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148 Cards in this Set
- Front
- Back
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The two forms of brain injury |
Congenital Acquired |
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The two forms of Acquired brain injury |
Traumatic Non-Traumatic |
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The two forms of traumatic brain injuiry |
closed open |
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What is a traumatic brain injury? |
Mechanical trauma to the brain as a result of strong forces to the brain |
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What is the leading cause of TBI? |
Motor Vehicle Accident |
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What are the 6 mechanisms of TBI injury? |
Coupe-Contre-Coupe Assault from one direction Cerebral Contusion Cerebral laceration Diffused axonal injury Deprived Oxygen |
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Which brain lobes does a coupe-contre-coupe affect? |
Front and occipital |
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In assualt from one direction, what happens in the brain when the force is applied? |
The force moves across the brain to the opposite side, and to areas of low pressure, down the brain stem |
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What is a cerebral contusion? (2 points) |
Bruise of the brain Swelling and capillary hemorrahge |
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What is a cerebral laceration? (3 points) |
Tears in neural tissue Brain pulls away from skull affecting connective tissue and layers (pia-arachnoid memberane) Brain hits bony prominances |
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What is diffused axonal injury? |
shearing of CNS axons as a result of twisting in the skull
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What part of the brain is affected in diffused axonal injury? |
The frontal bottom of the brain (emotional regulation) because of the location where axons are going down to the spinal cord is sharp |
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Diffused axonal injury is devestating: T/F? |
True |
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Give an example of a diffused axonal injury situation? |
Shaken Baby Syndrome |
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What does Anoxia mean? |
no oxygen |
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What does Hypoxia mean? |
low oxygen |
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How do oxygen levels cause brain injury? |
Lack of oxygen leads to cell death, loss of brain tissue, permanent deficiets |
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What are some causes of oxygen deprivation in the brain? |
Drowning, CO poisoning, heart attack |
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What term accounts for the fact that some brain injuries don't seem symptomatic at first, but then become significant? |
Secondary injury |
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What causes secondary injury? |
Physiological response to injury |
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The CNS recovers by regenerating neursons: T/F? |
False. The CNS contains factors that inhibit axonal growth |
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The CNS recovers by re-wiring remaining neurons: T/F? |
True. |
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Name 2 ways that the CNS re-wires itself |
Axonal Sprouting: more synaptic junctions Activation of Parallel pathways |
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What does Neurogenesis mean? |
Growth of new neurons |
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Name 1 place in the CNS where neurogenesis takes place |
The hippocampus |
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2 factors that promote neurogenesis |
Aerobic Exercise Mental Stimulation |
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3 Factors that diminish neurogenesis |
Stress, Depression, Chemotherapy |
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Primary damage can be _________ or ___________ |
focal or diffused |
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What are the 2 most common and long-lasting consequences of TBI? |
Cognitive Behavioural |
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What are 4 common cognitive deficits? |
-Difficulty remembering new info -Visual & Perceptual problems -Decreased ability to process info -Executive dysfunction |
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Secondary damage primarily results from which physiological symptom? |
lack of oxygen |
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5 complications of TBI |
Seizures Hydrocephalus Extremity injuries (eg fractures) Cardiovascular Pressure ulcers (in comatose pts) |
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Name the 8 layers of the skull to brain |
Cranium Periosteum Dura Matter Subdural Space Arachnoid Matter Subarachnoid space Pia Matter Cerebrum
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Which layer of the skull is the meningal artery found in? |
In the dura matter |
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Which layer of the skull are the veins found in? |
The subdural space |
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Which layer of the skull are the arteries found in? |
The Subarachnoid space |
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What is an epidural hematoma? |
Torn Meningeal artery |
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What happens in an epidural hematoma? |
blood fills the extradural space (between the skull and the dura) |
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Epidural hematoma: Slow deterioration or Quick deterioration? |
Quick |
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What is a subdural hematoma? |
Tearing of veins in the subdural space (between dura and arachnoid) |
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Subdural hematoma: slow deterioration or quick deterioration? |
slow |
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2 types of subdural hematoma |
Acute Chronic |
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What is a concussion? |
Any injury of the brain resulting from an impact |
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What is the most reliable indicator of concussive injury severity? |
Duration of unconsciousness |
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What is a coma? |
profound state of unconsciousness |
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What are the 4 levels of coma? |
Coma Vegetative State Minimally Conscious Abnormal Posturing |
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What is decerebrate rigidity? |
Extensor posturing d/t loos of extensor inhibition |
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What tracts are implicated in decerebrate rigidity? |
Reticulospinal and Vestibulospinal |
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What is decorticate rigidity |
Flexor posturing d/t reduced flexor inhibition |
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Which tracts are implicated in decorticate rigidiy? |
Rubiospinal tract |
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Name 5 scales of TBI severity rating |
