Traumatic Brain Injury (TBI) Flashcards
(22 cards)
TBI
Nondegenerative acquired brain injury due to impact of external force
Causes of TBI
Open (Skull fracture)/penetration
Closed
Blast
Nontraumatic injury:
CVA
TIA
Anoxic/hypoxic
Infection/tumor
Metabolic disorders
Toxic substances
Incidence/prevalence
1.4-1.5 million yearly incidence in US
300k hospitalized
50k pass away
Of survivors, 85k will have long-term disabilities
Risk factors
Gender (male)
Age (Early adol, late adulthood, toddlerhood and older adults)
School adjustment/SES
Substance abuse
High-risk sports
Abuse
Types of TBI/Mechanisms of injury
Primary (direct)
Skull fracture, coup and contracoup, contusions, hematoma, diffuse axonal injury
Secondary (indirect)
Edema, imparied metablism, elevated intracranial pressure, traumatic hydrocephalus
Primary mechanisms
Anterior skull fracture: CSF leakage from sinuses blood in periorbital tissue
Coup injury: Occurs at site of impact with object, point of initial hit to brain
Contracoup injury: Occurs at opposite side of soup, point of reflection of brain as it bounces back
Contusions and hematomas: Bruising, occurs in conjunction with diffuse shearing and near bony prominence in skull
Diffuse axonal: High velocity rotational forces, acceleration or deceleration to brain causing shearing injury and disruption to axons
Blast TBI
Wave of sudden change in pressure from explosive device
Fragments often cause local injury
Severe contusions
Secondary mechanisms
Edema: Usually a primary mechanism leads to swelling which leads to increased intracranial pressure or herniation
Identifying TBI
SLP’s do not diagnose TBI
Interdisciplinary team of professionals do with fMRI, CT, PET, and DWI scans
Functional assessments
Symptoms rating scales
Assessment and evaluation of type will depend on consciousness:
Glasgow coma scale (GCS)
Rancho los amigos levels of cognitive function
Rancho los amigos scale
I. No response
II. Generalized response
III. Localized response
IV. Confused and agitated
V. Confused and inappropriate
VI. Confused and appropriate
VII. Automatic and appropriate
VIII. Purposeful and appropriate
RLA: I, II, III
Arousal, tactile stimulation, thermal stim, aud stim, olfactory stim, gustatory stim, visual stim
EARLY STAGES
RLA: IV, V
Treatment focused on developing comfort and familiarity with treatment and rebuilding relationship between brain and behavior with less focus on accuracy
Increase rapport, memory aids, caregiver training and education, routine building, behavior management
MIDDLE PHASE TARGETS
RLA: VI, VII
Goal-directed behaviors and relearning old skills
Remediation of cognitive deficits
Functional skills and interpersonal functions
Addressing cognition
Addressing communication
LATE PHASE TARGETS
RLA: VIII
Response correct, carryover of new learning with no supervision
Poor tolerance to stress, some difficulty with abstract reasoning and functions at reduced levels in society
TREATMENT GOAL
TBI vs. Aphasia
TBI:
Confabulation
Irrelevance
Cognitive deficits
Lang> comm
Personality changes
Aphasia:
No confabulation
Relevant
No cog. deficits
Comm> lang
Personality intact
Glasgow Coma Scale (GCS)
Scale of 3-15 rated along 3 dimensions: Motor response, eye response, and verbal response
3 is bad, 15 is good
Post traumatic amnesia (PTA)
Length of time until new memories can be formed
Less than 1 day
1-7 days
More than 7 days
Loss of consciousness (LOC)
Length of time unconscious
0-30min
30min-24hrs
24hrs+
Severity of TBI
Mild TBI:
GCS: 13-15
PTA: Less than 1 day
LOC: 0-30min
Mod. TBI:
GCS: 9-12
PTA: 1-7 days
LOC: 30min-24hrs
Severe TBI:
GCS: 3-8
PTA: More than 7 days
LOC: 24hrs+
Severity of TBI not always associated with severity of outcomes
TBI characteristics
Cognitive difficulties
Language difficulties
Personality change
Signs and symptoms
Physical:
Dizzy, fatigue, seizure, headaches, vomiting, impaired movement, balance and speed
Sensory-perceptual:
Auditory and vestibular impairment, visual change, gustatory and olfactory change
Cognitive:
Attention, EF, thinking speed
Language:
Pragmatics, anomia, comprehension
Emotional/behavioral:
Personality change, more irritable and impulsive
Progression of goals
Sensory
Neurobehavioral
Cognitive rehab
EF skills
