovery is greates during the first ___ years, b/c of the inpact of ___ ___ ___
A
2
spontaneous neural recovery
4
Q
During the chronic timeframe (>2 yrs post-injurty), recovery is more related to
A
rehab and lifestyle choices
5
Q
regarding etiology of injury, individuals with a more __ injury, usually have a better prognosis than individuals with a more ____ injury
A
focal
diffuse/global
6
Q
Low velocity injuries have ___ outcomes than higher velocity injuries
A
better
7
Q
____ level is measured at the time of injury and is predictive of ___ of injury. it is measured using the
A
arousal
severity
glasgow coma scale
8
Q
a 15 pt scale based on the responsiveness of the individual according to 3 areas
A
glasgow coma scale
9
Q
what are the 3 areas scored in the glasgow coma scale
A
motor response
verbal response
eye opening response
10
Q
Scoring of glasgow coma scale
A
mild TBI > or equal to 13
Severe TBI < or equal to 8
Best score 15
11
Q
How is cognitive function measured
A
Ranchos Los Amigos Scale of Cognitive Function
12
Q
Rancho Level 1
A
No response
13
Q
Rancho Level 2
A
Generalized response
a. decerebrate (everything extended)
b. decorticate (flexed)
c. chewing (vertical opening and closing)
14
Q
decerebrate
A
everything extended Rancho 2
15
Q
decorticate
A
everything flexed Rancho 2
16
Q
Rancho Level 3
A
Localized response
a. visual tracking
b. withdrawal
17
Q
Rancho Level 4
A
confused and agitated
18
Q
Rancho Level 5
A
confused and inappropriate (non-agitated)
19
Q
Rancho Level 6
A
confused and appropriate
20
Q
Rancho Level 7
A
Automatic and appropriate
21
Q
Rancho Level 8
A
purposeful
22
Q
4 etiologies of TBI
A
Direct contact injuries
Ruptured cerebral aneurysms
Acceleration and deceleration injuries
Hypoxic injuries
23
Q
Brain injuries involving an event where a stationary object or moving object forecfully contacts the head
A
direct contact injury
24
Q
4 closed head injuries
A
concussion
cerebral contusion
epidural hemorrhage or hematoma
chronic subdural hematoma
25
rapid onset of neurological impairments following a minimal head injury which may or may not include loss of consciousness
concussion
26
areas of focal brain injury where there are multiple micro-hemorrhages into brain tissue. Damage frequently occurs from brain tissue moving against intracranial structures
cerebral contusion
27
damage to tissue on the side of the skull opposite to the impact
countrecoup cerebral contusion
28
management for crebral contusion
reducing intracranial pressure and maintaining cerebral perfusion pressure
29
impaired body functions with cerebral contusion
focal weakness, paresthesia, incoordination, aphasia, and difficulty with cognitive tasks
30
damage to major vessels including tearing of middle meningeal artery, middle meningeal veins or dural sinus resulting in blood accumulating in the epidural space
epidural hemorrhage or hematoma
31
_____ ____ neurological impairments are highly indicative of an ____ _____
progressively worse
| intracranial hemorrhage
32
Hematomas are identified on
CT or MRI
33
management of epidural hemorrhage or hematoma
surgery (craniotomy and evacuation)
34
stretching of tiny veins in the subdural space, which ultimately tears the veins and blood accumulates. This occurs slowly over time (often several weeks) before symptoms become apparent
chronic subdural hematoma
35
Chronic subdural hematoma is most common in
older adults, where the veins are already stretched do to atrophy of brain tissue
36
management of chronic subdural hematoma
surgery (Burr hole craniostomy)
37
