TBI Interventions

Question 1

2 main components of mTBI pathophys

Answer 1

Micro vascular supply and metabolic demand imbalance

Question 2

What are the two main guidelines for acute mTBI

Answer 2

Limit physical and cognitive activities
Decrease symp agg stimuli

Question 3

Chronic symp tx?

Answer 3

Symptom based approach

Question 4

How many days puts person with mTBI at a greater risk for another concussion

Answer 4

10 days

Question 5

What sports are males at higher risk of getting mTBI? Females?

Answer 5

Football and rugby

Soccer and basketball

Question 6

Ocular signs of mTBI

Answer 6

Reading, visual deficits

Question 7

Vestibular signs of mTBI

Answer 7

Cervical and ocular deficits; walk, head turn, driving

Question 8

Mild TBI symptom categories (3) and examples

Answer 8

Attention: difficulty focusing, mem loss

Emotion: irritable, sleep probs

Environment: emotion, sleep, noise

Question 9

What are the 5 main components of exam

Answer 9

Visual ocular (VOMS)
Balance (visual vestibular)
Coordination and reaction time
Endurance
Gait (head turns) and quick movements

Question 10

What symptoms are you watching out for during VOMS

Answer 10

HA, vomiting, dizziness, fatigue, visual changes, uneasy

Question 11

What assessments can you use for balance

Answer 11

BESS, computerized posturography, sway balance systems (BERTEC, APDM)

Question 12

What tests can you do for coordination and reaction time?

Answer 12

Ruler drop test
Cerebellar exams

Question 13

What is the gold standard endurance test

Answer 13

Buffalo concussion treadmill stress test

Question 14

What outcome measures for gait

Answer 14

DGI or FGA

Question 15

What are 3 main reasons to stop Buffalo

Answer 15

-VAS increased by greater than or equal to 3
-RPE greater than or equal to 17
-if pt stops communicating

Question 16

What is the fxn of VOR

Answer 16

Keeps eye gaze stable while c/s rotates and/or vertical movements

Question 17

What are 5 deficits during VOR

Answer 17

Dizziness, inability to read, vertigo, unsteady, eye fatigue

Question 18

What 3 CN are involved with VOR

Answer 18

Oculomotor (3), trochlear (4), abducens (6)

Question 19

What connects the oculomotor system

Answer 19

Medial longitudinal fasiculus

Question 20

With L c/s rotation, which lat and med rectus is turned on

Answer 20

R lat, L med

Question 21

With R c/s rotation, which lat and med rectus is turned on

Answer 21

R med, L lat

Question 22

What part of brain involved with short term mem

Answer 22

Hippocampus

Question 23

What is the unicinate fasciculus

Answer 23

Axonal fiber tract, connects hippocampus and amygdala to lower frontal lobe

Very vulnerable to injury

Question 24

What part of the brain involved with working mem disturbances in mTBI

Answer 24

Medial prefrontal cortex

Question 25

What are three 3 general progressive ocular system interventions

Answer 25

-sitting saccades -smooth pursuit -target training

Question 26

What are examples of advanced ocular and vestibular oculomotor exercises

Answer 26

-walking with visual activity (find object w/ visual saccade) -walking with head turns

Question 27

What is an important muscular performance deficit from a neurological exam

Answer 27

Motor planning

Question 28

What is a big sensation deficit from a neurological exam

Answer 28

Perceptual

Question 29

What is the purpose of the Brock string

Answer 29

Tx convergence insufficiency

Question 30

What two major things are altered after TBI regarding aerobic ex

Answer 30

Temperature and cardiac auto regulation

Question 31

What two symps should you stop graded aerobic ex? Why

Answer 31

HA and dizziness; decreased cerebral blood perfusion

Question 32

What does aerobic ex help increase? Reduce?

Answer 32

BDNF (hippocampal neurons) Apoptosis and inflam

Question 33

What are the 4 main categories of mod-severe brain injury interventions

Answer 33

Emotional, cognitive, motor, sensory

Question 34

What does task based exercise help with in the brain

Answer 34

Engage NS and follow norm brain activiation

Question 35

Benefits of tasks based ex

Answer 35

-selective visual attention -facilitates lat wt shift -handle facilitate pelvis

Question 36

Neuro development therapy (NDT) purpose

Answer 36

Hands on approach to improve movement and function

Question 37

What are the 4 priorities for NDT

Answer 37

1. Handing core, head and trunk alignment 2. LL alignment and connection to trunk 3. Motor learning task 4. Dual tasking

Question 38

3 benefits of parallel bar gait training

Answer 38

Provides feedback Physical barriers and reminders Safety

Question 39

3 advantages of task based gait acts

Answer 39

Less verbal interaction Visual feedback Planning

Question 40

What’s an example rx of aerobic act (think FITT)

Answer 40

12 wks, 3x/wk for 30 min at 70-80% THR

Question 41

What % of total O2 is consumed at rest

Answer 41

20%

Question 42

The maintenance of cerebral BF =

Answer 42

Precise control of nutrient supply

Question 43

What is way finding

Answer 43

Navigation through unknown areas

Question 44

What is the most common permanent post TBI personality change

Answer 44

Irritability

Question 45

What causes irritability

Answer 45

Environmental distraction Unable to reach goals Inability to express self Communication break down

Question 46

Main way to reduce irritability

Answer 46

Know triggers: auditory, busy environment, visual

Question 47

4 main ways to prevent agitation

Answer 47

-edu staff and fam how to approach TBI pt -use social greetings -formally end interaction -provide pt with choice (instead of command)

Question 48

Two main therapy strats when teaching exercises to mod-severe TBI

Answer 48

Keep acts simple** Show pts what to perform