Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Neuro TBI
Neuro wk7 onwards
| Question | Answer |
|---|---|
| What is TBI? What are they categorised as? | An insult to the brain from an external force which leads to temporary or permanent impairment. Open or closed |
| What can Mod-severe TBI result in? | - Loss of consciousness for at least 30mins - Post-traumatic amnesia fro at least 24hrs - GCS score below 13 during 24hrs following - Neuroimaging evidence of brain injury |
| How is TBI commonly classified? | By severity: Mild, Mod or severe By injury pattern: Diffuse or Focal injuries |
| What are some examples of common TBI pathology? | - Diffuse axonal injury - Cerebral contusion - Subdural or perdural haematoma - subarachnoid haemorrhage - Intraparenchymal haemorrhage |
| What are some commonly used outcome measures for TBI? | - WFNS Scale (World Federation of Neurological Surgeons) - Fisher Scale (CT Scan appearance) - GCS - PTA (Length of post traumatic amnesia) |
| How does the WFNS scale work? | Helps us understand how badly the patient is presenting Grade 1 GCS 15, MD abscent Grade 2 GCS 13-14, MD abscent 3 GCS 13-14, MD present 4 GCS 7-12, MD abscent or present 5 GCS 3-6, MD abscent or present |
| How does the Fischer Scale score? | Group 1 - No blood detected 2 - diffue subarachnoid blood, no clots, no layers of blood ^1mm 3 - localised clots/or layers of blood 1mm or greater 4 - diffuse or no subarachnoid blood, but intracerebral or intraventricular clots present |
| GCS how does it score? | Best eye response, Best verbal response, best motor response Mild 13-15, Mod 9-12, severe 3-8 |
| What does the ventricular system do? | The ventricles produce & circulate CSF which helps to cushion the brain and create normal physiology and contribute to pressure regulation within the cranial vault |
| What can happen in the centricular system with TBI? | Blood swelling or impaired CSF absorption can interfere with normal flow and lead to enlargement or hydrocephalus - this can contribute to reduced alertness, worsening cognition, poor progress in rehab, gait deterioration or unexplained functional decline |
| What are some interventions for excess CSF in TBI pts? | external ventricular drain (EVD) or Permanent procedure can help shunt CSF to another cavity |
| What is ICP ? and normal amounts | ICP norms 0-15mmHG., >20 bad. Increased ICP can compress brain tissue and reduce blood flow → brain injury. |
| What is CPP ? and normal amounts | Central Perfusion Pressure = the pressure driving blood to the brain. norms = 80-100mmHg. CPP=Mean Arteriole Pressure −ICP. If ICP increases → CPP decreases If CPP drops too low → brain gets ischemic |
| What are some impairments of the Primary motor cortex and corticospinal pathways | weakness, impaired selective movement, reduced motor control, abnormal movement patterns |
| What are some impairments of the frontal lobes | executive dysfunction, impaired attention, poor insight, impulsivity, disinhibition, reduced initiation, behavioural dysregulation, motor |
| What are some impairments of the temporal lobes? | memory impairments, emotional dysregulation, auditory/language processing difficulties, learning difficulties |
| What are some impairments of the parietal lobes? | sensory integration problems, reduced spatial awareness, body.environment interaction difficulties, neglect or perceptual dysfunction |
| What are some impairments of the occipital lobes? | visual processing and visual-perceptual difficulties |
| What are some impairments of the brainstem/cerebellum? | ataxia, balance dysfunction, impaired arousal, dysarthria, dysphagia, autonomic dysfunction |
| What are some impairments of Diffuse white matter disruption? | slowed processing, mixed cognitive-motor-behavioural impairments, inconsistent performance |
| What are some examples of Primary injury in TBI? | * Direct tissue damage from impact or acceleration-deceleration forces • May include: • Diffuse axonal injury • Contusions • Haemorrhage (subarachnoid, subdural, intraparenchymal and more) • Skull fracture / penetrating injury |
| What are some examples of secondary injury in TBI? | • Oedema and raised intracranial pressure • Reduced cerebral perfusion and ischaemia • Hypoxia and hypotension • Inflammation and metabolic disturbance |
| What are some common Physical consequences of TBI? | • Weakness • Incoordination/ataxia, dizziness and balance problems • Sensory loss • Spasticity and hypertonicity • Gait disorders reduced endurance increased pain |
| What are some common cognitive consequences in TBI? | • Impaired attention • Memory problems • Slow or delayed processing speed • Executive dysfunction and disinhibition |
| What are some common behavioural/emotional consequences in TBI? | • Impulsivity • Agitation • Irritability • Reduced insight • Emotional lability |