Glasgow Coma Scale Disability Rating Scale Rancho Los Amigos Level of Cognitive Functioning Galveston Orientation and Amnesia Test Duration of Post Traumatic Amnesia |
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Which severity scale is most commonly used? |
GCS |
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Which severity rating scale is used at discharge? |
DRS |
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The GCS can determine prognosis: T/F? |
True |
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3 components of the GCS |
Eye opening motor response verbal response |
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GCS in mild TBI |
13-15 |
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GCS in moderate TBI |
9-12 |
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GCS in severe TBI |
1-8 |
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4 categories of the DRS |
-arousability, awareness, responsivity -cognitive ability for self-care -dependence on others -psychosocial adaptability |
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How many levels does the Rancho LCFS have? |
8 |
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Rancho LCFS Level 1 description |
no response to stimuli |
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Rancho LCFS Level 2 description |
general response to painful stimuli |
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Rancho LCFS Level 3 description |
responds directly to stimuli responds inconsistently to simply commands |
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Rancho LCFS Level 4 description |
brief and non-purposeful attention |
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Rancho LCFS Level 5 description |
inconsistently responds to simple commands |
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Rancho LCFS Level 6 description |
Consistently follows simple directions |
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Rancho LCFS Level 7 description |
unaware of own limitations |
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Rancho LCFS Level 8 description |
purposeful and orientated |
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GOAT score is out of? And what is normal? What is impaired? |
/100 >76 is normal <66 is imparied |
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8 areas of OT assessment in TBI |
Tone Primitive Reflexes Ataxia ROM & MMT Functional Endurance Sensation Cognitive Psychosocial |
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Spasticity/Hypertonia: definition |
involuntary increase of muscle resistance |
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Spasticity/Hypertonia can lead to: |
contractions (permanent shortening) |
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Flaccidity/Hypotonicity: definition |
decreased muscle tone |
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Flaccidity/Hypertonicity is attributed to: |
peripheral nerve injury |
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If damage in in mid-brain, which primitive reflex is impaired? |
righting reaction |
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If damage is in basal ganglia, which primitive reflex is impaired? |
Equilibrium reaction |
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Ataxia is caused by: |
damage to the cerebellum |
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4 areas of psychosocial that we can assess |
Self-Concept Social roles Affective change Independent living status |
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Rancho LFCS level 1-3 Assessment areas (7 points) |
Arousal & Cognition Vision Sensation ROM Motor Control Dysphagia Emotion |
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Rancho LFCS level 1-3 Treatment (5 points) |
sensory stimulation positioning splinting family & caregiver education PREVENT DETERIORATION |
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Rancho LFCS level 4-8 Assessment areas (11 points - get 6) |
ROM & MMT Sensation Proprioception Fine & Gross motor control Static & Dynamic balance Cognition Vision Perception ADL & IADL Vocation Rehab Psychosocial |
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Assessments for motor control (4 - name 1) |
Jebsen Hand Function Test Minnesota Rate of Manipulation Tests Minnesota Manual Dexterity Tests Purdue Pegboard |
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Assessments for cognition (5 - name 2) |
Allen Cognitive Level Screen Loewenstein Occupational Therapy Cognitive Assessment Rivermead Behavioural Memory Test Kohlman Evaluation of Living Skills Cognitive Assessment of Minnesota |
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Components of vision to assess (4) |
Visual attention Near and distant acuities Depth perception Visual field function |
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Assessments for Perception (3 - name 1) |
Hooper visual organization test Motor-free visual perception test Rivermead Perceptual assessment battery |
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Assessment for ADL/IADL (2) |
FIM Observation |
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Rancho LFCS level 4-8 Treatment (11 - name 6) |
ADLs & IADLs Behaviour Management Cognitive strategies Social skills Wheelchair management Energy conservation Environment Modification Community re-integration Driving Education Work skill training |
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Treatment Considerations (5 points) |
minimize distraction short-term attainable goals easy to understand directions non-threatening body language frequent reassurance and reorientation |
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Rate of TBI in Men vs Women |
3x more common |
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What is post-traumatic amnesia? |
time period post-trauma for which the patient has no recall of events |
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why is post-traumatic amnesia significant? |
proportional to injury severity |
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Which age group has the worst prognosis with brain injury? |
+65 |
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The 4 rankings of post-traumatic amnesia severity |
<1hr - mild 1-24 hrs - moderate 1-7 days - severe >7 days - very severe |
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Diffused Axonal Injury will always be visible on imaging: T/F? |
False |
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What is decompressive crainectomy? |
Removing a skull portion to relieve pressure |
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Role of OT in acute TBI (4 points) |
Splinting Positioning Initial assessment Determine discharge location (potential for rehab) |
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Domains assessed by OT in inpatient TBI (6 points) |
Transfers ADLs U/E function Vision Cognition Community Access |
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U/E Assessments (5 points) |
Med Hx ROM & MMT Dynamometer Box & Blocks Pegboard |
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3 Differences between TBI and Stroke |
TBI more generalized - Stroke localized 4 limbs affected in TBI, Hemi in Stroke TBI may have other physical injury |
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7 U/E Impairments with TBI (name 4) |
