PCS TBI flash cards

A pediatric brain injury should be considered an injury that changes over _____ and not a static, one-time injury.

time

The Pediatric Glasgow Coma Scale is commonly used for children younger than ______.

6 years (or 6)

In the Rancho Los Amigos Pediatric Level of Consciousness Scale, Level ___ reflects the highest level of function/consciousness.

I (or 1)

In children with acquired brain injury, duration of posttraumatic amnesia has been found to be more predictive of future memory function than _____ scales.

coma

Boys are at _____ risk for traumatic brain injury than girls.

higher (or increased or greater)

What is the most common cause of brain injury in newborns?

A) Shaken baby syndrome

B) Falls

C) Head injury during delivery

D) Motor vehicle accidents

C) Head injury during delivery

Which Rancho Pediatric Level of Consciousness indicates 'no response to stimuli'?

A) Level I B) Level III C) Level V D) Level II

C) Level V

What is the common cause of brain injury in infants?

A) Sports injuries B) Bicycle accidents C) Accidental head injury and abusive head trauma D) Delivery complications

C) Accidental head injury and abusive head trauma

For children with acquired brain injury during acute management, which positioning should be avoided?

A) Sidelying B) Semi-prone C) Supine D) All positions are acceptable

C) Supine

Which assessment tool can be used for children 6 years and older with brain injury?

A) PEDI B) Coma Recovery Scale C) GMFM D) WeeFIM

B) Coma Recovery Scale

A 3-year-old with acquired brain injury is at Rancho Pediatric Level II. What is an appropriate treatment strategy?

Simple task training using a highly structured, consistent, and reinforcing environment with frequent verbal, visual, and tactile feedback; short-interval treatment sessions; modification of tasks to ensure success

A child with brain injury has a Pediatric Glasgow Coma Scale score of 5. What does this suggest about their prognosis?

This suggests a potentially fatal outcome, as scores of 3-5 indicate poor prognosis

An infant who experienced brain injury responds to their name and recognizes their mother. At which Rancho Pediatric Level of Consciousness are they functioning?

Level II - Demonstrates awareness of environment

What positioning strategies should be implemented for a child in acute care following brain injury to prevent secondary impairments?

Positioning in sidelying and semi-prone positions (avoid supine), splints or serial casting to maintain ROM, early upright positioning in wheelchair when able, early weight bearing on tilt table when vitals are stable

A school-age child with brain injury is at Rancho Pediatric Level I. What treatment strategies are appropriate at this stage?

Practice progressively challenging functional and relevant tasks in various environments, reduce environmental restrictions, increase physical conditioning during developmental activities to facilitate muscle strengthening and cardiorespiratory fitness

A concussion is a type of head injury caused by a bump to the head or blow to a person's body that causes changes in the brain at a _____ level.

cellular

Brain rest is defined as decreased ______ stimulation.

cognitive

_______ to ninety percent of concussions will heal on their own within one month.

Eighty (or 80)

Children with prolonged concussion symptoms who do not recover within one month may be diagnosed with ____.

Post-Concussion Syndrome

Physical activities should be limited for _____ hours after a concussion, then gradual return to exercise should be permitted.

24-48

Which symptom is indicative of a more serious concussion?

A) Mild headache B) Fogginess C) Light sensitivity D) Irritability

B) Fogginess

Which test can be used for children 10 years and older with Post-Concussion Syndrome?

A) PEDI B) WeeFIM C) ImPACT test D) GMFM

C) ImPACT test

What is NOT a component of brain rest after concussion? A) Decreasing lighting B) Limiting use of electronics C) Immediate return to sports D) Decreasing noise

C) Immediate return to sports

Physical therapy for concussion management should be completed by a therapist who specializes in: A) Orthopedic therapy B) Vestibular therapy C) Aquatic therapy D) Sports therapy

B) Vestibular therapy

Which professional may assess a child with concussion using the ImPACT test? A) Occupational therapist B) Speech therapist C) Athletic trainer or physician D) School counselor

C) Athletic trainer or physician

A 12-year-old soccer player sustained a concussion 2 weeks ago and continues to have dizziness, headaches, and balance problems. What type of physical therapy intervention is most appropriate?

Vestibular therapy with specific exercises for the head, body, and eyes to retrain the brain and improve balance, reaction time, and coordination; use the Gradual Return to Play Protocol

A parent brings their 8-year-old child to the clinic 3 days after hitting their head during a playground fall. The child reports ongoing headache and sensitivity to light. What should you recommend?

Assessment by their primary care physician, urgent care, or emergency room; implementation of brain rest with decreased cognitive stimulation (decreased lighting, noise, sensory stimulation); avoid contact sports until symptom-free

What environmental modifications should be provided to implement brain rest for a child with concussion?

