Etiology/Incidence
T/F: There is a strong link between TBI and substance use disorders.
TRUE! More than 1/2 of adults diagnosed with TBI report alcohol use near time of injury.
What are the two types of TBI?
1. Focal brain injury- direct blow to the head from a collision with an external object, fall, or penetrating injury
2. Multifocal and diffuse brain injury- sudden deceleration of body and head
The highest total score on the GCS is ___.
15- fully conscious person
You WANT a higher score!
What does the Ranchos Los Amigos Scale measure?
Descriptive measurement of awareness and cognitive function after TBI scored from Level I-Level X.
This is the initial step in the evaluation process.
Gathering an occupational profile
What is the difference between an open or closed TBI?
Open: penetration to the skull
Closed: rapid acceleration or deceleration of the brain/blunt external force
This can be a symptom of TBI- "abnormal movements resulting from cerebellar damage"
Ataxia
What is the Glasgow Coma Scale used to measure?
A neurological scale to provide an objective measure of a person's level of consciousness.
Person is completely unresponsive to any stimuli presented; requires total assistance.
Level I- No Response
Name 3 intervention focuses during the acute phase of a TBI.
Positioning (wc/bed- semiprone/side for abnormal tone or posturing), PROM, splinting/casting (examples in PDFs), sensory stimulation, management of agitation, family/caregiver education
Coup, countercoup, and diffusely along the temporal and frontal lobes
Describe decorticate rigidity.
UE spastically flexed with internal rotation and adduction. LE spastically extended with internal rotation and adduction.
Severe TBI if GCS score is < ___.
Moderate TBI if GCS score is ___-___.
Minor TBI is GCS score is > ___.
<8
9-12
>13
Person exhibits goal-directed behavior but is dependent on external input for direction; moderate assistance.
Exs: Mod A to problem solve barriers to task completion, S for old learning, Max A for new learning, follows simple commands, lack of insight to deficits/safety
Level VI- Confused, Appropriate
Clients in the inpatient rehabilitation phase of TBI are at what Rancho Level or higher?
Rancho Level V or higher.
T/F: The highest risk group for TBI is males 15-29 years old.
TRUE
Describe decerebrate rigidity.
UE & LE spastically extended, adducted, and internally rotated. Wrist and fingers flexed, plantar portions of feet flexed and inverted, trunk extended, head retracted.
What three tests are used with the GCS (what 3 things are tested?)
Eye, verbal, and motor responses
Person has a heightened sense of activity with severely decreased ability to process information- Maximal assistance.
Exs: mood swings, purposeful attempts to remove tubes/restraints, absent STM, unable to cooperative with tx efforts, performs basic motor tasks without purpose or upon request
Level IV- Confused, Agitated
What are ways to optimize motor function during the inpatient rehabilitation phase of TBI?
Utilize motor learning, focus on skill acquisition, begin with gross motor to support limited cognition
Ataxia- treated through compensatory strategies
Apraxia- treated with hand over hand to repair damaged neural pathways (photos or written directions may be appropriate)
1. Falls (35%-42%)
2. MVA (14%-17%)
3. Striking or being struck by an object (15%-17%)
4. Assault (10%)
T/F: Impaired righting reflexes are observed with damage to the basal ganglia.
FALSE! Impaired righting reflexes are observed with midbrain damage. Absence of equilibrium reactions and protective extension are seen with basal ganglia damage.
What are the three severe disorders of consciousness?
1. Coma
2. Vegetative State
3. Minimally Conscious State
Person is A&O and able to recall past and current events- Stand-By Assistance
Exs: uses assistive memory aids, requires no assist once new tasks are learned, aware of impairments, thinks of consequences to decisions with min A, may be depressed/irritable/easily angered/argumentative/self-centered
Level VIII- Purposeful, Appropriate
Levels VIII, IX, X are all purposeful appropriate with decreasing need for assistance and increased cognitive abilities.
In what settings does the postacute rehabilitation phase of TBI take place?
Home-health, residential programs, day treatment programs, outpatient community re-entry programs