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Neuro > TBI > Flashcards

TBI Flashcards

1
Q

Causes of acquire brain injuries-7

A
  1. strokes
  2. Tumors
  3. anoxia
  4. hypoxia
  5. toxins
  6. Degenerative disease
  7. near drowing
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2
Q

Definition of TBI

A

NOT DEGENERATIVE OR CONGENITAL

  • caused by external physical force
  • alteration in brain function caused by an external force
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3
Q

Outcomes of TBI depend on 5

A 
immediate damage
cumulative effects
pre-morbid
substance abuse
interpersonal relationships and work history
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4
Q

Open Vs Close brain injuries

A

OPEN:

  • penetrating types of wounds
  • gunshot, knife
  • skull is either fractured or displaced
  • brain injury follows path of object entry and exit
  • risk of infection increased from open wound and hair, fragments

Closed:

  • impact to the head but the skull does not fracture or displace
  • brain tissue damaged and dura remains intact
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5
Q

Contusion

A
  • bruising on the surface of the brain

- small blood vessels on the surface hemorrhage

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6
Q

Coup vs CounterCoup

A

Coup:
- same side of brain where impact is

Counter:

  • opp side of trauma
  • acceleration can cause further vessel occlusion and edema formation
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7
Q

Epidural Hematomas

A
  • between dura mater and skull
  • seen with MVA blow to head and side of skull fracture
  • Arterial Hematoma

Signs:

  • unconsciousness and then alert&lucid
  • immediate surgical intervention needed
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8
Q

Subdural Hematoma

A
  • venous hematoma
  • rupture of cortical bridging of veins
  • between dura and arachnoid
  • common in older adults who fall
  • slow to build up and detect

signs:
- resemble CVA and flucuate

Small clots can be reabsorbed vs. large need to be removed

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9
Q

Subarachnoid hematoma

A

space below arachnoid and above the pia mater

  • associated with cerebral aneurysm
  • -but can be caused by skull fx
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10
Q

Diffuse Anoxal injury

A
  • common

- usually from shaking brain back and forth

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11
Q

Symptoms of Diffuse Anoxal Injury

A 
disorientation or confusion
headache
nausea or vomit
drowsiness or fatigue 
trouble sleeping
sleeping longer than normal
LOB or dizziness
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12
Q

Concussion

A

most common
can be caused by open or closed injury
momentary loss of consciousness and reflexes
repeated concussion leads to CTE

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13
Q

Symptoms of concussion

A 
dizziness
disorientation
blurred vision
difficulty concentrating
altered sleep patterns
nausea
headache 
LOB
amnesia
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14
Q

3 types of secondary problems

A

*cerebral damage occurs in result to initial injury
1. Increased ICP
2 anoxic injuries
3. postraumatic epilepsy

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15
Q

Increased ICP

A
  • skull is rigid and does not expand to accommodate edema
  • leads to compression of brain tissue, decreased perfusion of blood and possible herniation

Treatment: monitor, drugs, shunt

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16
Q

S&S of increased ICP

A 
decreased responsiveness
impaired consciousness
severe headache
vomiting 
irritability
papilledema
changes in vital signs--increased BP and decreased HR
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17
Q

normal ICP range

A

5-10mmHg—> above 20 is abnormal

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18
Q

anoxic injuries

A

brain tissue demands 20% of bodys O2 intake to maintain proper o2 sats and metabolic functions

  • cardiac arrest most frequent cause
  • causes diffuse damage within brain tissue
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19
Q

What areas of the brain are vulnerable from anoxic injuries

A

hippocampus
cerebellum
basal ganglia

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20
Q

Post traumatic Epilepsy

A
  • at increased risk after TBI
  • open injury: subdural hematoma->older adults
  • vestibular stimulation is contraindicated
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21
Q

what triggers a seizure

A 
stress
poor nutrition
electrolyte imbalance 
missed meds
flickering lights
infection
lack of sleep
fever 
anger 
worry 
fear
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22
Q

what do you do if a pt. has a seizure

A

bring them to lowest safe level
do not put anything in mouth
protect them from hitting head but do not restrain
flip on side if they are starting to vomit

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23
Q

medications for seizures

A

Phenytoin
phenobarbital
carbamazepine

**also used to control behavior

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24
Q

Glasgow Coma Scale

A
  • used in ER to assess the individuals level of arousal and function of cerebral cortex
  • TYPICALLY: 3-4 scores do not make it
  • most powerful predictor of prognosis and outcome of TBI
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25
Q

Mild TBI

A
  • GCS of 13 or higher
  • LOC less than 20 minutes
  • normal CT
  • awake when arriving to hospital
  • may present dazed, confused
  • c/o headache or fatigue
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26
Q

Moderate TBI

A

GCS 9-12

  • confused and unable to answer questions
  • most have permanent physical, cognitive and behavioral deficits
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27
Q

Severe TBI

A

GCS of 3-8
individual is in coma
permanent functional and cognitive impairments

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28
Q

7 manifestations of TBI

A 
decreased level of consciousness
cognitive deficits
motor deficits
sensory deficits
communication deficits
behavioral deficits
associated problems
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29
Q

