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TBI
| Question | Answer |
|---|---|
| What is the number one cause of TBI? | falls (40.5%) |
| For the age group 5-24, what is the leading cause of TBI related death? >65 yrs? 0-4 yrs? | motor vehicle accidents; falls; assault |
| What type of head injury includes an object penetrating the skull and entering the brain? | open head injury |
| What type of head injury includes an external force or sudden, violent movement causing the brain to knock against the skull? | closed head injury |
| When there is extensive or widespread damage d/t shearing forces (usually rotational) from rapid acceleration or deceleration? | diffuse axonal injury |
| These result from direct impact to the head, bruising of the brain, usually more localized impairments than diffuse axonal injury. When an object comes into contact with a head that it stationary? | Contusion |
| Contusions at the site of impact and the opposite side of the brain from the brain rebounding? When a moving head comes into contact with a stationary object? | coup-contrecoup |
| When a sharp object (bullet, knife) breaks the skin and skull with a higher chance of infection? | penetrating injury |
| Mass of blood between the dura and the skull; associated with skull fractures and causes rapid increase in intracranial pressure. | epidural hematoma |
| Bleeding between the dura and arachnoid meningeal layers; associated with blunt trauma without skull fracture; usually from a tear in the veins of this area. | subdural hematoma |
| majority of these occur in the frontal and temporal lobes; appearance on CT at be delayed | intracerebral hematoma |
| increases in this result in displacement of the brain tissue, hydrocephalus, and ischemia | intracranial pressure |
| what is normal intracranial pressure? | 0-10 mmHg; increased is >20mmHg |
| What are the symptoms of increased ICP? | headache, papilledema, vomiting, drowsiness, altered consciousness |
| What is the difference between the mean arterial pressure and intracranial pressure (net pressure gradient within the brain)? | Cerebral perfusion pressure (normal CPP=/>70mmHg |
| At what level of cerebral perfusion pressure does it cause ischemia? | <40-50mmHg |
| What values on the Glasgow coma scale coincide with mild, moderate, and severe TBI? | mild:13-15; moderate: 9-12; severe: 3-8 |
| What do you call the stage of recovery where there is unarousable unconsciousness, no periods of wakefulness or eye opening in response to stimulation; usually ventilator dependent? | coma |
| Lack of awareness but preserved capacity for arousal (spontaneous or stimulus-induced); 7 criteria must be met (see slides); sleep-wake cycles are present; sufficient preservation of autonomic functions to permit survival with adequate medical care | vegetative state |
| once >1 yr there is no improvement in neurological function, pt is deemed what? | persistent vegetative state |
| discernable and reproducible evidence of awareness of self or environment by one or more of the following behaviors: simple command following, gestural or verbal yes/no responses, intelligible verbalization, purposeful behavior | minimally conscious state |
| amnesia from events prior to injury | retrograde amnesia |
| amnesia from events following injury | anterograde amnesia |
| When do they deem post-traumatic amnesia as resolved? | when a person can form and recall new memories |
| Describe the time parameters for severity of TBI based on duration of post-traumatic amnesia using the Westmead Post Traumatic Amnesia Scale | Mild: 5-60 min; moderate: 1-24 hrs; severe: 1-7 days; very severe: 1-4 weeks; extremely severe: >4wks |
| RLA I | no response |
| RLA II | generalized response |
| RLA III | localized response |
| RLA IV | confused/agitated |
| RLA V | confused, inappropriate, non-agitated |
| RLA VI | confused, appropriate |
| RLA VII | automatic, appropriate |
| RLA VIII | purposeful, appropriate (SBA) |
| RLA IX | purposeful, appropriate (SBA on request) |
| RLA X | purposeful, appropriate (mod I) |
| Name 4 medications that are used for management of increased tone/spasticity. | Baclofen-oral or pump (GABA receptor agonist); Diazepam (Valium)-benzodiazepine used to treat anxiety and relieve spasms; Dantrolene (muscle relaxant); Botulinum Toxin (neurotoxic protein)-injected for localized effects lasting 3-4 months |
| Name 3 other ways that contractures are managed. | serial casting, dynamic splinting, surgery |
| How long is a joint typically immobilized during serial casting before having it removed and replaced? | 7-10 days |
| Name an advantage and a disadvantage of dynamic splinting. | (+) can doff splints monitor and clean skin; (-) pressure points are common because splints are not total contact |
| What are the common muscle groups that typically become contracted and are lengthened with tendon lengthening procedures? | ankle PF, knee flexors, hip adductors, elbow flexors |
| What does a score of 21 or below indicate on the agitated behavior scale? | WNL |
| What does a score of 22-28 indicate on the agitated behavior scale? | mild agitation |
| What does a score of 29-35 indicate on the agitated behavior scale? | moderate agitation |
| What does a score >35 indicate on the agitated behavior scale? | severe agitation |
| When scoring your patient on the ABS, what is the method for determining between a 1 that a behavior is absent and a 4 that it is present to an extreme degree? | 1=absent, 2=doesn't disrupt, no cues, 3=can be redirected with cues, 4=cannot be redirected |
| What are the differences between FIM and IRF_PAI? | 4: SBA/CGA, 5=set up, no 7 on IRF PAI, IRF PAI includes car transfer and stooping to pick up object, breaks down components to rolling, STS, 1, 4 12 stairs, 10, 50, 150 ft, turf/unstable surface, w/c 50, 150 |
Created by:
metz
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