Shared Flashcard Set

Details

TBI notes
TBI notes
225
Anatomy
Graduate
11/26/2012

Additional Anatomy Flashcards

 


 

Cards

Term
is TBI or MS more common?
Definition
TBI
Term
is TBI or cancer more common?
Definition
TBI
Term
is TBI or SCI more common?
Definition
TBI
Term
why does TBI so often fall under the radar even though it is very common?
Definition
problems are complex and diverse
Term
what is the most common cause for TBI for all ages?
Definition
falls
Term
what ages are most likely to sustain a TBI?
Definition
children, older adolescents, and adults over 65
Term
are males or females more likley to sustain TBI?
Definition
males
Term
what is barotrauma
Definition
damage from pressure wave from a blast
Term
what is the greatest mechanism of TBI in military
Definition
blast
Term
what part of blast gives primary effects
Definition
barotrauma
Term
what part of blast gives secondary effects
Definition
blast projectiles
Term
what part of blast gives tertiary effects
Definition
acceleration injuries
Term
what are acceleration injuries
Definition
person is lifted by the force of the blast and then lands on something
Term
what are 4thary effects of blast
Definition
hypoxia or toxic fume inhalation
Term
are the majority of TBIs penetrating, severe, moderate, mild, or not classifiable
Definition
mild
Term
why is the area of the brain above the cribriform plate susceptible to injury?
Definition
cribriform plate is rough.
Term
what is a coup-contre coup injury?
Definition
blow to the front of the head causes brain to be pushed against front of skull and hten back against back of skull.
Term
what is the focal lesion
Definition
lesion at point of impact in a coup-contre coup injury
Term
what is the contre coup
Definition
opposite of piont of impact in a coup-contre coup injury
Term
why would there be problems with axonal connections in the brain with coup-contre coup injury?
Definition
forces go through the whole brain
Term
how to picture the person in a brain image
Definition
imagine patient supine in scanner. My view is from their feet up. This means the R/L seem backwards
Term
what is midline shift and what does it mean
Definition
midline of brain has shifted. This implies swelling on one side of the brain
Term
what color is blood on CT
Definition
white
Term
what is axon shear
Definition
post concussion syndrome: results from twisting of long axons
Term
what happens when axons are twisted
Definition
swelling occurs. Over time, the brain cell and the axon degrades. You can have diffuse brain cell death throughout the cortex that affects your ability to do things cognitively and rhetorically
Term
what is a diffuse axonal injury
Definition
you don't have a focal injury that occurred. Instead, there was acceleration on the body that threw the head around. The brain was twisted on the brainstem. Long axonal tracts that run throughout the brainstem are sheared and snapped. Little hemorrhages occur.
Term
diffuse axonal injuries occur following shear injury to what structures
Definition
cortical parasaggital white matter, corpus callosum, pontine-mesencephalic junction (cerebellar peduncles)
Term
list causes of primary TBI
Definition
skull fracture, contusion, hematoma, laceration, diffuse axonal injury, pituitary stalk transection, brainstem injury, hypoxia or ischemia
Term
what are causes of hypoxia or ischemia
Definition
near drowning, cardiac arrest
Term
how does hypoxia/ischemia affect prognosis
Definition
bad
Term
what is a secondary injury
Definition
continuing brain events that occur as a result of the primary event
Term
what are the 2 types of secondary injuries
Definition
intracranial events, cellular events
Term
what level trauma center is necessary to monitor ICP
Definition
level 1
Term
what does ICP stand for
Definition
intracranial pressure
Term
what does CPP stand for
Definition
cerebral perfusion pressiure
Term
how is ICP affected by cerebral swelling
Definition
increases
Term
how is CPP affected by cerebral swelling
Definition
decreases
Term
what is the problem with increased ICP and decreased CPP
Definition
decreases blood oxygenation
Term
what are other negative secondary intracranial events besides swelling
Definition
new bleeding, vasospasm, infection, seizure
Term
what are cellular events that occur as secondary brain injuries
Definition
axonal injury, ischemia, inflammation
Term
what causes secondary axonal injury
Definition
when you have a brain injury, you get a massive depolarization throughout your brain that disrupts the vascular activity of the brain causing axonal injury.
Term
why is it htat even with a mild injury like a concussion, a person has cloudiness to function
Definition
axonal injury from vascular disruption/depolarization
Term
what to do after a concussion to recover from axonal injury
Definition
rest
Term
what is the metabolic cascade following brain injury
Definition
your brain is trying to recover, and that's a costly process that takes a lot of energy. If you reduce the oxygen that's going to the system, you may start to have this malfunction of the energy supplying system within the brain. This can lead to cell death.