Definition of Coma

A

decreased level of awareness
state of unconsciousness

presents with:
eyes remain closed
unable to initiate voluntary activity
sleep/wake cycle not present

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30
Q

vegetative state

A

person who demonstrates a return of brain stem functions

  • respiration
  • digestion
  • BP control

no sleep/wake cycle

may experience arousal and spontaneous eye opening

pain responses may be evident
unaware of external and internal needs

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31
Q

persistent vegetative

A

been in this state for a year or longer with no improvements in neurological status

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32
Q

arousal

A

regulated by RAS

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33
Q

awareness

A

consciousness of int/ext env. stimuli

34
Q

consciousness

A

state of being aware

35
Q

stupor

A

condition of general unresponsiveness

36
Q

obtundity

A

people who sleep a great deal of the time

when aroused demonstrate disinterest in env. and slow to respond to sensory stim.

37
Q

delirium

A

disorientation, fear, misperception of sens. stim

38
Q

clouding of consciousness

A

state in which a person is confused, distracted and has poor memory

39
Q

Cognitive deficits

A

dysfunction can include: disorientation, poor attention span, loss of memory, poor orginizational and reasoning skills and inability to control emotional response

affect ability to learn new skills

40
Q

motor deficits

A

*when unconscious pt unable to initiate active movement

abnormal posture are frequently seen from brain stem injury

41
Q

Decerebrate Rigidity

A 
LE:
Hip add
Hip IR 
Knee ext
PF
supintation

UE: Shoulder ext and IR
elbow ext
pronation
wrist/fingers flex

42
Q

what causes decerebrate rigidity

A

severing of the neuroaxis in midbrain region

Pons medulla and SC remain functional

43
Q

decorticate rigidity

A 
UE: 
shoulder flex, add, IR 
Elbow flex
pronation
wrist flex

LE:
extension

44
Q

what causes decorticate rigidity

A

dysfunction above the level of the red nucleus

between basal nuclei and thalamus

45
Q

sensory deficits

A

loss of sense of smell
impairment or absence of tactile or kinesthetic sensations
visual deficits
perceptual and proprioceptive deficits

46
Q

communication deficits

A

initially lost or severely impaired
decreased awareness of env. can limit opportunities for interaction
may not be able to initiate communication because of abnormal tone or posturing

47
Q

behavioral deficits

A
  • most enduring and socially disabling deficits

- can exhibit neuroses, pychoses, sexual disinhibition, apathy, irritability, agression, low frustration tolgerance

48
Q

associated problems

A
  • 70% of TBI pts. will have other injuries

- may make care and rehab

49
Q

Early intervention goals of PT for TBI

A
  • increase pt. level of arousal
  • preventing development of secondary impairments
  • improving pt. function
  • provide pt. and family with education

**avg. length of stay in hospital is 2 weeks

50
Q

position of pts.

A
  • supine-facilitate extensor tone and tonic labyrinthine
  • sidelying or semi-prone: reduce influence of tonic labyrinthine refelx
  • UE: abd and ER to inhibit abnormal tone
  • Position out of decebrate or decorticate postures
  • contractures occur quickly
51
Q

reflex inhibiting postures

A

static then progressing to active movements

superimposed on static positions

52
Q

heterotopic ossification

A

abnormal bone formation in soft tissues and muscles
presents with loss of ROM, pain, swelling and erythema

no effective treatment

DRUGS: NSAIDS

53
Q

ways to increase patients awareness

A

important even with coma pts.

assume pt. can hear you and undestand

explain what youre doing all the time

orient pt. x4 and converse with pt. & family

54
Q

RLA 1-3 characteristics

A

decreased level of responsiveness

little interaction with env.

55
Q

RLA 1-3 goals and outcomes

A
  • physical function and alertness increased
  • risk of secondary impairments reduced
  • motor control improved
  • effects of tone managed
  • postural control improves
  • tolerance of activities and positions increased
  • joint integrity and mobility improved or remain functional
  • education of family and caregivers
56
Q

RLA 1-3 intervention

A

-prevent indirect impairments
-proper positioning both in bed and sitting
-turn every 2 hrs.
recline w/c or tilt in space
-postural drainage, percussion and vibration
-ROM and orthotics to prevent contractures

57
Q

RLA 1-3 improving arousal

A 
short sessions-15 to 30 mins
avoid over stim
normal toone and meaningful topics of auditory
photographs-visual
10-15 sec of olfactory 
swabs
low freq vibration or stroke/rub with wash cloth
rolling and neck rolling
58
Q

RLA 1-3 monitoring

A 
HR
BP
RR
Diaphoresis 
Facial grimicing 
changes in posture
head turning
vocalization
59
Q

1-3 RLA managing effects of tone and spasticity

A

positioning
rom
orthotics
inhibitory tech.