impairments include poor balance, hemiparesis, headache, slurred speech, dementia and lethargy
chronic subdural hematoma
38
open head injuries are called _____
penetrating injuries
39
Prognosis - recovery from direct contact injuries is usually ___ or ____, depending on the intensity or extent of the injury. Closed head injuries usually have ___ prognosis than penetrating injuries
good, fair, better
40
brain injuries usually associated with a minor direct contact injury, along with a cerebral aneurysm (weakness in the wall of the arteries usually in the ___ __ ___)
ruptured cerebral aneurysms
| circle of willis
41
most common cause of a subarachnoid hemmorrhage
ruptured cerebral aneurysm
42
bleeding into the CSF (the subarachnoid space) from small vessels, usually resulting from a ruptured aneurysm
subarachnoid hemorrhage
43
diagnosis of subarachnoid hemorrhage
identified on CT scan following an acute, severe headache, comfirmed with lumbar puncture (presence of RBCs in CSF)
44
management of subarachnoid hemorrhage
maintain cerebral perfusion and reduce likelihood of rebleeding from the aneurysm via surgery (clipping of aneurysm)
45
causes of ruptured cerebral aneurysms
direct contact injuries (fall, MVA, etc)
46
prognosis of ruptured cerebral aneurysms
recovery of this type of injury depends on the size and location of the aneurysm. Aneurysms with larger size and those located in more POSTERIOR circulation have worse prognosis
47
indirec brain injuries where the etiology of injury involves a high velocity incident
acceleration and deceleration injuries
48
most common cause of acceleration/deceleration injury is
MVA
49
other causes of acceleration/deceleration injuries
shaken baby (usually acute subdural hematoma) syndrome, and blast injuries which are most common to occur during combat
50
3 resulting health conditions from an acceleration/deceleration injury
complex concussion
diffuse axonal injury
acute subdural hematoma
51
occur when rotational forces cause unequal sheering of long axons within the brain
diffuse axonal injury
52
Because brain tissues differ in weight and density, tissues that are less ___ (ie. axonal pathways made primarily of white matter) are more likely to be stretched and damaged
dense
53
diffuse axonal injury is NOT ____, but rather associated with deformation of particualr areas: ___ __, ___ ___, ____ and ___ ___
```
diffuse
corpus callosum
internal capsule
brainstem
cerebellar peduncles
```
54
Diagnosis for diffuse axonal injury
sometimes identifiable on MRI (not on CT)
55
prognosis for diffuse axonal injury
poor
56
veins in the superior sagittal sinus are torn and blood accumulates in the subdural space.
acute subdural hematoma (acceleration/deceleration)
57
Regarding acute subdural hematoma, individuals who have a rapid onset of symptoms have a ___ prognosis of survival due to rapid increase in ____.
poor
| ICF
58
diagnosis of acute subdural hematoma
CT
59
management of acute subdural hematoma
surgery (craniotomy and evacuation)
60
prognosis of acceleration/deceleration injuries
poor
61
indirect brain injuries where the etiology of injury involves lack of oxygen to the brain
hypoxic injuries
62
most common cause of hyposxic injuries are ___ and ___
near drowning incidents and myocardial infarction
63
prognosis for hypoxic injuries
very poor
64
after a hypoxic injury most individuals do non survive and if they do, they remain in a stage of
impaired consciousness (coma, persistent vegetative state, or minimally conscious state)
65
Regarding ICP, we want this to be less than ____. what position is bad for patients with elevated ICP?