Decrease lighting, noise, and sensory stimulation; limit visits from friends; limit use of electronics; avoid sensory provoking situations or settings; may require accommodations at school

A 5-year-old with concussion cannot verbalize symptoms. What behavioral changes might parents observe that indicate prolonged symptoms?

Increased meltdowns, increased behavioral disturbances, mood changes, changes in sleep patterns, irritability

Why is concussion potentially more dangerous in the pediatric brain compared to the mature adult brain?

The pediatric brain is still developing, making it more vulnerable to injury despite children appearing resilient

The CDC defines TBI as 'a form of _ acquired brain injury resulting from a bump, blow, or jolt to the head, or penetrating head injury.'

non-degenerative

Mild TBI involves loss of consciousness for less than _ minutes and a Glasgow Coma Scale score of 13-15.

30

Severe TBI involves loss of consciousness for more than _ hours and a Glasgow Coma Scale score of 3-8.

24

TBI is the leading cause of death and acquired long-term ________ in children.

disability

Approximately ___% of TBIs each year are classified as mild TBIs.

80

What is the most common cause of TBI in children ages 0-14? A) Motor vehicle accidents B) Falls C) Assault D) Sports injuries

B) Falls

A Glasgow Coma Scale score of what range indicates moderate TBI? A) 3-8 B) 9-12 C) 13-15 D) 16-20

B) 9-12

What is the strongest predictor of whether a child will walk independently after TBI? A) Age at injury B) Lower extremity hypertonicity C) Brain injury severity D) Family cohesion

B) Lower extremity hypertonicity

For children with TBI, motor recovery appears to plateau between which time period post-injury? A) 6-12 months B) 12-18 months C) 24-36 months D) 48-60 months

C) 24-36 months

In what percentage of children with severe TBI are moderate to severe problems evident? A) 20% B) 30% C) 42% D) 60%

C) 42%

A 7-year-old sustained a moderate TBI in a bicycle accident. The child has a GCS of 10. What does this score indicate about loss of consciousness and posttraumatic amnesia?

Loss of consciousness and/or posttraumatic amnesia for 1-24 hours, with presence of intracranial lesions or neurological abnormality with imaging

When treating a child with TBI at Rancho Pediatric Level V-III (no response to early response), what are the primary goals of physical therapy?

Prevent complications from prolonged immobilization; position in sidelying or semi-prone (avoid supine); use splints or serial casting for ROM; provide assisted sitting and standing if stable; implement multisensory stimulation; educate family on functional mobility and positioning

What type of posttraumatic amnesia duration indicates a severe TBI? A)

C) >24 hours (specifically >7 days for severe TBI classification)

A child with TBI is demonstrating agitation and confusion. According to treatment strategies, what approach should be used?

Simple task training in highly structured, consistent, reinforcing environment; modify tasks to ensure success and decrease frustration; create calm structured environment; use short-interval treatment sessions; provide frequent verbal, visual, and tactile feedback

Research shows that intensity of physical therapy is significantly related to what outcome in children with TBI?

Mobility changes

Diffuse cerebral swelling is among the most life-threatening ___ of TBI.

complications

A concussion is a form of a ____ TBI.

mild

Children ages ___ years have the highest rates of TBI-related emergency room visits each year.

0 to 4 (or 0-4)

In children, intracranial pressure greater than ____ mmHg is abnormal and cause for concern.

20

For posttraumatic amnesia, a duration of 1-24 hours indicates ____ severity.

moderate

What is included in the primary causes of TBI? A) Diffuse cerebral swelling B) Skull fracture C) Post-traumatic stress D) Muscle weakness

B) Skull fracture

What percentage of children ages 0-14 experience TBI from being struck by or against an object? A) 6.8% B) 15.3% C) 24.8% D) 50.2%

C) 24.8%

Which age group has higher incidence of TBI? A) Females B) Males C) Equal between genders D) Varies by region

B) Males

What test can be used to assess functional ambulation in children with TBI? A) Berg Balance Scale B) Functional Ambulation Category C) PEDI D) BRIEF

B) Functional Ambulation Category

Which is a common long-term health condition following pediatric TBI? A) Type 2 diabetes B) Learning disorders C) Asthma D) Food allergies

B) Learning disorders

An adolescent with TBI at Rancho Adult Level IV (Confused-Agitated) is displaying bizarre behaviors and appears hostile. How should you approach treatment?

Understand this is due to confusion and fear; create a calm, structured environment; provide clear, simple directions; ensure safety; avoid busy or noisy environments that may trigger agitation

A child with severe TBI is medically stable and you need to prevent complications from immobilization. What interventions should you implement?

Positioning in bed (sidelying/semi-prone, avoid supine); splints or serial casting; assisted sitting and standing if vitals stable; early upright positioning in wheelchair; early weight bearing on tilt table

What is the difference between uncomplicated and complicated mild TBI?

