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59 Cards in this Set
- Front
- Back
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What is a focal injury
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-coup-contracoup (caused by a blunt trauma)
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what is diffuse axonal injury
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usually a result of deceleration in a MVA, usually causes instant loss of consciousness and several pts stay in a vegetative state, most pts don't regain consciousness
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what is hypoxic-ischemic injury
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usually caused by events such as cardiac arrest, near drowning, near hanging, carbon monoxide etc. Generally speaking is a dangerously low amount of blood flow and/or oxygen flow
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what is increased intracranial pressure
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swelling, increased blood in area
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what is the problem with blast injuries
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because they are "silent" and full effects may not be seen for awhile. Common cause of polytrauma
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what is the "take home point" of blast injuries
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-100% c/o P!, 30% have "mental issues" 93% have TBI
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what is the "polytruma triad"
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TBI, PTSS, pain
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what are the common problems with blast injuriest
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HA, fatigue
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what makes pain management so difficult to get under control
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because several comorbid cognitive, medical & emotional impairments
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what can blast injuries result in: (4)
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-peripheral hearing loss
-central auditory processing deficits -vestibular deficits -tinnitus |
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what factors making hearing and vestibular assessment difficult
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co-morbid attention and cognition
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what are the impairments that are associated with TBI (7)
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-cognitive
-behavioral -communication -dysphagia -visual -perceptual -neuromuscular |
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Describe the following:
Coma |
unresponsiveness, GCS 8
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Describe the following:
vegetative state |
sleep-wake cycles, nothing purposeful
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Describe the following:
persistent vegetative state |
more than 1 month
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Describe the following:
stupor |
general unresponsiveness, breifly aroused by vigorous stimulation
no meaningful interaction |
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Describe the following:
obtunded |
heavy sleep but arousable
dulled, not responsive |
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Describe the following:
minimally conscious state |
severely altered consciousness with minimal but definite evidence of awareness of self/environment
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what cognitive deficits are associated with TBI/ABI (5)
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-attention (decreased selective attention and perservation_
-confusion (decreased orientation and inability to comprehend tasks/events) -lack of insight (decreased awareness of impact of behavior, decreased safety awareness) -inability to problem solve -memory deficits (post traumatic amnesia, impact of memory deficit on new learning) |
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what behavioral impairments are associated with TBI (5)
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-dis inhibition
-apathy -aggression -low frustration tolerance -depression |
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what communication impairments are associated with TBI/ABI (4)
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-dysarthria
-apraxia -aphasia -difficult to differentitate between communication and cognitive deficits |
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swallowing impairments that are associated with TBI/ABI may be due to what (4)
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-cranial nerve damage
-motor control deficit -apraxia -poor postural control -beware of aspiration precautions |
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what visual impairments are associated with TBI/ABI (3)
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-homonymous hemianopsia
-cranial nerve or occipital lobe damage |
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what perceptual impairments are associated with TBI/ABI (3)
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-spatial neglect
-R/L discrimination problems -spatial relations problems |
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what types of primitive postures may be seen in pts with TBI/ABI
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-decorticate
-decerebrate |
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what is decorticate posture
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-extended LE, and flexed UE
-Red nucleus NOT involved |
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what is decerebrate posture
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-extended LE and UE
-red nucleus IS involved |
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what neurmuscular impairments are associated with TBI/ABI (generally) (3)
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-sensory
-vestibular -motor |
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what type of sensory impairments are associated with TBI/ABI (3)
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-somatosensory deficits
-proprioceptive deficits -kinesthetic deficits |
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what types of motor impairments are associated with TBI/ABI (4)
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-weakness, focal lesions (paresis/paralysis)
-balance deficits -motor control deficits (timing, sequencing, scaling, coordination problems) -motor learning deficits |
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T/F: There is a high incidence of musculoskeletal and neurological injuries associated with TBI/ABI
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True: due to mechanism of injury (i.e MVA)
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T/F: Neuromuscular impairments are constant regardless of the environment
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FALSE, the more distracting an environment the more prominent the impairments appear to be. This is a good way to progress a pt. Introduce them to a more distracting environment.
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what are indirect impairments that are due to complexity of TBI and immobility (8)
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-contractures
-decubitus ulcers -DVT -HO -Osteoporosis -Atrophy -infection -pneumonia |
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Interventions: Special considerations for pts with TBI/ABI include:
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-seating/positioning/splinting
-serial casting |
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what type of loading does dynamic splints have
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-low long long duration to encourage permanent change in length
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how quickly will pt loose range if they don't work through
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2 weeks
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what are the "long term" composite impairments associated with TBI/ABI
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-HA
-fatigue |
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what are the medical issues you need to remember when working with pts
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-sxs of ICP
-medications associated with TBI and SE |
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Describe the Glascow Coma Scale
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-most common scale that is used acutely
-based on pts best : motor response, verbal response, eye opening response -scores range 3-15 |
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on the Glascow Coma scale what indicates the pt is in a coma
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less than or equal to 8
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on the Glascow coma scale what indicates a moderate brain injury
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9-12
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on the glascow coma scale what indicates a mild brain injury
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13-15
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what is the RLA levels of cognitive function
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-outlines a predictable sequence of cognitive and behavioral recovery seen with pts with TBI
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T/F: All pts go through all levels of RLA
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False, they can platuea at any stage
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T/F: Pts Don't skip stages of RLA
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False
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T/F: can use a range to describe a pts RLA
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True, since pts may display different eye opening, verbal and behavioral responses then a range is used.
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describe glawcow OUTCOME scale
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8 categories: eye opening, verbailization, motor response, feeding,
toileting, grooming, level of function, employabilty |
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For a low level RLA (I-III) what will make up your examination
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observation, posturing, any response to visual, tactile (sternal rub), auditory
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what intervetions do you use for a low level RLA (I-III)
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multi-sensory coma stimulation programs (incorporating sensation, olfaction, gustatory, vestibular and conversation)
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what are tools you can use for the multi-sensory coma stimulation (4)
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-coffee (smell)
-lemon, mint (gustatory) -conversation, playing music for 10-15 sec and waiting for 30 sec for response) -position (sitting to give normal sensory) |
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what are the characteristics of response of a pt when responding to mult-sensory coma stimulation (4)
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-latency
-consistency -intensity -duration |
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what is the goal of the multi-sensory coma stimulation
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-develop a consistent reliabile response with minimal latency
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what is involved with the examination of a pt with RLA IV
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-observation, remember that the pt is living in their head, try to gather as much info as possible
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what is important to incorporate into your intervention for RLA IV (5)
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-structure and consistency
-prevent over-stimulation -manage agitation -high success activities -** don't over-react to negative behavior and manage things in a neutral way |
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what are the special considerations for RLA IV (8)
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-daily routine is important
-provide frequency orientation -don't expect carry over -don't try to teach new skills -expect limited attention span -expect egocentricity -give pt limited control -model calm behavior |
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what is involved in the examination for RLA V-VI
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observation, posture, functional mobility ( do as much of a normal exam as possible...but be SIMPLE, STRUCTURED AND GO SLOW)
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What are special considerations/interventions for RLA V-VI (5)
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-structure continues to be important
-emphasize safety -speak slowly, allow processing time -use physical props (timer, schedule, memory book) -relearning, but not new learning at this level |
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what RLA level is a pt generally D/C from inpatient care
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-RLA VI
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what are special considerations for RLA VII-X (4)
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-Goal: wean pts from structure as move through stages
-NEW learning can occur, but SLOW -involve pts in decision making -emphasize judgement, problem solving, planning |
