TBI

Question 1

what is the leading cause of TBI

Answer 1

falls (40%)

Question 2

how can you classify head injuries using the GCS

Answer 2

scaled on a 3-15 scale

8 or less = coma
9-12 = moderate head injury
13-15 mild head injury

Question 3

headache, confusion, lightheadedness, and blurred vision are characteristics of what level of TBI

Answer 3

mild head injury

Question 4

changes in memory, concentration, and attention are characteristics of what level of TBI

Answer 4

mild head injury

Question 5

fatigue and changes in sleep patterns are characteristics of what level of TBI

Answer 5

mild head injury

Question 6

nausea and vomiting are characteristics of what level of TBI

Answer 6

moderate to severe

Question 7

dilation of one or both pupils, coordination loss, and extremity weakness/numbness are characteristics of what level of TBI

Answer 7

moderate to severe

Question 8

slurred speech, confusion, restlessness, agitation are characteristics of what level of TBI

Answer 8

moderate to severe

Question 9

symptoms of concussion

Answer 9

dizziness, diorientation, burred vision, concentration difficulty, sleep alterations, nausea, headache, balance deficits

Question 10

what is a contusion in the context of TBI

Answer 10

brain surface hemorrhage of small vessels

Question 11

which areas of the brain are most susceptible to diffusion axonal injury

Answer 11

corpus callosum, basal ganglia, white matter, superior cerebellar peduncles

Question 12

what is a diffuse axonal injury

Answer 12

subcortical axon shearing within the myeling sheath due to high velocity acceleration/deceleration forces

Question 13

what typically causes a epidural hematoma

Answer 13

blow to side of head or MVA

Question 14

describe the pathogenesis of an epidural hematoma

Answer 14

alert > unconscious > lucid; rapid deterioration of the condition

Question 15

in what patient population do we typically see a subdural hematoma?

Answer 15

older adults after a fall or blow to the head

Question 16

describe the pathogenesis of a subdural hematoma

Answer 16

hematoma accumulates more slowly over hours to a week

Question 17

how does a subdural hematoma generally present

Answer 17

sxs mimic a CVA

Question 18

in what population do we typically see an intracerebral hematoma

Answer 18

acceleration/deceleration forces that shear cortical vessels beneath a skull fracture

Question 19

what is required for a functional arousal response

Answer 19

ARAS needs to be intact (upper 2/3 of brainstem connecting the thalamus to the cerebrum)

Question 20

what qualifies an intact arousal response

Answer 20

since its a primitive response, it is intact if the patient opens eyes spontaneously or in response to external stimulus

Question 21

T/F: awareness (of self and environment) is a primitive response

Answer 21

false: it is complex and requires cerebral function

Question 22

describe coma in two words, then define

Answer 22

unarousable unawareness: complete failure of arousal, no spontaneous eye opening, and no response to vigorous stimuli

Question 23

describe a vegetative state

Answer 23

arousal in the absence of awareness combined with sleep and wake cycles with either full or partial preservation of hypothalamic and brainstem autonomic function

Question 24

describe a minimally conscious state

Answer 24

demonstrated minimal but definite behavioral evidence of self or environmental awareness

Question 25

which three things qualify brain death

Answer 25

coma, absent brainstem reflexes, and apnea

Question 26

what is the most reliable and valid scale for determining recovery from a coma

Answer 26

DOC Scale CRS-R (coma recovery scale - revised)

Question 27

T/F: premorbid status influences TBI outcomes

Answer 27

true, disease and neural loss can negatively affect outcomes

Question 28

what three things are cause primary neurological damage

Answer 28

1. focal lesions 2. coup-countrecoup trauma 3. DAI

Question 29

what is the most common source of secondary neurological damage

Answer 29

increased ICP

Question 30

what four things most commonly raise ICP

Answer 30

1. cervical flexion 2. coughing 3. body position changes 4. increased blood and abdominal-thoracic pressure

Question 31

what is a typical precaution noted for patients with an ICP bolt

Answer 31

HOB at 30-45

Question 32

which areas of the brain are most susceptible to secondary hypoxia ischemia

Answer 32

hippocampus (memory), cerebellum, and basal ganglia

Question 33

what happens during a post-traumatic seizure

Answer 33

sudden, explosive, disorderly discharge of cerebral neurons causing transient alteration in brain function

Question 34

why do seizures hold potential for progressive brain injury and irreversible damage

Answer 34

during a seizure, oxygen is consumed about 60% more than normal, glucose is depleted, and lactate accumulates.

Question 35

what is auto-destructive cellular phenomena

Answer 35

surges of excitatory NTs which can contribute to further neural destruction following an DAI

Question 36

What can a RLA cognitive screen help you to determien

Answer 36

it can predict the sequence of cognitive and behavioral recovery in patients with TBI

Question 37

T/F: patients with severe cognitive issue will have severe motor issues

Answer 37

false: any cognitive function can be paired with any level of physical function

Question 38

what are the 8 levels of RLA from worst to best

Answer 38

1. no response 2. generalized response 3. localized response 4. confused-agitated 5. confused-inappropriate 6. confused-appropriate 7. automatic-appropriate 8. purposeful-appropriate

Question 39

what is a RLA generalized response

Answer 39

response is inconsistent but has gross verbal or motor response

Question 40

what is a RLA localized response

Answer 40

different responses based on different stimulus/location of stimulus

Question 41

what is a RLA confused-agitated response

Answer 41

combative heightened state of activity

Question 42

what is a RLA confused-inappropriate response

Answer 42

inappropriate responses must be redirected

Question 43

what is a RLA automatic-appropriate response

Answer 43

robotic movements, aware of environment, independent, slow learning

Question 44

what are the two major and two minor direct impairments related to TBI

Answer 44

cognition and behavior are major; communication and neuromuscular are minor

Question 45

what is the key strategy for addressing behavioral deficits

Answer 45

structure, consistency, positivity, and calmness

Question 46

what are goals of low level 1-3 treatment

Answer 46

1. prevent secondary impairment 2. minimize immobility 3. manage tone 4. interact with environment 5. behavioral correction

Question 47

describe manual technique to normalize tone

Answer 47

slow repetitive rotation to dampen general motor response/hypertonicity/posturing

Question 48

what can be done in TBI neuro patients to facilitation muscle contraction?

Answer 48

tapping the muscle belly

Question 49

what is a technique to relax the muscle

Answer 49

provide constant pressure across the muscle

Question 50

what is the first joint you should address when concerned about UE tone and ROM

Answer 50

ST joint

Question 51

how often should the coma stimulation approach be used

Answer 51

several times a day and 15 min per session

Question 52

how is the coma stimulation approach organized

Answer 52

1-2 multisensory modalities at a time allowing adequate response time in a controlled environment

Question 53

what is the goal of level 4 TBI management

Answer 53

minimize loss of function

Question 54

what is the goal of level 5-6 TBI management

Answer 54

maximize function through consistent patient participation and conditioning

Question 55

what is the goal of level 7-8 TBI management

Answer 55

wean from structure and reintegration into the community and decision making