TBI

Question 1

what is a traumatic brain injury

Answer 1

“A traumatic brain injury is caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.”

-Categorized as mild (concussion), moderate, or severe

Question 2

what % of TBI =’s have lasting effects

Answer 2

-15% of TBI’s have lasting effects
-Can have physical, psychological, or social
consequences

Question 3

incidence

Answer 3

-Annually, 69 million people worldwide will suffer from a TBI
-81% will be considered mild concussions
-11% will be considered moderate concussions
-89% of concussions may go unassessed by medical
professionals
-TBI’s are more common in North America and
Europe (per capita)
-North America 1,299 reports per 100,000 people
-Europe 1,012 reports per 100,000 people

Question 4

age ranges most likely to obtain TBI in united states

Answer 4

➢ 0-4
➢ 15-19
➢ 65+
➢ After the first concussion, chances of getting a second concussion are 3-6 times greater

Question 5

major causes of TBI in US

Answer 5

➢ 15% being struck by or against a force
➢ 15% caused from other/unknown
➢ electrocution, explosions, exposure to radiation
➢ 14% from traffic accidents
➢ 9% caused by assault

Question 6

sport and concussions

Answer 6

➢ Concussions account for 5% of all sporting injuries
➢ In a Canadian study, hockey nearly doubled the
number of TBI’s compared to cycling, football/rugby
and ski/snowboard
➢ 60% of concussions reported were from males

Question 7

diagnosing a TBI

Answer 7

➢Must be accessed quickly
➢Various types of evaluations include:
➢Glasgow Coma Scale
➢CT Scan
➢MRI
➢Intracranial pressure monitor
➢Consciousness

Question 8

glascows coma scale

Answer 8

➢ 15 point scale
➢ 1st step used in an emergency room
➢ Checks the person's ability to follow directions
and movement of their eyes and limbs
➢ The greater the score = the less severe the brain
injury is
➢13-15 = mild TBI (concussion)
➢9-12 = moderate TBI
➢8-1 = severe TBI

Question 9

CT scan

Answer 9

➢ The 1st imaging test performed
➢ Displays:
➢Visual fractures
➢Evidence of bleeding in the brain
➢Blood clots
➢Bruised brain tissue
➢Brain tissue swelling
➢If swelling is noticed further proceed with Intracranial Pressure monitor

Question 10

intracranial pressure monitor

Answer 10

➢If the brain has noticeable tissue swelling
➢Swelling of the brain can increase pressure
inside the skull
➢Can lead to further brain damage
➢Insert a probe through the skull to monitor the
brain pressure

Question 11

MRI

Answer 11

➢Creates a detailed view of the brain
➢Only used if:
➢ The person’s condition stabilizes
➢Symptoms don’t improve soon after injury

Question 12

ways to determine the severity of a TBI

Answer 12

-After diagnosing a traumatic brain injury, it is important to determine the severity of the injury and understand what symptoms may accompany each level of injury.

Question 13

symptoms of TBI

Answer 13

➢ Blurred vision
➢ Confusion (mental state changes)
➢ Dazed
➢ Dizziness
➢ Focal neurologic symptoms
➢ Headache
➢ Nausea

Question 14

mild severity

Answer 14

➢ Loss of consciousness of momentary to less than 30 minutes
➢ Post-traumatic anterograde amnesia of momentary to less than 24 hrs
➢ Depressed, basilar or linear skull fracture (dura intact)

Question 15

moderate-severe severity

Answer 15

➢ Death due to this TBI
➢ Loss of consciousness of 30 minutes or more
➢ Post-traumatic anterograde amnesia of 24 hours or more
➢ Worst Glasgow Coma Scale: full score in first 24 hours
(unless invalidated upon review, eg., attributable to
intoxication, sedation, system shock)
➢ Intracerebral hematoma
➢ Subdural hematoma
➢ Epidural hematoma
➢ Hemorrhagic contusion
➢ Penetrating TBI (dura penetrated)
➢ Subarachnoid hemorrhage
➢ Brain stem injury

Question 16

rehabilitation

Answer 16

➢ Living in a cloud
➢ Getting really drunk
➢ Being hungover 24/7
➢ Being in a hot tub way too long
➢ Waking up from fainting
➢ Looking around a dark room with a flashlight, and
forgetting what you just looked at

Question 17

prognosis

Answer 17

CNS is sensitive, when damaged, healing does not occur
like other tissues of the body. Many neurons are damaged
or die that cannot regenerate.
➢ No surgery or medications currently exist to
restore damaged neurons.