20 mmHg
| laying flat
66
prognosis for TBI decreases after
65
67
in a systems review, what is important to consider regarding MSK
flexibility in places for heteroptopic ossification
68
difficulty w/lip closure (drooling)
cranial nerve VII (facial)
69
difficulty chewing
CN V (trigeminal)
70
Difficulty moving bolus posteriorly
```
CN VII (facial-retention of food between cheeks and gums)
CN XII (hypoglossal-retention of food in mouth)
```
71
Difficulty initiating swallowing
```
CN IX (glossopharyngeal)
CN X (vagus)
```
72
cognitive impairments (6)
```
info processing speed
executive fxn
problem solving
attention
memory
communication
```
73
rate of activity is slowed, result is delayed reaction time or increased tak completion time
information processing speed impairment
74
difficulty engaging in independent, purposeful, self-serving behavior, result is difficulty initiating, planning, monitoring performance, anticipating consequences and responding flexibility (refer out to neuropsych)
executive functioning impairment
75
difficulty brainstorming, comparing ideas, prioritizing ideas and drawing inferences
problem solving impairment
76
difficulty receiving and beginning to process stimuli, difficulty maintaining focus, ignoring distractions and simultaneously attending to more than 1 thing (dual-task: motor and cognitive)
attention impairment
77
difficulty encoding, storing and retrieving explicit or implicit info (refer out to neuropsych)
memory impairment
78
difficulty understanding or expressing language (refer to SLP)
communication impairment
79
T/F subdural hemorrhage has poorer prognosis than subarachnoid or epidural hemorrhage
T
80
Longer duration of coma ___ has poorer prognosis
>24 hrs
81
longer duration of uncontrolled ____ disorder has poorer prognosis
seizure
82
longer duration of post-traumatic ____ has poorer prognosis
amnesia
83
Considering concussions, people should not get worse. worsening symptoms, pronounced amnesia, progressive balance dysfuction suggest
intracranial pathology and required imaging
84
cognitive rehab- alter demands on the patient
simplify or eliminate task
work in short segments with frequent breaks
reduce stimuli
85
cognitive rehab-provide salient cues for initiation
provide external cue
86
cognitive rehab--provide external guides for sequencing behavior
use metacognitive strategies
| training specific behavioral sequence for repetitious activities
87
metacognition
thinking about thinking
88
cognitive rehab-employ behavioral interventions
DO NOT ignore abusive, disruptive behavior, address it and have a natural consequence for their behavior
89
cognitive rehab--reduce aggressive, disruptive, or intrusive behaviors
because they impair adaptive social functioning
90
impaired processing speed management
tasks require decoding of info to perform and reaction time
91
examples of management for impaired processing speed
stepping to a target while matching footstep to an auditory or visual cue, standing while catching scarves of a particular color, path finding (reading and making a decision regarding a sign)
92
impaired executive functioning management
Tasks require initiation, planning, monitoring performance, anticipating consequences, and responding and responding flexibly
93
examples of management of impaired executive functioning
getting dressed, house cleaning activities, taking transportation to a destination
94
interventions for impaired executive function
task-specific metacognitive strategies
95
impaired problem solving
tasks require brainstorming, comparing ideas, prioritizing ideas, and drawing inferences
96
interventions for impaired problem solving
generalized metacognitive strategies
97
examples of management of impaired problem solving
novel tasks for the individual where decision making must be made, such as planning and implementing a dinner or going on a recreational trip (hiking)
98
impaired divided attention
tasks require the ability to respond to multiple stimuli simultaneously
99
examples of management of impaired divided attention
walking in a figure 8 while carrying different size grocery bags, tandem walking while adding numbers
100
Regarding the Coma stimulation program, what does the hierarchial level of cueing mean
force them to be successful: "squeeze my hand" WAIT for them and then manually make them squeeze you hand "you are squeezing my hand"
101
progression of interventions- arousal
increase the complexity of the response (amplitude or require a decision) or request a different response (motor or verbal rather than visual)
102
progression of interventions- info processing speed
increase the speed of the response or increase the complexity of the info
103
progression of interventions- executive function
decrease the number of external cues and increase reliance on internalized procedures
104
progression of interventions- problem solving
increase the complexity of the problem
105
progression of interventions- attention
increase time for sustained attention, increase distraction for selective attention, increase choices to select for alternating attention, and increase number of variables for divided attention
106
progression of interventions- vestibular spinal
decrease alternative sensory systems (vision and proprio), then add conflicting sensory stimuli from other systems
107
progression of interventions- vestibular ocular reflex
increase speed of head movement without excessive blurring
108
progression of interventions- dizziness
decrease the reliance on alternative sensory systems (vision and proprio) while encouraging re-orientation and anxiety management
109
progression of interventions- timing
improve reaction time
110
progression of interventions- sequencing
increase the amount of sequencing
111
progression of interventions- activation
increase the size of the response
112
progression of interventions- perceptions
decreased the amount of sensory stimuli to achieve same response
113
progression of interventions- proprioception
decrease the amount of sensory stimuli to achieve same response
114
progression of interventions- cutaneous sensation
decrease the reliance on other systems, particularly vision
115
progression of interventions- power
increase the resistance or decrease the time to complete activity
