Traumatic Brain Injury

What is the leading risk factor for TBIs?

MVA, falls, high risk behaviors, gunshot wounds

Open injury

direct penetration through the skull to the brain

location, depth of penetration, and pathway determine extent of brain damage

ex: gunshot wound, knife or sharp object penetration, skull fragments, direct trauma

Closed injury

injury to the brain w/out penetration through the skull

ex: concussion, contusion, hematoma, injury to extracranial blood vessels, hypoxia, drug overdose, near drowning, acceleration or deceleration injuries

Primary injury

initial injury to the brain sustained by impact

ex: skull penetration, skull fractures, contusions in grey and white matter

coup & contrecoup

Coup lesion

a direct lesion of brain under the point of impact; local brain damage is sustained

contrecoup lesion

an injury that results on the opposite side of the brain

lesion is due to rebound effect of brain after impact

Secondary injury

brain damage that occurs as response to initial injury

ex: hematoma, hypoxia, ischemia, inc cranial pressure, post-traumatic epilepsy

Epidural hematoma

hemorrhage that forms b/w skull and dura mater

Subdural hematoma

hemorrhage that forms d/t venous rupture b/w dural and arachnoid

Levels of consciousness: coma

state of unconsciousness and unresponsiveness to all internal and external stimuli

Levels of consciousness: stupor

general unresponsiveness w/ arousal occurring from repeated stimuli

Levels of consciousness: obtundity

characterized by state of sleep, reduced alertness to arousal, and delayed responses to stimuli

Levels of consciousness: delirium

characterized by disorientation, confusion, agitation, loudness

Levels of consciousness: clouding of consciousness

characterized by quiet behavior, confusion, poor attention, delayed responses

Levels of consciousness: consciousness

a state of alertness, awareness, orientation, memory

According to the American Academy of Neurology, how are concussions classified? P. 277

through Grade levels (1-3)

Grade 1 - Minor (symptoms resolves in 15 min)

Grade 2 - Moderate (confusion last longer than 15 min w/ other symptoms involved)

Grade 3 - Severe (loss of consciousness)

Rancho Los Amigos Level of Cognitive Functioning: l

No response

pt appears to be in a deep sleep and is completely unresponsive to stimuli

Rancho Los Amigos Level of Cognitive Functioning: ll

Generalized response

pt reacts inconsistently and non-purposefully to stimuli in nonspecific manner; responses are limited and the same; responses may be physiological changes, gross body mvmt, vocalization

Rancho Los Amigos Level of Cognitive Functioning: lll

Localized response

pt reacts specifically, inconsistently to stimuli; responses are direct; may follow simple commands in an inconsistent, delayed manner

Rancho Los Amigos Level of Cognitive Functioning: lV

Confused-Agitated

pt is in a heightened activity; behavior is bizarre and non-purposeful; does not discriminate among persons/objects; unable to cooperate w/ treatment; inappropriate verbalization; confabulation may be present; gross attention to environment is brief; selective attention is nonexistent; pt lacks short and long-term recall

Rancho Los Amigos Level of Cognitive Functioning: V

Confused-Inappropriate

pt responds to simple commands fairly consistently; responses are non-purposeful, random, or fragmented; demonstrates gross attention to environment; highly distractable and lacks ability to focus attention on a specific task; short period of conversation; memory is severely impaired; inappropriate use of objects; may perform previously learned task w/ structure, unable to learn new info

Rancho Los Amigos Level of Cognitive Functioning: Vl

Confused-Appropriate

pt shows goal-direct behavior, dependent on external input or direction; follows simple direction and carryover for relearned task; responses may be incorrect d/t memory problems, but appropriate to situation; past memory show more depth and detail rather than recent memory

Rancho Los Amigos Level of Cognitive Functioning: Vll

Automatic-Appropriate

pt appears appropriate and oriented; goes through daily routines automatically, frequently robot-like; pt shows minimal to no confusion and has shallow recall of activities; shows carryover for new learning, but at a dec rate; w/ structure is able to initiate social or recreational activities; judgement remains impaired

Rancho Los Amigos Level of Cognitive Functioning: Vlll

Purposeful-Appropriate

pt is able to recall and interrogate past and recent events and is aware and responsive to environment; shows carryover for new learning and needs no supervision once activity is learned; may continue to show a dec ability relative to premorbid abilities, abstract reasoning, tolerance for stress, judgment in emergencies or unusual circumstances

Galsgow coma scale

a neurological assessment tool used initially after injury to determine arousal and cerebral cortex function

Total score of 8 or less = severe brain injury or coma

Score 9-12 = moderate brain injury

Score 13-15 = mild brain injury

What are the three tests utilized to determine score for Glasgow Coma Scale?

eye opening, best motor response, verbal response

Anterograde amnesia

inability to create new memory

memory is usually the last to recover after comatose state

contributing factors: poor attention, distractibility, impaired perception of stimuli

Post-traumatic amnesia

time b/w injury and when pt is able to recall events

pt does not recall injury or events leading up to point of recovery

is used as an indicator of extent of damage

Retrograde amnesia

inability to remember events prior to injury

may progressively dec w/ recovery