Question 18

neural plasticity

Answer 18

-surrounding healthy neurons can sometimes work together to compensate for the damaged neurons, by growing new branches and making new connections. -These new connections may function in place of the damaged neurons, but may not work as well as the original neural pathway.

Question 19

person that is awake typically presents post traumatic amnesia

Answer 19

➢ May appear to be awake and aware but might act out of character
➢ Loss of short term memory: forget day to day
➢ Bizarre, antisocial behavior
➢ May or may not recognize family

Question 20

recovery stages

Answer 20

• patient- in hospital

- outpatient rehab- discharged from hospital

Question 21

outpatient rehab- discharged from hospital

Answer 21

➢ A formal discharge meeting takes place with social services, rehab staff, and family to discuss
continuing treatment, typically around level 6/7 on the Rancho Los Amigos scale.
➢ Social and cognitive rehab tends to be a longer process than physical rehab.

Question 22

Time amount for Recovery depends on:

Answer 22

1. how serious the patient’s brain was injured
2. How long it took to get medical help
3. Complications of secondary injuries
4. The age and general health of the patient before the injury
5. The involvement of family/friends.

Question 23

recovery team

Answer 23

• team of doctors
• therapists
• others- fam/friends, social worker, ect

Question 24

rehab considerations physical

Answer 24

➢ Sleep Problems:
► regulate sleep/wake times, change mattress, regulate room temperature-not too hot,
not too cold, avoid caffeine, get regular exercise
➢ Easily fatigued:
► Take regular breaks. Start with practicing simple activities, eventually working up to
more complex activities. Give person a lot of time
➢ Headaches:
► avoid alcohol, and cold food
➢ Chronic body pain:
► therapeutic modalities-massage, acupuncture
➢ Ringing in ears:
► medication
➢ Sensory Changes: sight, smell, taste and hearing
➢ Seizure:
► place something soft under head, don’t hold person down, check area for unsafe
objects, time seizure, place person on their side after seizure has susided.
➢ Balance and coordination:
► remove items someone can trip on, work on balance exercises, strengthen core
muscles
➢ Muscle spasms: stretching, therapeutic modalities
➢ Apraxia (inability to carry out movement):
► ADL’s might be a challenge. Living coordinates may need to be reorganized and
adapted-shower bars and seat, lower countertops, easier access to household items.
Vehicles/transportation changes, cane and walkers.
►Offer to guide a person, but always support independence

Question 25

rehab considerations cognitive

Answer 25

➢ Difficulty focusing:
► Keep everything in its same place
➢ Slowed thinking-world feels too fast:
► Give person a lot of time, slow down activities ex: use a weighted ball, or have less people in one
group
➢ Memory problems:
► Write out instructions-simple and clear
➢ Takes longer to learn:
► Ask simple questions with yes/no answers, give cues
➢ Fixation on certain thoughts
► Try to redirect attention to task at hand and what is important
➢ Frontal lobe changes: trouble knowing the order to do things, unorganized, hard
time planning, reasoning, decision making, doing more than one task and problem solving
► be patient

Question 26

rehabilitation psychological

Answer 26

➢ Fluctuated emotions: depression is very common
► encourage social support/programs
➢ Impulsive:
► relearning social skills can be taught
➢ Lower motivation:
► create easy and attainable goals.
➢ Change in personality:
► be patient, don’t react with anger
➢ Self medicate: using alcohol or drugs
► teach coping strategies, minimize stress

Question 27

considerations for PA

Answer 27

➢ Some standing exercises may need to be performed
seated or with a fixed support
➢ Coordination and balance exercises are key to implement within fitness programs
➢ Proper rest is necessary to be aware of, due to people
with TBI’s having lower oxidative capacities (65-74% of
“normal value”) and are quicker to tire
➢ For recent injuries, be aware of proper timing for a
return to activities, but after a month moderate amounts
of activity is better than none or high amounts

Question 28

exercise requirements

Answer 28

➢ Aerobic: 3-5x/week of moderate/high activity, for 20-60
minutes
➢ Strength: 2-3x/week, building up number of sets, starting with bands and machines before free weights
➢ Flexibility: everyday, static stretches for each muscle
group
➢ Balance: 2-3x/week, 60 minutes