Term
what is excitotoxicity
Definition
energy failure leading to cell death through the metabolic cascade of needing more energy to heal the brain and not getting enough oxygen to supply the energy supplying system of the brain
Term
what should a person experiencing metabolic cascade do
Definition
rest to return to homeostasis
Term
what are the steps of brain injury
Definition
injury - necrosis - axonal injury - apoptosis - demyelination - microgliosis - neuroregeneration
Term
what are the triggers of the metabolic cascade
Definition
ischemia/hypoxia, impact depolarization
Term
what perpetuates metabolic cascade
Definition
increased ICP, infection, edema, fever
Term
what is it called when the initial injury causes axonal injury and contusion, then a hematoma results. The contusion and hematoma cause swelling. You also have systemic insults to internal organs so you now get abnormal blood supply to body.
Definition
metabolic cascade
Term
what is the effect of metabolic cascade on ICP
Definition
increases
Term
what is the effect of metabolic cascade on CPP
Definition
decrease
Term
what will happen if you don't get ICP and CPP under control
Definition
continue ischemia
Term
what is the initial focus immediately upon TBI?
Definition
survival
Term
what does the EMS of TBI entail?
Definition
ABCs, rule out bleed, stabilize other injuries, prevent secondary injury to brain
Term
what is one important PT job because of early focus on survival
Definition
pick up on broken bones that were missed early on when survival was main focus
Term
what is normal adult intracranial puressure
Definition
<15mmHg
Term
what should child's ICP be
Definition
20-25mmHg
Term
what can happen if CPP is too low
Definition
not enough pressure to get oxygen to brain
Term
what can happen if CPP is too hight
Definition
you can end up with respiratory distress problems
Term
how to calculate CPP
Definition
MAP-ICP
Term
what does MAP stand for
Definition
mean arterial pressure
Term
what range should CPP be
Definition
50-70mmHg
Term
what are first tier interventions for ICP
Definition
head elevated to 30, neutral neck; sedatives; reduce hyperthermia; possible drainage of CSF
Term
what is second part of first tier interventions to do if other first tier interventions don't work to control ICP
Definition
neuromuscular blockade (paralytics), mannitol, short term hyperventilation
Term
how can you know if someone has an ICP
Definition
ventriculostomy
Term
what are second tier ICP treatments
Definition
barbituates, decompressive craniectomy, hypothermia, hyperthermia
Term
what are the disorders of consciousness
Definition
brain death, coma, vegetative state, minimally conscious state, emerging from MCS
Term
what is brain death
Definition
medical determination of lack of brain stem level responses. Will not survive without artificial life support
Term
how does a physician tell if a person is brain dead?
Definition
brainstem reflexes
Term
what is minimally conscious state
Definition
differentiates when people start to be able to interact at least in some way with the environment
Term
where is the wakefulness network that supports normal wakefulness necessary for usual daily function
Definition
brainstem
Term
why does injury to the brainstem cause coma
Definition
if you have a severe injury that involves the brainstem and serotonergic circuits, it damages your system of awakenss and alertness = coma
Term
what does someone in a coma look like
Definition
like they're asleep
Term
what is the arousal level of someone in a coma
Definition
eyes don't open spontaneoulsy or to stimulation
Term
what is the arousal level of someone in a vegetative state
Definition
eyes open, sleep-wake cycles resume, arousal sluggish and poorly sustained
Term
what happens in vegetative state?
Definition
the part of the midbrain that drives your wakefulness starts to come back. The patient wakes up from the coma
Term
what is the arousal level of someone in a minimally conscious state
Definition
eyes open, normal to abnormal sleep-wake cycles, arousal obtunded to normal
Term
what is the awareness/perception of someone in a coma
Definition
no evidence of perception, communication ability or purposeful activity. Don't do anything purposeful
Term
what is the awareness/perception of someone in a vegetative state
Definition
no evidence of perception, communication ability or purposeful activity. Don't do anything purposeful
Term
what is the awareness/perception of someone in MCS
Definition
reproducible but inconsistent evidence of perception, communication, or purposeful motor activity. Tracking often intact. Information is getting to them.
Term
what is the communication response of someone in a coma
Definition
no response, verbalization, or gestures
Term
what is the communication response of someone in a vegetative state
Definition
no response, verbalization, or gestures
Term
what is the communcation of someone in a minimally conscious state
Definition
ranges from none to unreliable and inconsistent Y/N, verbalization, gestures
Term
for what type of brain injury does locked-in syndrome occur
Definition
stroke
Term
what are possible outcomes following coma?