Hemiparesis/plegia Hyper/Hypo tone Ataxia Nerve injury Orthopedic injury Adhesive Capsulities Heterotropic Ossification |
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What is adhesive capsulitis? |
Frozen shoulder |
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What causes adhesive capsulities? |
immobilization/lack of active mvt |
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What are the 3 symptoms of adhesive capsulitis? |
pain, stiffness, limited ROM |
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What is Heterotopic Ossification? |
New bone formation in tissue where bone does not normally form |
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7 Signs of Heterotopic Ossification (name 4) |
decreased ROM pain edema spasticity palpable mass skin redness fever |
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Treatment for Heterotopic Ossification (3 points) |
maintain ROM Meds Surgery |
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Surgery to remove heterotopic ossification is a permanent fix: T/F? |
False. 100% re-occurance. |
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2 locations in body where heterotopic ossification is common |
elbow hips |
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What is a snellen chart? |
A chart to test visual acuity (the one with the letters that get smaller each line) |
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What is Diplopia |
double vision |
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What causes diplopia? |
Usually cranial nerve damage, causing difference in eye position or tracking |
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What is ptosis? |
dropping of the eyelid due to muscle weakness |
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5 interventions for visual field deficits |
scanning paper & pencil exercises lighthouse strategy dynavision IADL retraining |
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What is the cognitive domain of orientation? |
person, place, time, circumstance
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treatment for disorientation (2 points) |
repetitive rehearsal external aids |
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Why is executive functioning affected in brain injury? |
Damage to the frontal lobe |
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Types of attention (4 points) |
Focused, sustained, alternating, divided |
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You need attention in order to have __________ (a different cognitive domain) |
memory |
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What is divided attention? |
Focusing on more than one thing at a time |
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What is alternating attention? |
Switching between tasks |
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Strategies for attention (compensatory) (4 points) |
Environmental (quiet, declutter, avoid busy places) External aids Energy conservation Break tasks down to little steps |
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Rehab for attention (3 points) Which is best according to literature? |
Paper & Pencil Scanning Technology Functional practice *** best |
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What is memory? |
Process by which we encode, store, and retrieve information |
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Compensatory strategy for memory (1 point) |
external aids |
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Lack of insight is common in moderate-severe TBI: T/F? |
True. |
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When patients regain insight, their mood improves: T/F? |
False. It usually worsens. |
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Common behavioural problems in TBI (6 - name 4) |
Anger Agitation Non-compliance Aggression Depression Irritibility |
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Treatment for Agitation (2 points) |
medication education |
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Who's responsibility is it to report loss of driving abilities to the motor department? (in Alberta) |
Patient's |
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How many Canadians incur a TBI each year? |
~166,000 |
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How many people die in Canada each year from TBI? |
~11,000 (>50% of all trauma deaths) |
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What is the immediate medical costs of a severe TBI? |
>$400,000 |
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How much does TBI cost Canada each year? |
$3 Billion |
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TBI: Definition |
Traumatically induced structural injury and/or physiological disruption of brain function as a result of external force |
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5 Events to Diagnose TBI |
Loss of Consciousness Post-traumatic Amnesia Alteration of Consciousness Neurological deficits Intracranial Lesion |
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Mild TBI Criteria: Structural imaging ? LOC ? AOC ? PTA ? GCS ? |
Normal 0-30min 0-24 hours 0-1 day 13-15 |
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Moderate TBI Criteria: Structural imaging ? LOC ? AOC ? PTA ? GCS ? |
Normal or abnormal 0.5-24 hours >24 hours 1-7 days 9-12 |
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Severe TBI Criteria: Structural imaging ? LOC ? AOC ? PTA ? GCS ? |
Normal or abnormal >24 hours >24 hours >7 days <9 |
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Bomb blast TBIs are comprised of 3 mechanisms of injury- which ones? |
Direct Indirect Coupe-contra-coupe |
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Immediate physiological symptoms of TBI (12 - name 6) |
Pupil asymmetry seizures vomiting double vision headache disorientation altered consciousness unusual behaviour slurred speech unsteadiness weakness or numbness in extremities |
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Conclusions on treating TBI (3 points) |
Promote recovery and avoid harm Patient-centered TBI - is time-limited and predictable in course |
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Military TBI vs Civilian TBI (4 points) |
different injury environments different mechanism of injury different array of injuries more prone to co-morbities |
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Compared to civilians, military persons have ________ stressors and ________ resilience |
increased decreased |
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What is an Operational Stress Injury? |
Any physiological difficulty resulting from duty Can be PTSD, anxiety, substance use etc |
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TBI __________ risk of PTSD PTSD _________ risk of TBI |
increases increases |
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What % of veterens had either chronic pain, PTSD, or persistent post-concussive syndrome? |
96.5% |
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What % of veterans had chronic pain, PTSD, AND persistent post-concussion syndrome? |
46% |
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TBI Management in Veterans (7 - name 3) |
Include family Education Focus on positive outcomes Sleep hygiene Relaxation technique Self-Management Substance use reduction |
