TBI

Question 1

Diffuse axonal injury

Answer 1

Extensive and widespread damage due to shearing forces (usually rotational) from rapid acceleration/deceleration

Question 2

Contusion

Answer 2

Bruising on the brain resultant from a direct impact to the head

Question 3

Hematomas: Epidural, subdural, and intracerebral

Answer 3

• Epidural: Blood between the dura and skull, resultant from skull fxs that cause a rapid increase in ICP
• Subdural: Bleeding between dural and subarachnoid, resultant from blunt trauma without fx
• Intracerebral: Frontal/temporal lobes

Question 4

Normal ICP + increased ICP

Answer 4

• Normal: 0-10 mm HG

- Increased: >20 mm HG

Question 5

Sxs of increased ICP

Answer 5

• HA
• Papilledema
• Vomiting
• Drowsiness
• Altered consciousness

Question 6

CPP equation

Answer 6

CPP = MAP - ICP

Question 7

Normal CPP + abnormal CPP

Answer 7

• Normal >70 mm HG

- Ischemic <4–50 mm HG

Question 8

Glasgow Coma Scale

Answer 8

• Eye response (4)
• Verbal response (5)
• Motor response (6)

Question 9

GCS Severity

Answer 9

Mild 13-15
Moderate 9-12
Severe 3-8

Question 10

Coma

Answer 10

• Unarousable unconsciousness

- No periods of wakefulness or eye opening to stimulations

Question 11

Vegetative state

Answer 11

• Lack of awareness but preserved capacity for arousal (spontaneous or stim-induced)
  1. No evidence of awareness of self or environment
  2. No evidence of purposeful or voluntary behavioral response to stim
  3. No language
  4. Bowel and bladder incontinence
  5. Variable preservation of cranial nerve and spinal reflexes
  6. Sufficient preservation of autonomic function
  7. Intermittent wakefulness manifested by the presence of sleep wake cycles

Question 12

Minimally conscious state

Answer 12

• Reproducible awareness of self or environment by one of the following:
  1. Simple command following
  2. Gestural or verbal yes/no responses
  3. Intelligible verbalization
  4. Purposeful behavior (movement or affective)

Question 13

PTA Stages of Recovery

Answer 13

Mild 5-60 minutes
Moderate 1-24 hours
Severe 1-7 days
Very Severe 1-4 weeks
Extremely severe >4 weeks

Question 14

I: No response

Answer 14

• Complete absence of observable behavior to stim

Question 15

II: Generalized response

Answer 15

• Reaction to external stimuli in non-specific, inconsistent, and non-purposeful manner with stereotypical responses

Question 16

III: Localized response

Answer 16

• Responds specifically and inconsistently with delays to stim

Question 17

IV: Confused/gitated

Answer 17

• Alert and in heightened state of activity, restless, agitated
• Absent STM
• Lack of deficit awareness

Question 18

V: Confused/inappropriate/non-agitated

Answer 18

• Alert and non-agitated
• Not oriented to person, place, or time
• Absence of goal-directed, problem solving, self-monitoring behavior
• Appropriate responses to simple commands with external cueing (inappropriate/non-purposeful without cueing)

Question 19

VII: Automatic/appropriate

Answer 19

• Performs daily routine automamtically
• Carryover of new learning
• Initiates social interactions but judgement is impaired, overestimates abilities

Question 20

VIII: Purposeful/appropriate (SBA)

Answer 20

• Consistently oriented to person, place, and time
• Aware of impairments but difficulty taking corrective action when completing tasks
• Difficulty with abstract reasoning, stress tolerance, and judgement

Question 21

IX: Purposeful/appropriate (SBA on request)

Answer 21

• Independently shifts between tasks for 2 hours
• Requires some assist to adjust to life’s demands
• Emotional/behavioral issues possible

Question 22

X: Purposeful/appropriate (Mod I)

Answer 22

• Goal-directed behavior, able to handle multiple tasks independently but may continue to have decreased attention and require increased time to complete tasks

