TBI

General

100

What does TBI stand for? 

Traumatic brain injury

200

Orthopedic involvement sometimes needed after a TBI includes...

Crutches or a wheelchair

300

What skills will recover faster in a child than in an adult?

Motor and verbal skills 

400

Benefits of a water programs for a child who sustained a TBI

• Severe injuries can lead to weakening of joints and muscles -> water is easier on the joints and can be used to strengthen muscles.
• Great way to improve balance 

500

Explain the severity measurement of a TBI according to the duration of unconsciousness (LOC)

Mild - < 30 minutes 

Moderate - 30 minutes - 24 hours

Severe - > 24 hours 

Classifications

100

TBI's is classified as one of two types...

Open head injury and closed head injury

Primary and secondary injury

200

Area of the brain affected from an open head injury and possible cause of this

• More limited brain area
• Gunshot wound

300

Difference between focal and diffuse injuries

• Focal injury: Includes scalp injury, skull fracture, and surface contusions; generally caused by contact
• Diffuse injury: Includes diffuse axonal injury (DAI), hypoxic-ischemic damage, meningitis, and vascular injury; usually caused by acceleration-deceleration forces

500

Area of the brain affected from a closed head injury and possible cause of this

• Damage to the brain is usually diffuse
• The brain is shaken in the skull
• damages and tears nerve fibers in the brain that send messages to other parts of the CNS and all body parts

Symptoms

100

When can symptoms appear after sustaining a TBI?

Symptoms may appear immediately after a traumatic event or days or weeks afterwards.

200

Symptoms of a mild TBI

Physical symptoms

• Headache
• Nausea or vomiting
• Fatigue or drowsiness

Sensory symptoms

• Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell
• Sensitivity to light or sound

Cognitive, behavioral or mental symptoms

• Loss of consciousness for a few seconds to a few minutes
• No loss of consciousness, but a state of being dazed, confused or disoriented
• Memory or concentration problems

300

Symptoms of a moderate to severe TBI

Physical symptoms

• Loss of consciousness from several minutes to hours
• Persistent headache or headache that worsens
• Repeated vomiting or nausea
• Convulsions or seizures
• Dilation of one or both pupils of the eyes

Cognitive or mental symptoms

• Profound confusion
• Agitation, combativeness or other unusual behavior
• Slurred speech
• Coma and other disorders of consciousness

400

Symptoms that may be observed in a child with a TBI

• Change in eating or nursing habits
• Unusual or easy irritability
• Persistent crying and inability to be consoled
• Change in ability to pay attention
• Change in sleep habits
• Seizures
• Sad or depressed mood
• Drowsiness
• Loss of interest in favorite toys or activities

Causes

100

Name four causes of TBI's

• Falls
• Violence
• Sports injuries
• Vehicle-related collisions
• Assault to children - Shaken Baby syndrome, abuse, etc. 
• Lack of oxygen (anoxia)
• Cardiac arrest
• Near drowning

200

Risk factors for causes of TBI's

• Children, especially newborns to 4-year-olds
• Young adults, especially those between ages 15 and 24
• Adults age 60 and older
• Males in any age group

300

Causes of TBI's in children

• Road traffic accidents
• Falls from buildings, play equipment and trees
• Injuries from objects
• Child abuse
• Sports-related injuries
• Seizures and other causes of loss of consciousness 

400

Name three consequences of a TBI

• Posttraumatic seizures: Frequently occur after a moderate or severe TBI
• Hydrocephalus
• Deep vein thrombosis: Incidence as high as 54% 
• Heterotopic ossification: Incidence of 11-76%, with a 10-20% incidence of clinically significant heterotopic ossification 
• Spasticity
• Gastrointestinal and genitourinary complications: Among the most common sequelae in patients with TBI
• Gait abnormalities
• Agitation: Common after TBI
• Chronic traumatic encephalopathy (CTE)

500

The highest rate of injury is among young males between what ages?

14 and 24 years of age

Location

100

Children's head injuries tend to be more ... than ...

Diffuse than vocal

200

Explain possible complications from a parietal lobe injury

• Difficulty distinguishing left from right
• Lack of awareness of certain body parts (spatial orientation)
• Difficulty with hand-eye coordination
• Problems with reading, writing, drawing, naming, mathematics

300

Explain possible complications from injuring the cerebellum

• Difficulty coordinating fine movements
• Difficulty walking, tremors, dizziness (vertigo)
• Slurred speech

400

Name three adapatations that can be used when working with a child who sustained a TBI

• Using a pool noodle/towel underneath their hips to support them during an activity
• Making use of visual aids more than verbal aids 
• Use a pool noodle to support kids 
• Swim in the shallow part or where you are able to stand (to better assist)

500

Explain the Ranchos Los Amigos hospital scale

8 Levels of cognitive functioning. 

Typically used in the first few weeks or months following injury.

Level 1 - no response, deep sleep or coma. 

Level 2 - Generalized response: inconsistent and non-specific response to stimuli. 

Level 3 - Localized response: might follow simple commands in an inconsistent and delayed manner; vague awareness of self. 

Level 4 - Confused or agitated response: severely decreased ability to process info; poor discrimination and attention span.

Level 5 - Confused and inappropriate response: consistent reaction to simple commands; highly distractible; in need of frequent redirection. 

Level 6 - Confused and appropriate response: responses may be incorrect because of memory loss, but are appropriate to the situation; exhibits retention of tasks relearned; inconsistently oriented. 

Level 7 - automatic and appropriate: oriented and appropriate behaviour but lacks insight; poor judgment and problem solving; requires minimal supervision. 

Level 8 - purposeful and appropriate: ability to integrate recent and past events; requires no supervision once new activities have been learned.