NeuroPT - 17 - Acquired Brain Injury

acquired brain injury

an _____________ is a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairments of cognitive, physical, and psychosocial functions with an associated diminished or altered state on consciousness

complex

with moderate to severe TBIs, this population is typically very _______ and has multiple body systems affected, with a high likelihood for secondary impairments and behavioral issues

prevention

________ is the only successful cure for moderate-severe TBIs

falls :(

the leading cause of TBI in the under 4 and over 75 populations are ______

MVA

the leading cause of TBI in the 15-24yo population is _______

open

a/n ______ TBI is when an object enters the skull

closed

a/n ______ TBI

focal

a ______ injury is to a specific area of the brain under the site of impact

• hemorrhage/hematoma, edema, contusion

• coup-counter injury

examples of focal brain injuries: (2)

diffuse

a ______ brain injury would be an axonal injury, a hypoxic ischemic injury, or increased intracranial pressure

epidural

a/n________ brain bleed is the buildup of blood between the bones of the skull and the dura mater

subdural

a/n_________ brain bleed is a buildup of blood between the dura and the brain tissue itself

subarachnoid/intracerebral

a/n__________ brain bleed is bleeding deeper inside the brain

pressure

bleeding inside the skull causes increased ________

• drowsiness or confusion

• vomiting and nausea

• blurred vision

• pupil asymmetry

• loss of consciousness

• memory loss

• irritability

• headache

signs of a hemorrhage/hematoma:

coup

(coup/contracoup) injuries occur at the site of direct impact to the skull

contracoup

(coup/contracoup) injuries occur at the opposite side of the direct impact

diffuse axonal

a __________ injury is the disruption and tearing of axons and small blood vessels causing neuronal death

hypoxic ischemic

a ___________ injury is a lack of oxygenated blood flow to brain tissue

surgery

a hypoxic event is a risk of any __________

intracranial pressure ICP

increased _____________ can cause secondary cell death and higher mortality rates, and should be monitored and prevented/treated

increased ICP

________ is the most common cause of death after TBI

helmet

if a patient has had a craniotomy they need to wear a ______ when out of bed

DYNAMIC

ICP is ________ and constantly fluctuating

IAP

increased ______ pressure increases ICP

7-15

normal ICP is ___-___ mmHg

16-20

mildly elevated ICP is ___-___ mmHg

21-40

moderately elevated ICP is ___-___ mmHg

>40

ICP over ___ mmHg is considered critical

O2 delivery

increased ICP means there is less _________ to brain tissue

• head elevation ~30 deg

• steroids

• diuretics

• CSF drainage

4 ways to acutely manage elevated ICP:

• behavior changes

• decr consciousness

• headache

• lethargy

• neurological symptoms (weakness, numbness, double vision)

• seizures

• vomiting

RED FLAGS for increases in ICP:

paroxysmal sympathetic hyperactivity PSH

______________ ie excessive sympathetic nervous system activity that appears unprovokes, but often occurs after discontinuation of administration of sedatives and narcotics in the ICU

• ataxia: basically hypermetria w movement

• apraxia: PERCEPTUAL understanding of movement

what is the difference between ataxia and apraxia? definitions of both

trick question - all four

• motor output

• sensory input

• cognitive

• perceptual

which of the four types of impairments are possible with moderate-severe TBIs?

time

after TBI patients often need more _______ for executive functioning

JFK coma recovery

the ___________ scale is used to determine the severity of brain injury acutely, and has more detail than the glasgow coma scale; intended to be repeated to see what areas are making improvement

• motor response

• verbal response

• eye opening

the three categories of scoring for the glasgow coma scale are:

4-8

a glasgow coma scale score of ___-___ is considered a coma (minimally conscious)

3

a glasgow coma scale score of less than _____ is considered a vegetative state

COGNITIVE RECOVERY

the ranchos los amigos levels describe the levels of ___________ and we can use this to determine how much assistance we may need to provide

4

level ___ of rancho los amigos for cog functioning is infamous because emerging is agitated and confusion trying to orient

lower

a (higher/lower) rancho los amigos level of cognitive functioning indicates MORE impairments

quieter

brain injury recovery units are often much _______ than other rehab settings for decr stimulation

**go look at de-escalation techniques

**go look at de-escalation techniques

push into

if a patient bites you, _________ the bite

move closer

if a patient grabs your hair, grab their hand and _________

*do we need to know detailed ranchos los amigos levels? idk

*do we need to know detailed ranchos los amigos levels? id