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22 Cards in this Set
- Front
- Back
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Defination of Tbi brain injury association. |
As an insult to brain not degenerative or congenital that us caused by external physical force This insult may produce a diminished or altered state of consciousness and hence impairment of cognitive behavioral emotional or physical functioning |
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Causes of TBi |
1) falls major cause 2) RTA greatest cause of hospitalization 3) interpersonal violence 4) alcohol use is a contributing factor to accident resulting in TBi |
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Definate severity of TBI |
1) severe- Initial GCS less than 8 ,loss of consciousness longer than 6 hours 2) moderate- initial GCS 9-12 ,post traumatic amnesia for 1 hour to 24 hours 3)mild- trauma induced physiological disruption of brain with atleast one of following a. Loss of consciousness b. Loss of memory for event immediately before or after accident c. Altered state at time of accident d. Neurological deficits may or may not be transient |
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Mechanism of injury |
1. Closed Head Injury- Often occurs as a result of RTA, or a blow to the head, or a fall where the head strikes the floor or another hard surface. In closed head injury, the skull is not penetrated, but it is frequently fractured.Generally, there is both focal and diffuse axonal damage. 2.Open Head Injury- This is caused by a penetrating wound, eg. by a weapon or from a bullet.In these cases, the skull is penetrated. The brain injury is usually largely focal axonal damage. 3.Deceleration Injury -This frequently occurs in RTA, when rapid deceleration occurs as the skull meets a stationary object, causing the brain to move inside the skull.Mechanical brain injury occurs due to axonal shearing, contusion and brain oedema. 4.Coup Injury-This occurs beneath the point of impact may be associated with a skull fracture at the site of impact 5.Contracoup Injury- This occurs when the impact is sufficient to cause the brain to move within the skull; the brain moves in the opposite direction, and hits the opposite side of the skull, causing bruising. 6.Coup-Contracoup Injury- This is a frequent occurrence where opposite poles of the brain suffer injury. |
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Fractures associated with TBi |
Skull fracture is mostly associated with TBi. Pt with brain injury from RTA or fall may have other systemic trauma Luke fractures of extremities, shoulder girldle, pelvis face , spine or abdominal trauma or pneumothorax |
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Cranial nerve damage with Tbi |
CN can be torn, stretched or contused. 1) olfactory nerve is tor 2) optic nerve - injury to optic tract or visual cortex or direct injury to eye 3)3,4,6 CN - most vulnerable stretched because of edema or bleeding 4) 7,8 CN temporal lobe fractureA at base of skull 5) 5,9,10,11,12 rarely damage |
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Secondary effects of TBi |
1.disrupt cSf flow, BBB, vasomotor function leading to intracranial hypotension , cerebral vasospasm, increase ICP. 2. Secondary effects are intracranial bleed, ischemic brain damage, herniation of brain, electrolyte imbalance |
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Four stages of TBI survivor |
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Glasgow coma scale |
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Tell Ranchos los amigo scale of cognitive function |
It is a descriptive scale that uses cognitive behavioural interaction of person within their environment after Tbi |
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Level 1 Ranchos |
No response Complete absences of observable changes in behaviour when presented with visual , Auditory, proprioceptive , vestibular or motor stimuli |
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Non-surgical intervention in Tbi |
Medications are used to regulate neuroendocrine function,sleep , seizure activity and attention Drug induced coma may be initiated im sever TBI Mechanical ventilation using noninvasive measure assists respiration Diuretics, given intravenously, can be used to reduce the amount of fluid in soft tissues and thus help reduce pressure on the brain. Anti-epileptic medication is often provided in the early stages to avoid any additional brain damage, which may be caused if a seizure were to occur |
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Surgical medical intervention |
1. Craniotomy with hemoatoma evacuation to remove excess blood clot or blood 2. Decompression craniotomy- reduced sever intracranial pressure 3. VP shunt drain CSF and reduce ICP 4. Mechanical ventilation 5.Surgical repair of severe skull fractures, and/or removal of skull fragments from brain tissue |
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Level II rancho |
Generalised response : total assistance Demonstrates generalized reflex response topainful stimuli. • Responds to repeated auditory stimuli withincreased or decreased activity. • Responds to external stimuli withphysiological changes generalized, gross bodymovement and/or not purposefulvocalization. • Responses noted above may be sameregardless of type and location of stimulation. • Responses may be significantly delayed |