60
Q

RLA 4

A

confused

agitated

61
Q

goals for RLA 4

A 
pt. edurance improved
joint mobility and integrity maintained
risk of 2ndary impairments decreased
increase tolerance of activities
pt family educated on dx, prognosis, pt outcomes
62
Q

RLA 4 INTERVENTION

A 
utilize same therapist, time and place of tx
expect no carry over
model calm behavior 
redirect 
provide options
expect egocentricity
63
Q

RLA 4 PT. FAMILY EDUCATION

A

difficult to provide education directly at this level
pt. does not have control of behavior
entering this stage is good because it indicates improvement
aggressive behaviors are usually short-lived
keep consistency

64
Q

RLA 5&6

A

confused but no longer agitated
simple commands improved
improved carry over

65
Q

RLA 5&6 GOALS AND OUTCOMES

A

performance of fun. mobility and ADL skills increased

gait, mobility and balance improves

motor control, postural control increase

risk of 2ndary impairments reduced

strength and endurance increased

safety with fun mobility & ADL skills improved

pt. fam education

tolerance of activities increased

66
Q

RLA 5&6 INTERVENTION

A

ROM exercise & task

physical conditioning

focal lesions: balance and ataxia

67
Q

RLA 5&6 2 TREATMENTS STRATEGIES

A
  1. Compensatory
    - improve functional skills by compensating for the lost ability
  2. Restorative
    - locomotive training via BW support and treadmill
    - constraint induced movement therapy for UE function
68
Q

RLA 5&6 INTERVENTION CONSIDERATIONS

A 
maintain structure 
emphasize safety
simple instructions 
short term goals:
-gradual increased in the number of reps&exercise time
practice should be distributed
-sufficient rest periods to minimize physical and mental fatigue 
extrinsic feedback
69
Q

RLA 5&6 FAMILY EDUCATION

A

emphasize safety awareness ed
family should learn to assit pt. with fun mobility
fam should learn to assist pt. with strength &ROM
fam should be aware of methods to enhance decision making skills and safety

70
Q

RLA 7&8 CHARACTERISTICS

A

cognitive and emotional deficits are usually greater than the physical deficits

71
Q

RLA 7&8 GOALS AND OUTCOMES

A

pt.& fam education

safety of pt. & family is improved

ability to perform physical tasks related to ADL skills, community, work integration and leisure is improved

motor control, balance and postural control increased

Strength & endurance increased

level of supervision and assistance for task performance is decreased

72
Q

RLA 7&8 INTERVENTIONS

A

ROM exercise and functional tasks

physical conditioning

ADL and IADL training - pt. integrating cognitive, physical and emotional skills necessary to function in community

73
Q

RLA 7&8 PATIENT AND FAMILY EDUCATION

A

pt. should be educated how to best compensate for residual impairments and disabilities
pt. and family should contact local support group

74
Q

RLA level 1 characteristics

A

NO RESPONSE; TOTAL ASSIST

-complete absence of change in behavior when stimuli presented

75
Q

RLA Level 2 Characteristics

A

GENERALIZED RESPONSE; TOTAL ASSIST

  • reflex response to painful stimuli
  • response to repeated auditory stimuli
  • response to ext. stimuli with gross body movement or vocalization
76
Q

RLA 3 Characteristics

A

LOCALIZED RESPONSE;TOTAL ASSIST

  • withdrawal or vocalization to pain stim
  • head turns with auditory stim
  • follows objects with eyes
  • responds to discomfort
77
Q

RLA 4 Characteristics

A

CONFUSED/AGITATED; MAX ASSIST

  • alert and heightened state of activity
  • purposeful attempts to remove tubes and restraints
  • non purposeful movements of divided attention
  • may cry or scream to stimulus
  • unable to cooperate with treatment
  • mood swings for no apparent reason
  • incoherent verbalization
78
Q

RLA 5 Characteristics

A

CONFUSED, INAPPROPRIATE NON AGITATED;MAX ASSIST

  • Alert not agitated
  • not oriented to person, place or time
  • may be able to perform learned tasks with cues
  • simple commands can be followed but random
  • able to converse on social, level for brief periods of time with cues
79
Q

RLA Level 6 Characteristics

A

CONFUSED, APPROPRIATE; MOD ASSIST

  • inconsistently oriented
  • able to attend to familiar tasks for 30 minutes
  • able to use assistive memory aide with max assist
  • mod assist to problem solve
  • unaware of impairments
  • verbal expressions are appropriate
80
Q

RLA Level 7 characteristics

A

AUTOMATIC, APPROPRIATE; MIN ASSIST

  • consistently oriented
  • min supervision with new learning and with safety in routine at home and community
  • overestimates abilities
  • unable to recognize inappropriate social-interaction behavior
  • unaware of others needs and feelings
81
Q

RLA Level 8 characteristics

A

PURPOSEFUL, APPROPRIATE; STAND BY ASSIST

  • consistently oriented
  • independently attends and completes task for 1 hour
  • uses assitive memory devices to recall schedule
  • thinks about consequences
  • aware and acknowledges impairments
  • over or under estimates abilities
  • able to recognize inappropriate social interactions
  • self centered and uncharacteristically independent/dependent
82
Q

Locked in Syndrome

A

rare neurological disorder that results after TBI

  • complete paralysis of all voluntary muscles except those that control eye movement
  • pt. remains conscious and possesses cognitive function but is unable to move

Neuro (11 decks)

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