Term
| is TBI or MS more common? |
|
Definition
|
|
Term
| is TBI or cancer more common? |
|
Definition
|
|
Term
| is TBI or SCI more common? |
|
Definition
|
|
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
|
|
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
|
|
Term
|
Definition
| damage from pressure wave from a blast |
|
|
Term
| what is the greatest mechanism of TBI in military |
|
Definition
|
|
Term
| what part of blast gives primary effects |
|
Definition
|
|
Term
| what part of blast gives secondary effects |
|
Definition
|
|
Term
| what part of blast gives tertiary effects |
|
Definition
|
|
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
|
|
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
|
Definition
| lesion at point of impact in a coup-contre coup injury |
|
|
Term
|
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
|
|
Term
|
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
|
|
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
|
|
Term
|
Definition
|
|
Term
|
Definition
| cerebral perfusion pressiure |
|
|
Term
| how is ICP affected by cerebral swelling |
|
Definition
|
|
Term
| how is CPP affected by cerebral swelling |
|
Definition
|
|
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
|
|
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
|
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
|
|
Term
| what is the effect of metabolic cascade on ICP |
|
Definition
|
|
Term
| what is the effect of metabolic cascade on CPP |
|
Definition
|
|
Term
| what will happen if you don't get ICP and CPP under control |
|
Definition
|
|
Term
| what is the initial focus immediately upon TBI? |
|
Definition
|
|
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
|
|
Term
| what should child's ICP be |
|
Definition
|
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
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
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
|
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
|
|
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
|
|
Term
| when is vegetative state considered permanent |
|
Definition
|
|
Term
| what is the time frame for late recovery from vegetative state |
|
Definition
|
|
Term
| http://www.msnbc.msn.com/id/13690450/ |
|
Definition
|
|
Term
| http://www.youtube.com/watch?v=Pl1IPTpHUHs |
|
Definition
|
|
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
|
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
|
|
Term
| how does retrograde amnesia change with recovery |
|
Definition
|
|
Term
| does the memory of the accident usually return with recovery |
|
Definition
|
|
Term
|
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
|
|
Term
| what is injury severity for PTA 5-60 minutes |
|
Definition
|
|
Term
| what is injury severity for PTA 1-24 hours |
|
Definition
|
|
Term
| what is injury severity for PTA 1-7 days |
|
Definition
|
|
Term
| what is injury severity for PTA 1-4 weeks |
|
Definition
|
|
Term
| what is injury severity for PTA >4 weeks |
|
Definition
|
|
Term
| what does the Galveston Orientation and Amnesia test do |
|
Definition
| assess orientation, memory |
|
|
Term
| does a PT administer GOAT? |
|
Definition
|
|
Term
| when are you trying to determine mortality rather than morbidity? |
|
Definition
|
|
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
|
|
Term
| what PTA duration indicates positive outcome |
|
Definition
|
|
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
|
|
Term
| what are obstacles to speech following TBI? |
|
Definition
|
|
Term
| what 2 stages of TBI recovery is 4 score more sensitive to? |
|
Definition
|
|
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
|
|
Term
| what part of the brain is affected with absent cough reflex |
|
Definition
|
|
Term
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719522/figure/F1/ |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the IMPACT project |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| if you're working in the ICU, are you worried about someone's participation |
|
Definition
|
|
Term
| what are some injury severity measures |
|
Definition
|
|
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
|
|
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
|
|
Term
| what is a good ADL outcome measure |
|
Definition
|
|
Term
| what is a higher level mobility outcome measure |
|
Definition
|
|
Term
| what are some participatoin and QOL outcome measures |
|
Definition
|
|
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
|
|
Term
| is the Coma Recovery Scale reliable and valid |
|
Definition
|
|
Term
| is the Coma Recovery Scale reliable in distinguishing between vegetative and minimally conscious states |
|
Definition
|
|
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
|
|
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
|
|
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
|
Definition
| Executive Route Finding Test |
|
|
Term
|
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
|
Definition
| guessing about the location and using a gradual process of elimination |
|
|
Term
|
Definition
| asking for information limited to the next closest location |
|
|
Term
|
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
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is the Rancho Level VII |
|
Definition
|
|
Term
| what is Rancho Level VIII |
|
Definition
| purposeful and appropriate, needs SBA |
|
|
Term
|
Definition
| purposeful, appropriate, SBA on request |
|
|
Term
|
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 |
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Term
| are global outcome measures more helpful for specific PT outcome assessment or research? |
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Definition
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Term
| how is the Glasgow Outcome Scale different from the GCS |
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Definition
| extended, has half points |
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Definition
| severe disability requiring supervision or assistance most or all of 24 hour period |
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Definition
| severe to moderate disability requiring supervision or light assistance some of the day, not independent in the community |
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Definition
| moderate disability relatively independent in community, able to ride public transportation |
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Definition
| moderate disability/good outcome approaching previous level of function but still disabled |
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Definition
| good revcovery: at or near premorbid level. May still have minor impairments. |
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Term
| describe the disability rating scale |
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Definition
| inverse GCS. Looks at cognitive ability for ADL, dependence on others, employability |
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Term
| what should you consider when choosing outcome measure for TBI |
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Definition
| context, goals, life course. Must cover range of cognitive, behavioral, and motor issues. Cover ICF. Avoid floor-ceiling effects |
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Term
| look at word doc Adult TBI Objectives for more info about standardized measures for TBI |
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