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Level III rancho |
Localized Response: Total Assistance • Demonstrates withdrawal or vocalization topainful stimuli. • Turns toward or away from auditory stimuli.• Blinks when strong light crosses visual field.• Follows moving object passed within visualfield. • Responds to discomfort by pulling tubes orrestraints. • Responds inconsistently to simple commands. • Responses directly related to type of stimulus.• May respond to some persons (especiallyfamily and friends) but not to others |
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Level IV rancho |
Confused/Agitated: MaximalAssistance • Alert and in heightened state of activity. • Purposeful attempts to remove restraints ortubes or crawl out of bed. • May perform motor activities such as sitting,reaching and walking but without anyapparent purpose or upon another's request. • Very brief and usually non-purposefulmoments of sustained alternatives and dividedattention. • Absent short-term memory. • May cry out or scream out of proportion tostimulus even after its removal. • May exhibit aggressive or flight behavior. • Mood may swing from euphoric to hostilewith no apparent relationship toenvironmental events. • Unable to cooperate with treatment efforts. • Verbalizations are frequently incoherent and/or inappropriate to activity or environment |
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Level V rancho |
Confused, Inappropriate Non-Agitated: Maximal Assistance Shows increase in consistency with following and responding to simple commands Responses are non-purposeful and random to more complex commands Behavior and verbalization is often inappropriate, and individual appears confused and often confabulates If action or tasks is demonstrated individual can perform but does not initiate tasks on own Memory is severely impaired and learning new information is difficult Different from level IV in that individual does not demonstrate agitation to internal stimuli. However, they can show agitation to unpleasant external stimuli. |
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Level VI Rancho |
Confused, Appropriate: Moderate Assistance Able to follow simple commands consistently Able to retain learning for familiar tasks they performed pre-injury (brushing teeth, washing face) however unable to retain learning for new tasks Demonstrates increased awareness of self, situation, and environment but unaware of specific impairments and safety concerns Responses may be incorrect secondary to memory impairments but appropriate to the situation |
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Level VII Rancho |
Automatic, Appropriate: Minimal Assistance for Daily Living Skills Oriented in familiar settings Able to perform Daily routine automatically with minimal to absent confusion Demonstrates carry over for new tasks and learning in addition to familiar tasks Superficially aware of one’s diagnosis but unaware of specific impairments Continues to demonstrate lack of insight, decreased judgment and safety awareness Requires at least minimal supervision for learning and safety purposes. |
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Level VIII Rancho |
Purposeful, Appropriate: Stand By Assistance Consistently oriented to person, place and time Independently carries out familiar tasks in a non-distracting environment Beginning to show awareness of specific impairments and how they interfere with tasks, however, requires standing by assistance to compensate Able to use assistive memory devices to recall daily schedule Acknowledges other’s emotional states and requires only minimal assistance to respond appropriately Demonstrates improvement of memory and ability to consolidate the past and future events Often depressed, irritable and with low frustration threshold |
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Level IX |
Purposeful, Appropriate: Stand By Assistance on Request Able to shift between different tasks and complete them independently Aware of and acknowledges impairments when they interfere with tasks and able to use compensatory strategies to cope Unable to independently anticipate obstacles that may arise secondary to impairment With assistance able to think about consequences of actions and decisions Acknowledges the emotional needs of others with stand by-assistance. Continues to demonstrate depression and low frustration threshold |
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Level X |
Purposeful, Appropriate: Modified Independent Able to multitask in many different environments with extra time or devices to assist Able to create own methods and tools for memory retention Independently anticipates obstacles that may occur as a result of impairments and take corrective actions Able to independently make decisions and act appropriately but may require more time or compensatory strategies Demonstrate intermittent periods of depression and low frustration threshold when under stress Able to appropriately interact with others in social situations |