Uncomplicated mild TBI has no overt neuroimaging findings, while complicated mild TBI shows intracranial abnormalities on brain imaging such as bruising or blood collection on the brain

What evidence-based gait training approach has been found more effective for children with TBI?

Conventional overground gait training has been found to be more effective than bodyweight supported treadmill training

A 6-year-old sustained a TBI 3 months ago. The family asks about home programming. What does research support?

A short, simple, home-based, task-oriented exercise program can improve balance performance in children with severe TBI; a well-conceived intervention plan can improve family resilience and problem-solving ability, also improving the child's outcome

The highest prevalence of post-TBI health conditions includes learning disorders, ADHD, speech and language difficulties, developmental delay, bone/joint/muscle problems, and ____ problems.

anxiety

For term infants, normal intracranial pressure is ____mmHg.

1.5-6

Vestibular therapy for concussion typically lasts ____ months.

3-6

In the Cantu Evidence-Based Grading System, a Grade 1 concussion has post-concussion signs and symptoms (other than amnesia) lasting less than ___ hours.

24

According to research, poor post-injury outcomes are related to pre-injury level of function, age (younger equals worse outcomes), and level of family ____.

cohesion

Abusive head trauma is most commonly associated with which pediatric age group? A) Newborns B) Infants C) Toddlers D) Adolescents

B) Infants

What medical treatment helps control intracranial pressure by lowering cerebral blood flow? A) Barbiturates B) Hyperventilation C) Nutritional management D) Anticonvulsants

B) Hyperventilation

Which assessment measures health-related quality of life in children with TBI? A) GMFM B) PedsQL C) FAC D) PAMS

B) PedsQL

According to Cantu grading, what defines a Grade 3 (severe) concussion? A) No loss of consciousness B) Loss of consciousness <1 minute C) Loss of consciousness ≥1 minute D) Posttraumatic amnesia <30 minutes

C) Loss of consciousness ≥1 minute

What is the most common mechanism of injury for adolescents with TBI? A) Falls B) Abusive head trauma C) Bicycle and motor vehicle accidents D) Sports only

C) Bicycle and motor vehicle accidents

You are treating a child 6 months post-severe TBI who has reached a plateau in motor recovery. Based on evidence, what is the expected timeframe for motor recovery plateau after TBI?

Motor recovery after TBI appears to plateau between 24 and 36 months post-injury

A 4-year-old with TBI demonstrates loss of postural stability, dizziness, and difficulty hearing. What body system is likely affected and what intervention is appropriate?

The auditory/vestibular system is affected; vestibular therapy with specific exercises for head, body, and eyes to improve balance, coordination, and reaction time

When should hypothermia be used to control intracranial pressure in children with severe TBI?

Best if used early in treatment, within the first 48 hours after injury

What critical factor in care transition helps children with TBI meet their greatest potential for functional recovery?

A quick and smooth transition from acute care to an aggressive rehabilitation program

A teenage athlete sustained a concussion during football practice. The athletic trainer wants to return them to play immediately since they seem fine. What should you recommend?

Any athlete with suspected concussion should be removed from play immediately; they should remain out of contact sports until fully symptom-free; return to play should be assessed individually using Graduated Return to Play Protocol

Infants and young children have low seizure _____, causing them to be at high risk for seizures after head injury.

thresholds

Greater step length variability and decreased _____ speed are both found post-TBI in children.

gait

In what position should decompression craniectomy typically be performed in children? A) Occipital B) Temporal C) Bifrontal D) Parietal

C) Bifrontal

What cognitive symptom involves deficits in short-term memory, working memory, and difficulty with information retrieval? A) Attention deficits B) Memory and learning deficits C) Executive functioning deficits D) Metacognition deficits

B) Memory and learning deficits

A child 18 months post-severe TBI continues to have communication difficulties. Based on evidence, at what time point are communication skills, daily living skills, and adapted functioning still lower than baseline?

4 years post-severe TBI, children still have lower communication skills, daily living skills, and adapted functioning

What symptoms in a young child who cannot verbalize may indicate concussion? A) Increased appetite B) Advanced language skills C) Persistent crying and inability to be consoled D) Improved balance

C) Persistent crying and inability to be consoled

Define cerebral perfusion pressure.

The net pressure gradient that drives oxygen delivery to cerebral tissue

According to the Pediatric Glasgow Coma Scale, a child who localizes pain receives what motor response score? A) 3 B) 4 C) 5 D) 6

C) 5

What medical management option is used when other therapies have failed to control intracranial pressure? A) Hyperventilation B) Temperature control C) Barbiturates D) CSF drain

C) Barbiturates

A PT is working with a child at Rancho Pediatric Level I (highest function). What environmental strategy should be implemented?

Reduce environmental restrictions to progress task difficulty (e.g., different surfaces, indoor/outdoor); practice tasks in a variety of environments