TBI Intro: Clinical Presentation

Question 1

what cognitive deficits do they have

Answer 1

• arousal dysfxn
• disorientation
• poor attention span
• loss of memory
• poor organization & reasoning skills
• inability to control emotional responses
• learning difficulties

Question 2

walkie talkie pt’s typically ..

Answer 2

• may be able to ambulate independently without an AD negotiating barriers but might not remember their name or family members
• may fill in info with fabricated stories: confabulation
• could be more problematic to functional independence than the physical limitations

Question 3

what is the most common and debilitating cognitive deficit following tbi

Answer 3

impaired attention

Question 4

executive function deficits looks like

Answer 4

impairment to volition/planning, problem solving, insight, social pragmatics, self-regulation

Question 5

what can u see with executive fxn deficits

Answer 5

• difficulties with motivation, preparation and organization
• poor problem solving
• impulsivity
• mood disturbances
• difficulty in social situations

Question 6

what memory deficits do we see

Answer 6

• retorgrade and/or anterograde amnesia
• posttraumatic amnesia
• short term > long term memory deficits
• declarative and procedural memory often impaired

Question 7

what is common about language deficits

Answer 7

• non-aphasic nature and related to cognitive impairment
• disorganized and tangential oral and written communication, imprecise language, word retrieval difficulties, disinhibited language

Question 8

most enduring and socially disabling of impairments after TBI

Answer 8

• sexual disinhibition
• apathy
• aggressive disinhibition
• agitation
• hyperactive, restless
• low frustration tolerance
• depression
• easily over stimulated**

Question 9

dysexecutive syndrome

Answer 9

frontal lobe syndromes

Question 10

orbitofrontal lobe syndrome

Answer 10

• disinhibited
• impulsive behavior
• inappropriate jocular affect, euphoria
• emotional liability
• poor judgement and insight
• distractibility

Question 11

frontal convexity syndrome

Answer 11

• apethetic
• apathy
• indifference
• psychomotor retardation
• motor perseveration and impersistence
• stimulus bound behavior
• motor programming deficits
• poor word list generation

Question 12

focal lesions result in what strength deficits

Answer 12

hemiparesis/hemiplegia

Question 13

diffuse injury results in what strength deficits

Answer 13

motor control and coordination deficits over true strength deficits

Question 14

tone abnormalities could look like

Answer 14

flaccidity
rigidity
hypertonicity

Question 15

brainstem injuries result in

Answer 15

posturing

Question 16

decorticate rigidity

Answer 16

LE ext & UE flex

Question 17

decerabrate rigidity

Answer 17

LE & UE ext

Question 18

what sensory deficits are most common

Answer 18

proprioceptive and kinesthetic

Question 19

how often is CN I damaged in TBIs

Answer 19

7% of them

Question 20

what CN are crucial to examine

Answer 20

optic
occulomotor
trochlear
abducens

Question 21

intact pupillary fxn indicates what about the location of the injury …

Answer 21

the injury is above the level of the brainstem

Question 22

if a pt has conjugate gaze palsy, what is that due to

Answer 22

CNS

Question 23

if a pt has unilateral gaze palsy, what is that due to

Answer 23

PNS

Question 24

if a pt has tonic downward gaze, what is that due to

Answer 24

severe injury to thalamus, midbrain or pons

Question 25

if a pt has tonic upward gaze, what is that due to

Answer 25

severe injury to both hemispheres

Question 26

if a pt has rapid horizontal eye movement, what is that due to

Answer 26

seizure activity

Question 27

optic n. damage may result in what

Answer 27

monocular blindness, absent pupillary response

Question 28

what is the common culprit of gaze abnormalities

Answer 28

abducens n.

Question 29

which nerve damage is the most uncommon with tbi and what do you see instead

Answer 29

CN 3 & 4 | damage to actual muscle bellies/tendons

Question 30

where is the trigeminal n. damaged and what is the effect of that

Answer 30

peripheral injury to where divisions leave orbit loss of sensation to the nose, eyebrow and forehead

Question 31

where is the facial n. damaged and what is the effect of that

Answer 31

perioheral injury when the temporal bone damaged muscle weakness, loss of tear production, decreased saliva secretion, taste

Question 32

how many pt's experience vestibular dysfunction

Answer 32

50% - dizzy and imbalance

Question 33

how do you end up with vestibular dysfunction

Answer 33

injury to vestibulocochlear n. injury to vestibulocerebellum damage to brainstem or cortex involving vestibular pathways

Question 34

S&S for vestibular dysfunction

Answer 34

``` dizziness vertigo imbalance nausea vomiting inability to perform sensory integration for balance ```

Question 35

for pt's who have TBI, how long does vestibular rehab take

Answer 35

3x as long compared to those not with TBI

Question 36

what are common ANS symptoms seen with TBI

Answer 36

``` HR, RR, BP variability elevated body temp excessive sweating, salivation, tearing dilated pupils vomiting anxiety, panic disorder, PTSD ```