Question 23

Onset of spasticity

Answer 23

Occurs 3 days post-injury

Question 24

Pharmacological Management: Baclonfen, Dizepam (Valium), Dantrolene, Botox

Answer 24

• Baclofen: GABA receptor agonist, orally or intrathecally
• Diazepam (Valium): Benzo, used to treat anxiety
• Dantrolene: Muscle relaxant
• Botox: Injected for localized effects lasting 3-4 months

Question 25

Serial casting

Answer 25

- Joint is immobilized for 7-10 days - Stretching is performed after removal of cast - Apply new cast at endrange * *Effective for improving PROM but not spasticity or function

Question 26

Dynamic splinting

Answer 26

Be careful of pressure points and skin integrity

Question 27

Coma is caused by:

Answer 27

- Diffuse B hemispheric damage and/or failure of the ascending reticular activating system - Unilateral hemisphere lesion does not cause coma - Brainstem infarction or hemorrhage commonly causes coma, as well as drug and metabolic disease

Question 28

Self-efficacy

Answer 28

Rehab should address patient's self-efficacy beliefs in addition to their cog/phys impairments **Shows a strong relationship with life satisfaction post-TBI

Question 29

Rehab of executive function

Answer 29

Required in regaining independence 1. Ask patient to predict their performance prior to beginning the task 2. Ask patients to provide post-task feedback about performance 3. Use systematic cueing strategy to maximize patient recognition of errors and improve ability to generate solutions

Question 30

Balance and dual-task performance

Answer 30

Balance more strongly related to falls hx then measures of attention or dual-task performance **Motor slowing utilized as a compensatory strategy

Question 31

Guidelines for cardiorespiratory and endurance training

Answer 31

- 60-90% of age predicted max HR - 20-40 min per session - 3-4x per week

Question 32

Acute care highly recommended outcome measures

Answer 32

- ABS - CRS - Moss Attention Rating Scale - Rancho Levels of Cognitive Functioning

Question 33

ABS cut-off scores

Answer 33

Within normal limits: <21 Mild agitation: 22-28 Moderate agitation: 29-35 Severe agitation: >35

Question 34

Moss Attention Rating Scale

Answer 34

- Observational tool used to measure attention-related behaviors after TBI Observation of 22 items reflecting both good and impaired attention - Each item scored from 1 (definitely false) - 5 (definitely true) **No cut-off scores

Question 35

Recommended outcome measures for moderate-severely dependent in ambulation

Answer 35

- Functional Assessment Measure | - FIM

Question 36

Recommended outcome measures for mildly dependent to independent in ambulation

Answer 36

- 6MWT - 10MWT - Balance Error Scoring System - Community Mobility and Balance Scale - HiMAT - Functional Assessment Measure

Question 37

Community Mobility and Balance Scale

Answer 37

- Used to assess high level balance and mobility in the community - Allowed to wear orthotic but may not use AD - 13 tasks with total score of 96 (most able) * *No cut-off scores

Question 38

Disability Rating Scale

Answer 38

- Used to monitor recovery from coma to community in people with moderate to severe TBI - Scores range from 0 (without disability) - 29 (vegetative state) * *No cut-off scores

Question 39

Functional Assessment Measure

Answer 39

- Consists of 12 items that are added onto 18-item FIM test - Scored 0 (TOTAL) - 7 (IND) - Cut-off score: <65 identifies individuals at risk for long term unemployment

Question 40

HiMAT

Answer 40

- Scale used to assess high level balance and mobility performance - 13 items, scored 0-4 - Orthotics are permitted, must be able to ambulate independently over 20 meters without AD

Question 41

Patient Health Questionnaire

Answer 41

- Self-report questionnaire to assess depressive symptoms over previous two-week period - Scoring from 0 (not at all) - 3 ( nearly every day) - 9 items with maximum score of 27 * *Cut-off score: >12 suggests possible major depressive disorder

Question 42

Quality of Life After Brain Injury

Answer 42

- Health-related quality of life questionnaire - 37 items - Scored 0 (worst possible QOL) - 100 (best possible QOL) * *No cut-off scores