TBI - COMPLETE

Question 1

Difference between ABI thats a TBI vs. ABI thats not a TBI?

Answer 1

TBI - external forces
Non-TBI - internal forces

Question 2

Acquired Brain Injury

Answer 2

Brain injury acquired after birth

Question 3

Causes of Non-TBI

Answer 3

Stroke
Toxins
Drugs
Anoxia (e.g. drowning)
Infection
Tumors

Question 4

TBI: occurrence of injury to the head, with one or more of the following conditions… (5)

Answer 4

1. Decreased consciousness
2. Amnesia
3. Skull fracture
4. Objective neuro/neurophysical abnormality
5. Intracranial lesion

Question 5

T/F: TBI can occur in absence of perceptible head injury

Answer 5

TRUE

Question 6

Classification Systems for TBI (3)

Answer 6

1. Glasgow Coma Scale (GCS)
2. Post Traumatic Amnesia (PTA)
3. Loss of Consciousness (LOC)

Question 7

The ______ (lower/higher) the score on GCS, the more conscious the patient is.

Answer 7

HIGHER

Question 8

The ______ (lower/higher) the score on GCS, the less conscious the patient is.

Answer 8

LOWER

Question 9

T/F: abnormal imaging (MRI/CT) immediately classifies the patient as having a severe TBI

Answer 9

FALSE; moderate

Question 10

Patient is considered Vegetative if GCS is < ______

Answer 10

3

Question 11

What qualifies as an Open Head Trauma?

Answer 11

If dura is breached (invasion through skull)

Question 12

Characteristics of mild TBI

Answer 12

GCS: 13-15
+/- LOC (< 30 min)
Normal imaging

Question 13

Characteristics of moderate TBI

Answer 13

GCS: 9-12
LOC > 30 min (but < 24 hrs)
Normal or abnormal imaging

Question 14

Characteristics of severe TBI

Answer 14

GCS: 3-8
Coma
Normal/abnormal imaging

Question 15

Common Sources of Brain Damage (3)

Answer 15

1. Subdural Hematoma (clot b/w dura and arachnoid)
2. Diffuse Axonal Injury
3. Contusions (bruising of brain)

Question 16

Diff between Primary and Secondary Damage

Answer 16

Primary — at moment of injury
Secondary — manifests later

Question 17

Post Traumatic Vision Syndrome (PTVS):
What are some functional vision issues caused by TBI? (7)

Answer 17

1. Convergence Insufficiency
2. Accommodation Insufficiency
3. Oculomotor Dysfunctions
4. ET/EP
5. Low Blink Rate
6. Visual Midline Shift (affects Balance/Posture)
7. VF defects

Question 18

Post Traumatic Vision Syndrome (PTVS):
What are some symptoms caused by TBI? (8)

Answer 18

1. Diplopia
2. Blur at near
3. Loss of reading place
4. Asthenopia/HA
5. Photophobia
6. Visual memory deficits
7. Visual perception deficits
8. Bumping into things

Question 19

Key Visual Processing Systems (2)

Answer 19

1. MP Pathway
2. Top Down Processing

Question 20

Parvocellular System is for ____ vision and important for _____.

Answer 20

Parvocellular System is for central (foveal) vision and important for clear and precise vision.

Question 21

Describe course of Parvocellular System

Answer 21

Nerve fibers from retina —> ON —> optic chiasm —> optic tract —> LGN —> optic radiations —> primary visual cortex (occipital lobe) —> temporal lobe

Question 22

Magnocellular System is for ____ vision and important for _____.

Answer 22

Magnocellular System is for spatial orientation and important for balance, movement, coordination, and posture.

Question 23

What is the parietal cortex responsible for that contributes to spatial orientation?

Answer 23

1. Spatial working memory
2. Visually guided action
3. Navigation

Question 24

Function of Top Down Processing

Answer 24

Selectively filters sensory info input

Question 25

Neuroplasticity

Answer 25

Ongoing reorganization of functional cortical map

Question 26

What is required for synaptic plasticity? (2)

Answer 26

1. Internal Processing 2. Repetition

Question 27

What is the major modulator for neuroplasticity?

Answer 27

Norepinephrine

Question 28

Why is VT the perfect environment for neuroplasticity? (5)

Answer 28

1. Feedback 2. Repitition 3. Multisensory, intermodal approach 4. Motor/sensory match 5. Cortical involvement

Question 29

Causes of Disequilibrium (And % of each)

Answer 29

1. Otologic — 50% 2. Idiopathic (includes visual & brain filtering problems)— 25% 3. Psychological — 15% 4. Central/Neuro — 5% 5. Medical — 5%

Question 30

VOR requires stability of… (3)

Answer 30

1. Ocular input 2. Binocular input 3. Processing of vestibular and visual info

Question 31

VOR regulates balance with… (4)

Answer 31

1. Visual System 2. Semicircular canals 3. Otolith apparatus 4. Vestibular nerve

Question 32

Feelings of ____, ____, and ___ are important for synaptic formation and thus, important components of VT.

Answer 32

Motivation Repetition Feedback

Question 33

What is the “underlying trigger for [neuroplasticity]”?

Answer 33

Synaptic plasticity

Question 34

Vision/Optical Related Causes of Disequilibrium (5)

Answer 34

1. Aniso 2. Uncorrected Hyperopia 3. Uncorrected Astigmatism 4. PAL Distortion 5. Glare

Question 35

Fixation is a function of _______

Answer 35

Visual *attention*

Question 36

When evaluating fixation, we should look for…

Answer 36

Saccadic intrusions and/or latent nystagmus

Question 37

When evaluating saccades, what should we look for?

Answer 37

Slowness or over/udnershoots

Question 38

What modification should be made to W4D testing for TBI patients?

Answer 38

Should be *dynamic* (15 ft to nose)

Question 39

What does **Fixation Dot c Head Shake** test for?

Answer 39

Binocular Stability

Question 40

How to perform **Fixation Dot c Head Shake**?

Answer 40

1. Use R/G glasses 2. Ask pt “how many dots do you see?” 3. Shake head side to side (1-2 rotations/sec) 4. Ask “what happens?”

Question 41

How to test for Visual Midline Shift Syndrome

Answer 41

1. Target (Wolff wand or pen) at 40 cm 2. Test horizontally (target held vertical); move from left to right and ask to say when pen is directly in front of nose 3. Repeat vertical (target held horizontal, tell when pen at eye level) *Note: examiner should not sit directly in front of— gives clues to midline*

Question 42

Ways to correct for photophobia (4)

Answer 42

1. Transitions 2. 15% Blue tint and A/R 3. Over 40% gray tint 4. Wrap sunglasses for outdoors