TBI and Shaken Baby Syndrome

Question 1

traumatic brain injury

Answer 1

• an external force either accidentally or intentionally impacts the head
• symptoms vary depending on location/extent of injury

Question 2

T or F: most children diagnosed with TBI only have mild injury

Answer 2

T: 97%

Question 3

what is the leading cause of death and disability in children 1-19 years

Answer 3

brain injury

Question 4

is brain injury more common in boys or girls

Answer 4

boys

Question 5

what are some risk factors for TBI in pediatrics

Answer 5

• hyperactive
• attention deficits
• impulsivity
• previous TBI

Question 6

what are some causes of TBI in peds

Answer 6

• falls
• MVA
• abuse/assalt
• gunshot wounds
• sport

Question 7

acceleration-deceleration injuries

Answer 7

• when a moving head hits a fixed object
• infants are more susceptible
• result in translational and rotational injury

Question 8

_____ is the initial impact damage while ____ is the deceleration damage

Answer 8

coup
counter-coup

Question 9

impression injuries

Answer 9

when a solid object impacts a stationary head

Question 10

what are some examples of primary brain damage from trauma

Answer 10

• concussion
• contusion
• skull fx
• intracranial hemmarrhage

Question 11

extradural hematomas

Answer 11

• tearing of an artery in the brain
• caused by skull fx or bending of the skull into the brain

Question 12

subdural hematoma

Answer 12

injury to veins in a subdural space

Question 13

intracerebral hematoma

Answer 13

trauma or rupture of a congenital vascular abnormality

Question 14

diffuse axonal injury

Answer 14

• shearing trauma disturbs cellular structures following a rotational injury
• associated with loss of consciousness, extensor rigidity, and autonomic dysfunction

Question 15

what are some secondary injuries from TBI? which one is the most common

Answer 15

• cerebral edema - most common
• herniation syndromes
• hypoxic ischemic injury
• neurochemical events

Question 16

what are some other consequences of brain damage

Answer 16

• hydrocephalus
• seizures
• infections
• dysautonomia
• endocrine disorders

Question 17

T or F: seizures are more common after brain damage in adults than children

Answer 17

F: more common in children

Question 18

communicating hydrocephalus

Answer 18

cerebral spinal fluid can still flow within ventricles

Question 19

non-communicating hydrocephalus

Answer 19

obstruction to the flow of CSF within the ventricles

Question 20

glasgow coma scale

Answer 20

eyes, verbal, motor
lower scores = worse outcome

Question 21

pediatric coma scale is used in what ages

Answer 21

birth to 5 years

Question 22

peds GCS eyes

Answer 22

4 - spontaneously
3 - to speech
2 - to pain
1 - none

Question 23

peds GCS motor

Answer 23

5 - obeys commands
4 - localizes to pain
3 - flexion to pain
2 - extension to pain
1 - none

Question 24

peds GCS verbal

Answer 24

5 - oriented
4 - localizes to pain
3 - vocal sounds
2 - cries
1 - none

Question 25

what is the most consistent predictor of outcome in peds TBI

Answer 25

duration of coma longer duration = worse outcomes

Question 26

T or F: young children rarely stay in persistent state of coma

Answer 26

T

Question 27

other than duration of coma, what are other predictors of injury severity/outcomes in peds TBI

Answer 27

- depth of coma (GCS) - orientation and amnesia assessment - duration of post-traumatic amnesia - rancho los amigo score - age - function - environment

Question 28

children's orientation and amnesia test (COAT) is used to assess PTA in what ages

Answer 28

4-15 years

Question 29

greater than ___ weeks of post-traumatic amnesia indicates significant impairment of future memory function

Answer 29

3

Question 30

a peds rancho scale is used for what ages

Answer 30

birth - 7 years

Question 31

are younger or older children more vulnerable effect of diffuse brain injury

Answer 31

younger because they have increased plasticity

Question 32

what are some factors that influence walking ability after TBI in peds

Answer 32

- time in coma - LE injury - impaired responsiveness - LE spasticity

Question 33

what is the most common cog impairment in children after TBI

Answer 33

memory deficits - due to damage to temporal lobe

Question 34

decorticate posturing

Answer 34

UE flexion LE extension

Question 35

decerebrate posturing

Answer 35

UE and LE extension *more severe

Question 36

ataxia is due to damage in the...

Answer 36

cerebellum and basal ganglia

Question 37

T or F: all children with TBI should have audiologic evaluation

Answer 37

T

Question 38

visuospatial skills can be impaired due to damage in the...

Answer 38

temporal or occipital lobes

Question 39

figure-ground deficit

Answer 39

inability to distinguish a figure from the background

Question 40

signs of heterotopic ossification

Answer 40

decreased ROM pain swelling erthema warmth

Question 41

what are 2 factors that increases the risk of heterotopic ossification in kids

Answer 41

>11 years longer coma duration

Question 42

what 2 fractures are common in peds TBI

Answer 42

pelvic LE

Question 43

you should reposition every ____ hours in lying and every _______ minutes in sitting

Answer 43

2 30?

Question 44

what is the best position when lying after pediatric TBI

Answer 44

side lying

Question 45

shaken baby syndrome

Answer 45

vigorous manual shaking of an infant who is being help by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding and no external signs of head trauma

Question 46

victims of shaken baby syndrome are usually less than ____ year(s) old

Answer 46

1 year old *most <6months

Question 47

what 2 injuries are often found in shaken baby syndrome

Answer 47

- intracranial injury - retinal hemorrhages (typically bilateral)

Question 48

parental risk factors of shaken baby syndrome

Answer 48

- psychiatric problems - stress - unrealistic expectations - inadequate knowledge of infant development/needs - substance abuse - young/immature parents - poor impulse control

Question 49

infant risk factors of shaken baby syndrome

Answer 49

- prematurity - critically/chronically ill - born drug-addicted - congenital abnormalities - physical/developmental delays - colic/inconsolable crying