TBI- Traumatic Brain Injury

Question 1

What can a TBI result in?

Answer 1

Challenges that impact a persons physical, cognitive and psychological functioning

Question 2

True or false:

The more functional domains that are impacted by the TBI, the more challenging the recovery course

Answer 2

True

Question 3

Post-TBI; what changes hinder greater functional dependency?

Answer 3

Behavioral

Cognitive

Emotional

Psychosocial

Personality

Question 4

True or false:

In the US in 2010, the CDC estimates 2.5 million TBIs, with approximately 50,000 deaths, 280,000 hospitalizations, and 2.2 million emergency department visits resulting from TBIs

Answer 4

True

Question 5

What are some risk factors for TBI?

Answer 5

Age

Gender

Prisoner status

Sports (under reported and undiagnosed)

Prior TBI

Question 6

What percent of patients who experienced a TBI have found to have elevated blood alcohol levels at the time of injury?

Answer 6

50%

Question 7

The care and medical costs of a person with severe TBI can easily surpass how much over a lifetime?

Answer 7

$1 million

Question 8

True or false:

Approximately 3.17 million Americans were determined to be living with long term disability related to TBI

Answer 8

True

Question 9

What functions are potentially compromised from a TBI?

Answer 9

Coordinated movement

Speech

Memory

Reasoning

Altered behavioral responses

Question 10

What are the 3 TBI classifications?

Answer 10

Mild: <30 min loss of consciousness (GCS 13-15)

Moderate: 30 mins to 24 hrs loss of consciousness (GCS 9-12)

Severe: >25 hrs loss of consciousness (GCS 3-8)

Question 11

What is a primary injury of a TBI?

Answer 11

Occurs at the moment of impact due to the actual trauma

Question 12

What is a secondary injury of a TBI?

Answer 12

Occurs as a consequence of the primary injury and can develop anywhere from hours to days after the initial injury

Question 13

What is an open injury?

Answer 13

The intracranial vault is exposed to the outside environment

Question 14

What is a closed injury?

Answer 14

The skull and lining of the brain are left intact

Question 15

What does blunt force trauma refer to?

Answer 15

Impact against a relatively flat object or surface

Question 16

What is primary brain damage?

Answer 16

May be focal or diffuse

Direct impact, acceleration, deceleration, rotation of the brain, intrusion into the brain by penetrating object

DAI= diffuse axonal injuries

• head collision 15 mph or greater
• results in coma

Coup and countrecoup injuries

Question 17

What is secondary brain damage?

Answer 17

Occurs working hours or days following the injury

Factors include:

• inflammatory response
• increased intracranial pressure
• decreases cerebral blood flow or ischemia

Question 18

What are the 3 leading causes of TBI?

Answer 18

Falls (most common)

MVA (most damage)

Violence

Question 19

What ages are TBI ER visits the most common?

Answer 19

5 to > 85

Question 20

True or false:

61% of vehicle accidents involve females

Answer 20

False: males

Question 21

True or false:

1/3 to 1/2 people are intoxicated at the time of injury

Answer 21

True

Question 22

True or false:

About 1.7 million Americans per year

52,000 die

About 80,000 to 90,000 have a life long disability

Answer 22

True

Question 23

True or false:

Permanently disabled:
10% mild TBI
66% moderate TBI
100% severe TBI

Answer 23

True

Question 24

Who is the greatest risk for injury?

Answer 24

Men ages 15-24

Question 25

True or false: Inner city environments have the lowest incidence rates

Answer 25

False: HIGHEST

Question 26

True or false: American Indians, Alaskan and African Americans have the lowest TBI cases

Answer 26

False: HIGHEST

Question 27

What is dysautonomia characterized by?

Answer 27

Hypertension Tachycardia Increased body temp Profuse sweating Decerebrate or decorticate posturing

Question 28

Is a comas duration an important predictor of functional recovery?

Answer 28

Yes State of unconsciousness and cannot be aroused

Question 29

What is post traumatic stress amnesia (PTA)?

Answer 29

Gradual regaining of consciousness following coma Permanent memory gap from time of injustice to the point at which patient starts to remember events PTA (with GCS) important predictor if functional recovery PTA less than 5 min= very mild injury PTA greater than 7 days= very severe injury

Question 30

What is a vegetative state?

Answer 30

Patient exhibits spontaneous arousal through eye opening No purposeful behavior or communication

Question 31

What is a minimally conscious state?

Answer 31

Some awareness of self and environment

Question 32

What are the most common early onset medical complications of TBI?