| What are some common Participation consequences in TBI? | • Reduced independent • Difficulty returning to work or study • Impact on return to driving • Return to sport, leisure and recreation |
| What is the physical impairment relevancy for physio's and rehab? | • unsafe transfers and mobility • reduced walking capacity • high falls risk • difficulty with dual-task mobility • reduced tolerance for therapy • inconsistent physical performance across the day |
| What are some communication impairments in TBI? | • Aphasia • Expressive – difficulty producing words • Receptive – difficulty understanding words • Dysarthria • Dyspraxia • Cognitive/communication disorders • Social skills and pragmatics • Processing speed |
| What is the relevance on communication impairments for physio and rehab? | • Adapt communication (simple language, demo, check understanding) • Allow extra time and use clarification strategies • Communication issues can affect movement assessment • Social/pragmatic deficits may limit therapy participation |
| What is the relevance of cognitive impairments for physio rehab? | • difficulty following instructions • reduced carryover between sessions • poor safety awareness • difficulty learning new tasks • reduced ability to self-monitor performance • need for simpler cueing and structured tasks |
| What is the relevancy of behavioural impairments for physio and rehab? | • getting up without assistance • refusing or disengaging from therapy • becoming overwhelmed or overstimulated • variable participation across sessions • conflict or distress during challenging tasks |
| What are the short term participation goals for TBI? | • Supporting consistent engagement in mobility rehabilitation requires an interdisciplinary team approach • Use of structured routine in rehab • Develop confidence and autonomy in rehabilitation • Build skills needed for discharge and transition |
| What are the long term participation goals for TBI? | • Return to school, university, work or meaningful occupation • Return to recreation, exercise and sport • Community mobility and access • Relationships, family roles and social participation • Rebuilding identity, independence and quality of life |
| What is PTA? It is an indicator or TBI severity | A period of confurion and disorientation after TBI. Often associated with Imparied attention, agitation, poor insight and inconsistenct performance |
| What is the structure of a Physio Ax of TBI? | 1. Info from med chart 2. Observe pt and current state/movement 3. SE/Pt interview 4. Functional Ax 5. select objective Ax to support hypothesis 6. interpretation and problem list |
| What are some saftey risks in TBI? | impulsivity, poor awareness, agitation → ↑ falls + fatigue risk |
| What are some Precautions in TBI? | consider injuries, equipment (lines/helmet), medical stability, swallowing/resp |
| What are some red flags in TBI? | ↓ consciousness, sudden cognitive/behaviour change, new neuro signs, worsening headache/N&V, unexplained deterioration |
| What does acute hospital Mx look like in TBI | • Protect lungs + prevent complications • Prevent contractures • Monitor/manage issues • Start early movement |
| What does sub-acute inpatient rehab for TBI look like? | • Build function (goals, neuro rehab) • Plan discharge + transition • Work in MDT + with funding bodies |
| What does community rehab for TBI look like? | • Return to life (work, sport, school) • Focus on participation • Continue MDT + funding support |
| How do we support cognitive rehab Mx? | • Know cognitive rehab principles • Adapt physio tasks to cognition • Work with MDT (OT, neuropsych, speech) • Optimise learning + participation |
| How do we support attention and processing speed? | • Screen contributing factors • Train with functional + dual-task • Modify environment/tasks |
| How do we suport insight and motivation? | • Aware → set goals, plan, self-monitor • Unaware → educate + build awareness |
| How do we support fatigue, attention and session dosing? | • Common, unpredictable, worsens cognition • Dose sessions carefully + allow breaks |
| How to Mx balance and postural control? | • Progress difficulty • Improve alignment/weight shift • Challenge stability • Vary tasks • Add attention/sensory • Address strength/flexibility |
| How does muscle weakness occure and what are some Mx approaches? | Focal brain injury pathology or deconditioning from immobilisation. Repetitive task specific funcxtional training and strength training or electrical stimulation |
| What is spasticity Mx? | Pharmacological management = cornerstone • Physio: strengthen antagonists • Adjuncts: e-stim, casting, taping |
| What is the HiMAT scoring useful for? | People with ABI may be more likely to benefit from ballistic resistance training if score under 27 |
| What are wheelchairs important for in TBI? | • Optimise posture (midline, safety) • Enable function + participation • Use adjustable seating (tilt/support) • Improve sitting tolerance |
Created by:
HollyRicho