3.2 Traumatic Brain Injury

Bruise behind the ear

Battle sign

Bruise around the eyes

Raccoon eyes

Late signs of basilar skull fracture following head trauma

• Battle sign

• Raccoon eyes

DTR: Biceps

C5-C6

DTR: Brachioradialis

C6-C7

DTR: Triceps

C7-C8

DTR: Patellar

L2-4

DTR: Achilles tendon

S1

Pathologic reflexes

Abnormal skin & muscle reflexes

Cremasteric reflex

Anal pucker & bulbocavernosus reflex

Plantar reflex

Pathologic reflexes: Abnormal skin and muscle reflexes

Upper quadrant - T8-9

Lower quadrant - T11-12

Beevors sign

Pathologic reflexes: Cremasteric reflex

Afferent: L1

Efferent: L2

Pathologic reflexes: Anal pucker reflex

S4-S5

Pathologic reflexes: Bulbocavernosus reflex

S3-S4

Pathologic reflexes: Plantar reflex

Babinski maneuver

Afferent: S1

EfferentL L5-S2

Sensory:

Superficial sensory modalities

Deep sensory modalities

Determine the distribution pattern

Sensory: Superficial sensory modalities

Light touch

Temp

Pain perception

Sensory: Deep sensory modalities

Vibration

Position

Asterognosis

Romberg test

Severe TBI: Low arousal state & abnormal tone: Pts in coma, vegetative state, or minimally conscious states may exhibit

Abnormal tone (spastic hypertonia)

Primitive postures

Severe TBI: Low arousal state & abnormal tone: Pts in coma, vegetative state, or minimally conscious states may exhibit: Primitive postures

• Decorticate rigidity

• Decerebrate rigidity

Severe TBI: Low arousal state & abnormal tone: Pts in coma, vegetative state, or minimally conscious states may exhibit: Primitive postures: Decorticate rigidity

UE flexion

LE extension

Severe TBI: Low arousal state & abnormal tone: Pts in coma, vegetative state, or minimally conscious states may exhibit: Primitive postures: Decerebrate rigidity

UE and LE extension

__ levels of cognitive functioning tool

Rancho los amigos levels of cognitive functioning (LOCF)

Rancho los amigos levels of cognitive functioning (LOCF)

1-8

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names

1. No response

2. Generalized response

3. Localized response

4. Confused-agitated

5. Confused-inappropriate

6. Confused-appropriate

7. Automatic-appropriate

8. Purposeful-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt appears to be in deep sleep and is completely unresponsive to stimuli

1. No response

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt reacts inconsistently and nonpurposefully to stimuli in nonspecific manner

2. Generalized response

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Responses are limited and often the same regardless of stimulus presented

2. Generalized response

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Responses may be physiological changes, gross body mvts, and/or vocalization

2. Generalized response

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt reacts specifically but inconsistently to stimuli

3. Localized response

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Responses are directly related to the type of stimulus presented

3. Localized response

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: May follow simple commands such as closing eyes or squeezing hand in an inconsistent, delayed manner

3. Localized response

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt is in a heightened state of activity

4. Confused-agitated

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Behavior is bizarre and nonpurposeful relative to immediate environment

4. Confused-agitated

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Does not discriminate among persons or objects; is unable to cooperate directly with tx efforts

4. Confused-agitated

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Verbalizations frequently are incoherent and/or inappropriate to the environment; confabulation may be present

4. Confused-agitated

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Gross attention to environment is very brief; selective attention is often nonexistent

4. Confused-agitated

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt lacks short term recall

4. Confused-agitated

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt is able to respond to simple commands fairly consistently

5. Confused-inappropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: With increased complexity of commands or lack of any external structure, responses are nonpurposeful, random, or fragmented

5. Confused-inappropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Demonstrates gross attention to the environment but is highly distractible and lacks ability to focus attention on a specific task

5. Confused-inappropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: With structure, may be able to converse on a social automatic level for short periods of time

5. Confused-inappropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Verbalization is often inappropriate and confabulatory

5. Confused-inappropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Memory is severely impaired; often shows inappropriate use of objects; may perform previously learned tasks c structure but is unable to learn new information

5. Confused-inappropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt shows goal-directed behavior but is dependent on external input or direction

6. Confused-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Follows simple directions consistently and shows carryover for relearned tasks such as self care

6. Confused-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Responses may be incorrect d/t memory problems, but are appropriate to the situation

6. Confused-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Past memories show more depth and detail than recent memory

6. Confused-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt appears appropriate and oriented within the hospital and home settings; goes thru daily routine automatically, but frequently robot-like

7. Automatic-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt shows minimal to no confusion and has shallow recall of activities

7. Automatic-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Shows carryover for new learning but a decreased rate

7. Automatic-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: With structure is able to initiate social or recreational activities; judgement remains impaired

7. Automatic-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Pt is able to recall and integrate past and recent events and is aware of and response to environment

8. Purposeful-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: Shows carryover for new learning and needs no supervision once activities are learned

8. Purposeful-appropriate

Rancho los amigos levels of cognitive functioning (LOCF): Stages: Names: __: May continue to show a dec ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgement in emergencies or unusual circumstances

8. Purposeful-appropriate