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Traumatic Brain Injury
Terms in this set (57)
an alteration in brain function, or other brain pathology, caused by an external force
A TBI is further characterized by
LOC at scene of accident, possibly a single-associated seizure, gradual progression through stages of recovery, recovery may not be complete.
What is the % of TBIs caused by MVA/MVC?
What is the % of TBIs caused by falls?
What is the % of TBIs caused by assaults and violence?
What is the % of TBIs caused by sports and rec?
TBI is the leading cause of mortality in ______
American children and young adults
Men are injuried _____ as often as women.
Typical patients with TBIs are between _____ years of age
Coma generally lasts how long after a TBI? If they remain in a coma > 1 year they are referred to as what?
-generally only a few weeks at most
-if >1 year = persistent vegetative stage (PVS)
If a patient is in a PVS are they able to speak or produce purposeful behaviors?
Many patients with TBI will be left with residual cognitive deficits such as
learning disorders, memory deficits, problems with complex information processing, inability to attend, inability to limit distractions, short attention span, inability to think of a plan of execution, agitation, lack of interest/apathy.
Communication deficits following a TBI
receptive (fluent) aphasia
expressive (nonfluent) aphasia
Some behavioral deficits seen in TBI patients are
sexual disinhibition, apathy, confabulation, wandering, aggression, low frustration tolerance, lack of motivation and depression
Are physical restraints and sedatives used more or less then redirection, alarms, medications, video monitoring, locks on exit doors, and sitters?
Common sensorimotor deficits include:
hemiparesis, bilateral paresis, increased reaction time, general deconditioning, balance deficits from vestibular, increased tone, ataxia/incoordination
True/False- Patients with TBI tend to have problems with the identification or timing of the perception of a visual stimulus.
False- tend to NOT have problems
True/False- Patients with TBI tend to have difficulties with target following, dynamic visual acuity, and gaze stabilization
TBI mobility deficits
Mobility deficits will coincide with the typical deficits observed with a particular lesion located.
TBI Visual Disturbances
anomalies of accommodation
visual field integrity
What is vergence?
turning of one eye in reference to the other; nonstrabismic, as well as strabismic- optic axes cannot be directed to the same object, resulting in diplopia or one eye squinting
Headaches occur in what % of TBI patients?
80% of cases of headaches resolves in how many months?
Unfavorable prognostic factors for headaches include:
an age >40, a low intellectual, education, and socio-economic level, previous head trauma, or a history of alcohol abuse
Most causes of headaches are
posttraumatic cervicogenic headache or symptomatic, secondary headaches due to SDH, SAB, ICB, or increased ICP
If the cause of the headache is cervicogenic, what may be helpful for the patient.
cervical collar for a short time, head and muscle relaxation techniques
TBI- somatic pain
pain may also be present or exaggerated, particularly with uncomfortable positioning or stretching.
Sympathetic Storm is also known as
paroxysmal sympathetic hyperactivity
Sympathetic Storm occurs
-in up to 33% of patients with TBI in the ICU
-typically seen in patients who are in a coma
What causes the sympathetic storm
dysfunction of diencephalon or connections from diencephalon that mediate autonomic function
-Noxious stimuli may trigger storming
- may persist weeks or months depending on severity
S/S of sympathetic storm
intermittent agitation, diaphoresis, hyperthermia, HTN, tachycardia, tachypnea, extensor posturing
TBI Secondary Impairments
Seizures, DVT, pressure ulcers, pneumoia, chronic pain, contractures, decreased endurance, muscle atrophy, fracture, peripheral nerve damage
What % of patients with severe TBI will develop post-traumatic seizures?
TBI medical diagnosis is determined by...
HPI, neurologic exam, GCS and imaging (CT and/or MRI)
Determining brain death
Irreversible cessation of all functions of the entire brain including cerebrum (lack of response to pain), brainstem (absent brain stem reflexes- pupil, corneal, dolls eyes- negative if reflex is absent)
Loss of activity is deemed irreversible if all the following conditions are met:
1. the cause of the coma is established
2. there is no possibility of recovery of brain funtion
3. the cessation of brain function persists for an appropriate period of time
Medical intervention for intracranial pressure (ICP)
Neurosurgeon is often called in to place an ICP bolt in the subarachnoid space of a shunt can be placed where CSF is actually drained from the brain down into the peritoneal cavity or right atrium.
Normal ICP level
15 mm Hg
What is something you can do if the ICP goes above 20
raise the HOB to 30 deg.
ICP levels effect from exercise
PROM decreases ICP, AROM yields no change, isometrics increase IP in patient with normal ICP, isometrics do not further increase ICP in a patient whose ICP is elevated.
Surgical interventions for increased ICP
craniotomy with evacuation of edema and/or bleeding or craniectomy are other surgical procedures that are performed to relieve pressure on the brain.
Medical/surgical interventions for body temperature regulation
hypothermia to 32 deg C for a 24-hr period soon after onset results in better functional outcomes 3-6 months later in patients with GCS scores on admission of 5-7.
Hyperthermia (>37.5 deg C) can be deleterious to the recovery of someone with TBI
Medical interventions for behavior and cognition
With agitation, pharmacological agents are available but sedation is a concern, esp if Haldol or benzodiazepines are used.
This medication administration along with rehab services has been shown to provide faster and greater improvements in cognitive recovery
bromocriptine- a dopamine agonist also used in patients with parkinson's
Medical interventions for spasticity
Physical Therapy Exam/Interventions - Ranchos Scale 1-3
-SBP >90 O2 above 90
-Co-treating is often appropriate
-Evaluate PROM, spontaneous activity, response to stimulation from environment, reflexes
-Exam of gross motor skills should wait until patient is alert enough to have a sense of what you are doing.
-early bed mobility/transfers = Total A
PT considerations - Rancho 1-3 ROM
All major joints are susceptible to developing joint contractures but the most common problem occurs with plantarflexor contracture.
Mobilize the scapula during shoulder PROM in supine
What % of patient with TBI with develop contractures that are secondary to what.
Secondary to spastic hypertonia, improper positioning, and/or inadequate ROM ex.
This can be used to decrease spasticity and subsequent stiffness of ankle plantarflexors up to 24 hours
e-stim of tibialis anterior.
PT considerations based on Rancho scale 1-3 - Sensory Stimulation
Provide stimulation in a controlled, multisensory manner with intermittent periods of rest will stimulate the reticular activating system and cause a general increased in arousal
-auditory, visual, olfactory, tactile, vestibular
the most common form of stimulation. Talk to the patient as you would any other. Make sure you introduce yourself and tell the person what you're going to do to them. Make sure the TV or radio is not left on constantly.
youll often see pictures of family members in the room
the value of touch is easily underestimated. Touching someones hand is unlike touching any other part of their body.
can be provided by neck ROM, rolling on a mat, rocking, or pushing the patient in a wheelchair.
In a patient in a deep coma, patient response to stimulation will be reflected in what responses
With a medium coma, stimulation should result in
increased head and eye movements and spontaneous movements.
Positioning considerations based on Rancho 1-3
positioning assists with pulmonary hygiene, ROM, and skin integrity.
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