Traumatic Brain Injury & Related Concepts

Vocabulary flashcards summarizing major traumatic brain injury terms, mechanisms, clinical signs, and assessment scales discussed in the lecture.

Brunnstrom Stages

Sequential stages of motor recovery after stroke that clinicians must know (Stage I–VI).

Ischemia

Lack of blood flow; one primary mechanism of cerebrovascular accident (stroke).

Hemorrhage

Bleeding into brain tissue; alternate mechanism of stroke distinguished from ischemia.

Traumatic Brain Injury (TBI)

Damage to the brain from external force; may produce cognitive, emotional, behavioral, and physical impairments.

Penetrating (Open) Head Injury

TBI in which an object breaches the skull, raising infection risk and often requiring surgical repair.

Non-penetrating (Closed) Head Injury

Blunt TBI where skull remains intact but brain moves within cranium causing injury.

Diffuse Axonal Injury (DAI)

Shearing of axons as brain moves against rough skull floor; major mechanism of severe TBI and shaken-baby syndrome.

Coup Injury

Primary brain lesion occurring at the site of impact.

Contrecoup Injury

Secondary lesion on the opposite side of initial impact when brain rebounds.

Concussion

Mild TBI; may occur without loss of consciousness and present with dazing, headache, or cognitive issues.

Grade 1 Concussion (Bell Rung)

Mild concussion with transient confusion but no loss of consciousness.

Rancho Los Amigos Scale

Ten-level scale describing cognitive & behavioral recovery after TBI (Levels I–X).

Glasgow Coma Scale (GCS)

Score (3–15) assessing eye, verbal, motor responses to classify TBI severity.

Subdural Hematoma

Venous bleed beneath dura; slower onset, can evolve over days to a week.

Epidural Hematoma

Arterial bleed between skull and dura; rapid onset requiring urgent care.

Hydrocephalus

Excess cerebrospinal fluid causing increased intracranial pressure after injury.

Basilar Skull Fracture

Break at skull base; may produce ear bleeding and periorbital ecchymosis (raccoon sign).

Raccoon Sign

Bilateral periorbital bruising indicating possible skull fracture.

Projectile Vomiting

Forceful vomit associated with severe concussion or intracranial hemorrhage.

Photophobia

Light sensitivity often seen after head injury.

Primary Brain Injury

Immediate damage from impact (contusion, laceration, DAI).

Secondary Brain Injury

Cascade of inflammation, swelling, apoptosis causing additional neuronal loss post-impact.

Retrograde Amnesia

Loss of memory for events before the injury.

Anterograde Amnesia

Inability to form new memories after the injury.

Decorticate Rigidity

UE flexion & LE extension posture indicating damage above red nucleus; less severe than decerebrate.

Decerebrate Rigidity

UE & LE extension posture from midbrain/brainstem lesion; signifies more severe injury.

Ataxia

Lack of coordinated movement that may appear after TBI.

Apoptosis

Programmed cell death contributing to secondary neuronal loss after injury.

Brunnstrom Stage I

Immediately after stroke, there is no voluntary movement or reflex activity ; the limb is flaccid

Brunnstrom Stage II

Basic limb synergies or some components of the synergies may appear as associated reactions, or minimal voluntary movement responses may be present. Spasticity begins to develop.

Brunnstrom Stage III

Marked spasticity where the synergies or components of the synergies are performed voluntarily.

Brunnstrom Stage IV

Movements that deviate from the basic synergies can be performed. Spasticity begins to decrease.

Brunnstrom Stage V

More complex movements independent of the synergies are possible. Spasticity continues to decrease.

Brunnstrom Stage VI

Spasticity has disappeared, and individual joint movements are possible, and coordination approaches normal.

Rancho Los Amigos Level I (No Response)

No response to sound, touch, sight, or movement. Patient appears to be in a deep sleep or coma.

Rancho Los Amigos Level II (Generalized Response)

Generalized reflex response to pain. Patient may respond to repeated visual or auditory stimuli with body movements, but responses are inconsistent and non-purposeful.

Rancho Los Amigos Level III (Localized Response)

Patient blinks at strong light, turns toward sound, responds to physical discomfort. May follow simple commands in an inconsistent or delayed manner.

Rancho Los Amigos Level IV (Confused-Agitated)

Patient is alert and in a heightened state of activity. Purposeful attempts to remove tubes or restraints, may cry out or scream, aggressive behavior, absent short-term memory.

Rancho Los Amigos Level V (Confused-Inappropriate, Non-agitated)

Patient is alert but not agitated. May wander randomly or with vague intent. Inappropriate use of objects. Unable to learn new information, but is able to perform highly familiar tasks.

Rancho Los Amigos Level VI (Confused-Appropriate)

Beginning memory of recent events. Able to attend to a familiar task for 30 minutes with redirection. Recognizes staff and family. Max assist for problem-solving.

Rancho Los Amigos Level VII (Automatic-Appropriate)

Patient is oriented to person and place within familiar environments. Minimal supervision for new learning. Initiates and carries out familiar tasks. Judgement is impaired.

Rancho Los Amigos Level VIII (Purposeful-Appropriate (Stand-By Assistance))

Patient is independently attends and completes familiar tasks for 1 hour. Uses assistive devices as appropriate. Requires no supervision, but subtle impairments in reasoning, tolerance for stress, judgment persist.

Rancho Los Amigos Level IX (Purposeful-Appropriate (Stand-By Assistance On Request))

Patient is able to independently shift between tasks and complete them accurately. Awareness and acknowledgement of impairments even if not always able to predict them. Requires Stand-By Assistance on Request for problem-solving.

Rancho Los Amigos Level X (Purposeful-Appropriate (Modified Independent))

Patient is able to multitask in many different environments. May require periodic breaks. Uses compensatory strategies. Able to independently anticipate and avoid problems. Depression and irritability may occur.