Definition
fast recovery, brain death, locked-in syndrome, MCS, vegetative state
Term
what are possible outcomes following vegetative state
Definition
MCS, persistent vegetative state
Term
what are possible outcomes following MCS
Definition
recovery, persistent MCS
Term
define coma
Definition
disruption of brainstem level wakefulness center
Term
when does a person go into a coma
Definition
brainstem twisting or swelling, focal lesino
Term
what type of posturing goes with MCS, vegetative state
Definition
decerebrate posturing, increased tone
Term
what is decerebrate posturing
Definition
extension all extremities. All these E's, all in extension
Term
is decerebrate or decorticate posture worse?
Definition
decerebrate
Term
what is decorticate posturing
Definition
flexion in UE, extension in LE
Term
what to do for someone in a coma, vegetative state, or MCS
Definition
ROM, positioning, checking skin, transfer to chair, stand with tilt table
Term
what are the best consitions for determining responsiveness
Definition
quiet environment, daytime, simple instructions, feasible motor response, ask for non-reflexive movement, sitting position,
Term
what is a good question to ask someone to determine responsiveness
Definition
open your eyes, watch me, ask them to do things you've seen them do before, automatic gestures such as shake my hand
Term
when is vegetative state considered persistent
Definition
1 month
Term
when is vegetative state considered permanent
Definition
12 months
Term
what is the time frame for late recovery from vegetative state
Definition
after 1 year
Term
http://www.msnbc.msn.com/id/13690450/
Definition
ok
Term
http://www.youtube.com/watch?v=Pl1IPTpHUHs
Definition
ok
Term
what cognitive/behavioral deficits peresist in emergence from MCS
Definition
consion, memory deficits, attention deficits, executive function deficits, inappropriate behavior
Term
what is retrograde amnesia
Definition
can't remember what happened before the accident
Term
why does retrograde amnesia occur
Definition
don't have the opportunity to form the memory during/after the accident
Term
what does PTA stand for
Definition
post-traumatic or anterograde amnesia
Term
what is PTA/anterograde amnesia
Definition
inability to make and hold onto new memories after an injury
Term
what would duration of PTA indicate
Definition
severity of an injury
Term
how does retrograde amnesia change with recovery
Definition
typically shrinks
Term
does the memory of the accident usually return with recovery
Definition
no
Term
is PTA used in FIM
Definition
yes, used in cognitive/motor and disability rating scale scores
Term
how does PTA duration relate to days of lost consiousness
Definition
strong relationship between PTA duration and days of lost consciousness
Term
what is injury severity for PTA <5min
Definition
very mild
Term
what is injury severity for PTA 5-60 minutes
Definition
mild
Term
what is injury severity for PTA 1-24 hours
Definition
moderate
Term
what is injury severity for PTA 1-7 days
Definition
severe
Term
what is injury severity for PTA 1-4 weeks
Definition
very severe
Term
what is injury severity for PTA >4 weeks
Definition
exteremely severe
Term
what does the Galveston Orientation and Amnesia test do
Definition
assess orientation, memory
Term
does a PT administer GOAT?
Definition
no, neuropsychologst
Term
when are you trying to determine mortality rather than morbidity?
Definition
in the ED
Term
what t o determine when evaluating independence and need for assistance
Definition
need for rehab, discharge status/environment
Term
what pre-injury factors affect outcome positivel
Definition
higher IQ, youth except under 2, absence of substance abuse, absenceof previous TBI, higher education, stable wok histoyr
Term
what injury factors influence postive outcome
Definition
GCS greater than 12 within 48 hours, PTA less than 48 hours, absence of mass lesions, CBF >33ml/100g/min, absence of hypoxia/anoxia, absence of other system injuries
Term
What GCS level within 48 hours indicates positive outcome
Definition
>12
Term
what PTA duration indicates positive outcome
Definition
< 48 hours
Term
absence of what 3 things influences positive outcome
Definition
mass lesions, hypoxia/anoxia, other system injuries
Term
what are the 4 components of the Four Score
Definition
eye, motor, brainstem reflexes, breathing
Term
does the 4 score require verbal responses
Definition
no
Term
what are obstacles to speech following TBI?
Definition
injury, intubation
Term
what 2 stages of TBI recovery is 4 score more sensitive to?
Definition
MCS, locked-in syndrome
Term
what are the gradations of brainstem level responses in the 4 score?
