tbi

 

No AD= more cognitive issues for these pts compared to CVA

Any injury from a traumatic event=TBI

Second most common=stupid activities

 

Outcome predictors:

  • Small fall vs unconscious for 6 hours

  • Intracranial pressure=secondary damage

  • Not smart before won't improve in intelligence=pre-morbid cog.

  • Personality=support

 

Open=skull is fractured (skull is re-structured/prosthetic)

Closed=brain sloshed around

  • Coup: first hit

  • Countercoup: second hit

  • Coup-countercoup: 1,2,3

  • Teach them behaviors (no don't do that=they need to learn)

  • No inhibitions: be careful

  • Bribe them?!

 

Impairments

  • Very literal

  • Pick your battles: energy conservation towards the end

S&S

  • Decreased response

  • In and out consciously

  • Severe headache: physically holding their head

  • Vomiting

  • Irritability

  • Changes in VS

 

Hippocampus, cerebellum, basal ganglion

 

Seizure: down to ground, protect the head, once waking up=roll onto side

  • Tired

  • Don't leave them: schedule

 

GCS/glasgow coma scale: only when out

  • Lower=worse

  • 3-4 scale: don't survive often (brainstem activity only)

  • Less than 8: indicate coma, TBI severe

  • Eye, verbal, motor

    • Eyes open on 2

    • Extension to pain on 2

  • Combine the numbers with addition: 2 on eye, 1 on verbal, 2 on motor = 5

  • 3 levels of orientation: if only know name/1 then disoriented

    • Name, place, date

 

Coma vs vegetative

  • V: sleep/wake cycle can be determined (eyes open only)

 

Lability: inability to control emotional responses

Confabulation: making things up

  • Correct it for reorientation repeatedly

 

Decerebrate posture

Decorticate

Full extension everywhere=worse

 

Neuroses/psychoses: hallucinations visually/smell

 

begin as soon as medically stable

  • Touching/talking/increasing arousal

  • Secondary impairment prevention

  • Function

  • Education fam

 

Rancho los amigos

  • Level IV: start moving with simple cues

  • VIII: normal

  • V-VII: modified normal life

 

Rotational movement/outside of line with body: helps to normalize tone

Heterotrophic ossification prevention:  body deposits sharp bone pieces in muscle

 

Attention: build up form a little

Problem solving: give them some to figure out

Aggressive: back off and somewhere quiet

 

To progress cognition: 1 step plan to 5 step plan over time