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Lecture 8: TBI
Terms in this set (66)
What is a TBI?
Application of force to the rbain and the consequences of that force
Traumatic brain injury
Due to force
Acquired brain injury
Due to tumor, neurological illness, stroke, anoxic brain injury
What is a diagnosis that occurred due to an anoxic brain injury?
What age groups are at greatest risk for a TBI?
Why are 0-4 and >65 year olds at greatest risk for TBIs?
Primary brain injury
Due to force impact
Direct injury from trauma
Secondary brain injury
Due to resulting physiological changes
What are some examples of secondary brain injuries?
Intracranial hemorrhage (ICH)
Caused by impact forces
At one specific point
Bruises on the brain
If there is bleeding, then they will have to be evacuated
Open brain injury
Involves skull fracture
Closed brain injury
Skull remains intact
What is an example of a closed brain injury?
Skull fragments, skin, or other material enters the brain
Coup contrecoup injury
Injury on side of impact and then injury on opposite side of brain from impact of skull rebounding
Diffuse atonal injury
Caused by inertial forces
Shearing forces on axons
Brain connections altered
What are the theories of early recovery?
Stabilization of intracranial environment
Restoration of blood flow
Elimination of by products
What are the theories of late recovery?
Neuroplasticity: the axons adapt, regrow and reconnect
What are the common impairments
What are the common impairments for disorders of consciousness?
What are the common impairments for cognitive/behavioral?
What are the common impairments for language/oral motor?
Inability to swallow
Not bale to form speech due to inability to use vocal cords and tongue
INABILITY TO EXPRESS, but can understand others
INABILITY TO UNDERSTAND others, but you CAN express
What are the common impairments for sensory?
Loss of hearing
Loss of smell
Vestibular (peripheral or central)
Impaired depth perception
Inability to move eyes together (same time)
What are the common motor impairments?
What are the common medical complications?
Dysautonomia (sympathetic storming)
Glasgow coma scale
Good predictor of survival
Quantifies severity of brain injury
Provides definition for coma
What are the 3 categories of observation for the Glasgow coma scale?
Best verbal response
Best motor response
Glasgow Coma scale 13-15
Mild head injury
Glasgow coma scale 9-12
Moderate head injury
Glasgow coma scale 3-8
Severe head injury
RLA Level I
RLA Level II
RLA Level III
RLA level IV
Confused, agitated response
RLA level V
Confused, inappropriate, non agitated response
RLA level VI
Confused, appropriate response
RLA level VII
Automatic, appropriate response
RLA level VIII
Purposeful, appropriate response
RLA Level IX
RLA level X
Rancho los amigos scale
Correlates cognition and behavior
Tool for guiding treatment decisions
Early phase of recovery
NO sleep-wake cycle
What are positive predictors of recovery?
Early eye opening
Gestures or verbal Y/N
What are the negative predictors of recovery?
Midline shift >4mm
Hypoxia (paO2 <60)
What is the PT focus for early recovery?
What does stimulation in the early recovery phase consist of?
Do RLA I, II, III have head control?
An exaggerated response of the sympathetic nervous system
What are the S/S of sympathetic storming?
Dilation of pupils
Middle phase of recovery
What are the S/S of RLA IV?
Does not understand environment
Overreacts to stimulus
HIGHLY focused on basic needs
Attention span = 1 minute
Some times recognize family
What is the PT focus for RLA IV?
CALM and REDIRECT
What are the S/S of RLA V?
Attention span=several minutes
Severe memory impairment
No new learning
What are the S/S of RLA VI?
Some awareness of time/place
Attention span= 30 minutes
What is the PT focus for RLA V and VI?
STRUCTURE AND REPETITION
What are the therapy goals for the middle phase of recovery?
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