Definition
one blown pupil, pupil OR corneal reflexes absent, pupil AND corneal reflexes absent, absent pupil AND corneal AND cough reflexes
Term
what type of injury is indicated by one blown pupil
Definition
transtentorial herniation, CN III midbrain
Term
what CN is affected with absent corneal reflex
Definition
CN V
Term
what part of the brain is affected with absent cough reflex
Definition
reticular formation
Term
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719522/figure/F1/
Definition
ok
Term
www.crash2.lshtm.ac.uk/
Definition
ok
Term
what is the IMPACT project
Definition
prognostic calculator
Term
www.tbi-impact.org
Definition
ok
Term
www.tbi-impact.org
Definition
ok
Term
what post-injury factors positvely affect outcome
Definition
early cognitive status, access to care, self-awareness, early improvements in FIM motor/motor function
Term
what factors influence outcome negatively
Definition
older age, severity of injury (GCS of 5 or less), PTA greater than 12 weeks, ICP greater than 40 mmHg, pupillary areflexia
Term
what are some preinjury factors that determine outcome
Definition
age, education, employment history, alcohol history, drug history, social history
Term
whata re some injury severity factors that influence outcome
Definition
GCS, PTA duration, worst CAT scan results, pupillary responsiveness
Term
what are ways to assess cognitive status to determine outcome following TBI
Definition
controlled word associationa ttest, Trails Making Test, Block Design
Term
what are aspects of emotional status that influence outcome
Definition
self-approval rating, disinhibition, depression, anxiety, lability
Term
what test shows functional status, which can influence outcome
Definition
FIM
Term
what final measures can show outcome after TBI
Definition
employment status, disability rating scale, community integration questionnaire
Term
what are reasons for using outcome measures
Definition
characterize injury severity, predict global outcome, direct intervention, research, program evaluation
Term
do measures that characterize injury severity show changes from my job as a PT
Definition
no
Term
what do direct intervention measures show
Definition
are the things I'm doing as a PT making a difference?
Term
if you're working in a community re-entry environment, is it valuable to know someone's GCS?
Definition
no
Term
if you're working in the ICU, are you worried about someone's participation
Definition
no
Term
what are some injury severity measures
Definition
GCS, 4 score, PTA
Term
what determins which outcome measures you would choose for a patient
Definition
where the patient is along the recovery timeline and what therapeutic priorities are
Term
what are the biological priorities immediately after trauma
Definition
survival
Term
what are the mobility goals immeidiately after traumatic onset
Definition
prevent complications of immobility. Early mobilization.
Term
what are the social priorities upon discharge to home
Definition
impact on family, burden of care
Term
what are mobility goals upon discharge to home
Definition
community re-integration, self-efficacy
Term
what are the psychological priorities with long-term adjustment
Definition
emotional health, psychosocial adjustment
Term
what are mobility goals with long-term adjustment
Definition
chronic health management, well-being
Term
what are disorders of consciousness outcome measures
Definition
JFK CRS, DOCS
Term
what is a good ADL outcome measure
Definition
FAM
Term
what is a higher level mobility outcome measure
Definition
HIMAT, CBMS, ERFT
Term
what are some participatoin and QOL outcome measures
Definition
CIQ, POPS, MPAI, QOLIBRI
Term
what are behavioral/cognitive outcome measures
Definition
Rancho levels, ABS, PTA, MARS, Functional Self-Assessment scale
Term
what outcome measures show ability to do activities and would be good for discharge to home
Definition
Barthel Index, FIM, Berg, SF 36, Dynamic Gait Index, TUG, 6 minute walk test, 10 meter walk test,
Term
what outcome measure to think of first when someone has an issue with consciousness
Definition
JFK Coma Recovery Scale
Term
is the Coma Recovery Scale reliable and valid
Definition
yes
Term
is the Coma Recovery Scale reliable in distinguishing between vegetative and minimally conscious states
Definition
yes
Term
what are the subscales of the Coma Recovery Scale
Definition
arousal, auditory, visual, motor, and verbal communication subscales
Term
what is another consciousness scale besides the Coma Recovery Scale
Definition
Disorders of Consciousness Scale
Term
what are the subscales of the Disorders of Consciousness Scale
Definition
social knowledge, taste/swallowing, olfactory, proprioceptive/vestibular, auditory, visual, tactile, testing readiness
Term
is the Disorders of Consciousness Scale reliable and valid
Definition
yes
Term
what other impairments are important to assess
Definition
vestibular function, fatigue
Term
what does the FAM add in addition to FIM
Definition
swallowing, car transfers, community access, reading, writing, speech intelligibility, emotional status, adjustment to limitations, employability, orientation, attention, safety/judgment
Term
what is modified independence
Definition
subject does not need a helper but does need adaptive devices, keep trips short, use safety considerations
Term
what does HiMAT stand for
Definition
high level mobility assessment test
Term
what does the HiMAT look at
Definition
walking, running, skipping, hopping, bounding, stairs
Term
what does HiMAt do with these test performances
Definition
times performance over a 10 meter distance
Term
who would the HiMAT be good for
Definition
someone who wants to get back to running, for example
Term
what is the definition of independent ambulation according to HiMAT
Definition
ambulates 20m without assistive devices
Term
what injury is Community Balance and Mobility Scale specifically for
Definition
TBI
Term
what aspects does the Community Balance and Mobility Scale look at
Definition
unilateral stance, tandem walk, 180 tandem pivot, lateral foot scooting, hopping forward, crouch and walk, lateral dodging, walking and looking, running with controlled stop, forward to backward walking, walk/look/carry, stairs, step up
Term
can you do the Community Balance and Mobility Scale with an assistive device?
