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The difference between TBI and CVA or SCI is cognitive and behavioral impairments, particularly the behavoiral impairments.

What are two mechanisms of injury for TBI?

Closed and Open

What is the difference between closed and open TBI injuries?

A closed injury is when the skull is not fractured. An open injury is when the skull is fractured or broken.

What are two types of closed injuries?

Coup- contusion directly below the site of injury- damage localized to area of impact. (one bruise to the brain)

Coup de contrecoup-most common type of TBI. Brain ricochets inside the skull. Brain bounces and makes contact with skill opposite the side of impact. Diffuse injury leaving a bruise at 2 locations.

What are the most vulnerable sites of injury and what are the characteristics?

The brainstem, frontal, and temporal lobes are vulnerable.

Brainstem- regulates basic arousal and regulatory function, attention and short term memory.

Limic system- emotions

temporal lobes- many cognitive skills such as memory and language.

fontal lobe- large and location near the front of cranium- very vulnerable to injury. Many cognitive functions, emotional and personality control.

What is diffuse brain injury and what is the cause?

This means that the damage is throughout the brain due to shearing of the axons in their sheath. This is the reason for behavioral problems. global diffuse injury bruises are usually in the frontal or temporal lobes.

What are two types of secondary damage for TBI's?

Cerebral hypoxia/anoxia,

Swelling/Cerebral edema

intracranial hematoma- this is also known as "talk and die" when a pt comes into the ER talking and they die in mins or hours.

What are types of TBI injuries?

skull fracture
direct injury to the head
acceleration/deceleration
near drowning
hypoxia
drug overdose
penetrating injuries to the head
poisoning
infection
post traumatic epilepsy

Define concussion and name the two components.

loss of consciousness due to injury of the head

Mild-may have retrograde amnesia=loss of memory right before the injury

moderate: loss of consciousness for <24hours. May have retrograde amnesia and post-traumatic amnesia=loss of memory after a tragic event.

Anything more than these types of concussions are considered to be a TBI.

What is the Glasgow Coma Scale?

It is used to assess the level of consciousness. (universal scale)

It is a tool for determining prognosis of a patient

Prognosis is determined based upon the change in rating over time.

Three indicators are assessed as part of the GCS
1. Eye opening
2.Verbal Response
3.Motor Response

When are patients diagnosed as being in a persistent vegetative state?

When they have a score of 8 or less for a number of weeks

What are the motor impairments related to head injury?

Cranial nerve involvement

Hemiparesis

Decrease balance and righting reactions

predominance of primary reflexes and abnormal tone

Poor timing; cerebellar disturbances; intention tremor

What are the sensory impairments related to head injury?

Visual disturbances

Altered taste

decreased touch/pressure

altered arousal

What are the perceptual disturbances related to head injuries?

Decreased proprioception

Decreased ability to recognize time, enviroment, and events

Decreased integration of movement

Decreased body image and bodyawareness

Unilateral neglect

What are types of cognitive disturbances seen w/ head injuries?

Altered mental awareness

Decreased attention span

Impaired recent memory
A. Retrograde amnesia(loss of receall of events leading up to injury)
B. Anterograde amnesia- loss of recall of events post injury to the point of normal function, e.g. loss of recognition if events of day. The longer this period lasts, the more diffuse/global and serious injury

Loss of abstract reasoning

Decreased problem-solving

Lack of initiation

Lack of reasoning

What are the two communication disorders seen w/ head injuries?

Apasia- general term used to describe an acquired language disorder caused by brain damage, which results in linguistic errors in word choice, understanding or formulation rather than problems in pronunciation.

Dysarthia- Dysarthria is a motor speech disorder. The muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury. The type and severity of dysarthria depend on which area of the nervous system is affected.