Answer 32

Increases in intracranial pressure (ICP) Post traumatic hydrocephalus (PTH) Post traumatic agitation

Question 33

Explain increases in intracranial pressure (ICP)

Answer 33

ICP Due to cerebral edema or bleeding can cause compression of brain structures, cerebral ischemia from reduced cerebral blood perfusion, or herniation of the brain through the skull

Question 34

Explain post traumatic hydrocephalus (PTH)

Answer 34

Caused by blockages of normal cerebrospinal fluid (CSF) flow, overproduction of CSF, or insufficient absorption of CSF back into the body

Question 35

Explain post traumatic agitation

Answer 35

A subtype of delirium marked by relentlessness, impulsivity, aggression, emotional liability, disinhibition, and confusion usually occurring during early recovery

Question 36

What are some complications people with TBI’s deal with that have lifelong medical and rehabilitation management?

Answer 36

Hypertension, headache, sleep disturbances, dysautonomia, Traumatic seizures, Deep vein thrombosis, malnutrition, bowl related issues, coma ETC

Question 37

What are some motor deficits people TBI have?

Answer 37

Decerebrate rigidity Decorticate rigidity- brain stem intact despite several cortical damage Spasticity- common in adults after moderate to severe TBI Hemiplegia Heterotopic ossification Bone formation at an abnormal soft tissue site Tremors/ ataxia

Question 38

What is decerebrate rigidity?

Answer 38

Damage to brain stem between the vestibular nuclei and the red nucleus TEST QUESTION

Question 39

What are some potential medical complications?

Answer 39

Hydrocephalus- excessive accumulation of fluid in the brain Seizure Dysautonomia Deep vein thrombosis- give rise to pulmonary embolism Coma

Question 40

What are cerebellar (intention) tremors?

Answer 40

Slow tremors that occur at the end of purposeful movement Associated with ataxia, hypotonia, and balance disorders Tend to occur in trunk and proximal muscles with intentional movement

Question 41

What are essential tremors?

Answer 41

Slow constant tremors Typically affect more distal musculature

Question 42

What are resting tremors?

Answer 42

Pill- rolling movement at rest

Question 43

What are physiologic tremors?

Answer 43

A normal phenomenon Occurs in all contracting muscle groups Be exacerbated by fatigue, stress, strong emotions, caffeine, fever

Question 44

What are cognitive deficits?

Answer 44

Most common, difficult and long lasting consequences of all levels of TBI in adults and children - retrograde/ ante retrograde amnesia - sustained attention - reasoning skills - impulse control

Question 45

What are psychosocial deficits?

Answer 45

Preservation Poor control or temper Aggression/ irritability Apathy Depression Suicide PTSD

Question 46

What are visual deficits?

Answer 46

Diplopia Problems with accommodation Problems with convergence Visual field deficits Saccadic dysfunction Strabismus

Question 47

What is diplopia?

Answer 47

Double vision has been called the hallmark of visual deficits for persons with TBI Often results in the individual closing one eye to eliminate double vision TEST QUESTION

Question 48

What are signs and symptoms of cranial nerve dysfunction?

Answer 48

Absent pupillary reflex to light Fixed dilated pupil Homonymous hemianopsia Bitemporal hemianopsia Loss of sense of smell High frequency hearing loss Glossopharyngeal/ vague nerve- absent or depressed gag nerve

Question 49

How many years can a TBI reduce your life span by?

Answer 49

9 years

Question 50

What are prognosis factors?

Answer 50

Trauma score GCS score Bio markers Presence/ absence of hypoxia Length of coma Duration of amnesia

Question 51

What is the disability rating scale (DRS)?

Answer 51

Expanded GCS assessment to more clearly determined disability after TBI May be use at admission and discharge from rehab

Question 52

What is the ranchos los amigos scale (levels of cognitive functioning scale- LCFS)?

Answer 52

Used in many rehabilitation programs Classifies the admitted patient into one of either levels of cognitive functioning Limitations for the scale Are that it does not adequately reflect small changes in the recovery, may not accurately please a patient with characteristics of two or more categories, and is less accurate at highest levels

Question 53

What is the acute phase or surgical and medical management?

Answer 53

Focus- preservation of life, secondary damage and management of complications Endotracheal tube- maintain patent airway CAT scan- surgical decompression Indwelling urinary catheter Nasogastric tube Skin integrity Medications to control seizures ROM/ splinting

Question 54

What are the admission requirements for inpatient rehabilitation?

Answer 54

Medical Stability Need for close medical supervision Need for active and ongoing intensive therapy by multiple therapy disciplines

Question 55

What is acute inpatient rehab?

Answer 55

Must be able to tolerate at least 3 hrs of therapy a day (2 or more therapists) 5-7 days a week

Question 56

What is subacute inpatient rehab?

Answer 56

Must be able to tolerate 0.5- 2 hrs per day

Question 60

What does TBI impact in occupational performance?

Answer 60

Community living skills Meal preparation/ Safety Feeding skills Employment Bathing Money management Driving