Definition
yes, but you don't have to
Term
what does ERFT stand for
Definition
Executive Route Finding Test
Term
how to do the ERFT
Definition
give patient an office to find
Term
what are the score areas of the ERFT
Definition
task understanding, information seeking, retaining directions, error detection, error correction, on task behavior
Term
what kinds of problems are you looking for with the EFRT
Definition
emotional, interpersonal, communcation, perceptual
Term
what are the 4 approaches to wayfinding?
Definition
wandering aimlessly, trial and error, step by step, strategy use
Term
describe wandering aimlessly
Definition
non-directed, non-systematic walking around
Term
describe trial and error
Definition
guessing about the location and using a gradual process of elimination
Term
describe step by step
Definition
asking for information limited to the next closest location
Term
describe strategy use
Definition
obtaining a map or written directions
Term
what are the 4 types of cognitive impairments tested by EFRT
Definition
cognitive abiliteies, attention, memory, executive function
Term
what is Rancho Level I
Definition
No response
Term
what is Rancho Level II
Definition
Generalized response
Term
what is Rancho Level III
Definition
Localized response
Term
what is Rancho Level IV
Definition
confused - agitated
Term
what is Rancho level V
Definition
confused - inappropriate
Term
what is Rancho Level VI
Definition
confused - appropriate
Term
what is the Rancho Level VII
Definition
automatic - appropriate
Term
what is Rancho Level VIII
Definition
purposeful and appropriate, needs SBA
Term
What is Rancho level IX
Definition
purposeful, appropriate, SBA on request
Term
what is Rancho Level X
Definition
purposeful, appropriate, MI
Term
what is a functional outcome measure for attention
Definition
Moss Attention Rating Scale (MARS)
Term
what are the 3 main categories the MARS looks at
Definition
problematic behaviors, positive behaviors, differences over time
Term
what is the purpose of the Functional Self-Assessment Scale
Definition
self rating of safety designed for inpatient rehab
Term
What are some good outcome measures to give for long term adjustment
Definition
community integration questionnaire, Mayo-Portland Adapatability Inventory, Participation Assessment with Recombined Tools - Objective
Term
what topics does the community integration questionnaire ask about
Definition
shopping, preparing meals, caring for children, leisure activities, travel, volunteer, friends, work, school, relationships
Term
what is the Mayo-Portland Adaptability Inventory
Definition
Functional outcome measure specific to TBI that measures ability, adjustment, participation, and other conditions
Term
what does the Participation Assessment with Recombined Tools - Objective measure look at?
Definition
hours per week in different activities.
Term
what is the purpose of Global Outcome Measures
Definition
broad representation of important issues post TBI
Term
are global outcome measures more helpful for specific PT outcome assessment or research?
Definition
research
Term
how is the Glasgow Outcome Scale different from the GCS
Definition
extended, has half points
Term
what is Glasgow 1.0
Definition
vegetative state
Term
what is glasgow 1.5
Definition
low responsive state
Term
what is glasgow 2.0
Definition
severe disability requiring supervision or assistance most or all of 24 hour period
Term
what is glasgow 2.5
Definition
severe to moderate disability requiring supervision or light assistance some of the day, not independent in the community
Term
what is glasgow 3.0
Definition
moderate disability relatively independent in community, able to ride public transportation
Term
what is glasgow 3.6
Definition
moderate disability/good outcome approaching previous level of function but still disabled
Term
what is glasgow 4.0
Definition
good revcovery: at or near premorbid level. May still have minor impairments.
Term
describe the disability rating scale
Definition
inverse GCS. Looks at cognitive ability for ADL, dependence on others, employability
Term
what should you consider when choosing outcome measure for TBI
Definition
context, goals, life course. Must cover range of cognitive, behavioral, and motor issues. Cover ICF. Avoid floor-ceiling effects
Term
look at word doc Adult TBI Objectives for more info about standardized measures for TBI
Definition
ok
Supporting users have an ad free experience!