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Phineas Gage

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Due to an explosion, a tamping rod penetrated through his head. He ended up being a very famous case study in neuropsychology/neuroscience. After his injury he was able to talk and function with personality changes and issues.

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Glascow Coma Scale

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Measures the function of Eye Movement, Motor Response, Verbal Response. Measures the level of alertness

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Glascow Coma Scale Range 3-15

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13 - 15 Mild Traumatic Brain Injury 9 - 12 Moderate Traumatic Brain Injury 8 or lower Severe Traumatic Brain Injury

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Edema

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Swelling of the brain tissues after a brain injury

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Coup Injury (TBI)

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Brain injury that occurs at the site of impact

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Contrecoup Injury (TBI)

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Brain injury that occurs on the opposite side of the brain (because of the brain hitting the skull)

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Coup-Contrecoup Injury (TBI)

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Contusions at the site of impact and on the complete opposite side of the brain.

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Contusion (TBI)

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Brain injury, bruising to the surface of the brain. Can be a direct impact to the brain

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Diffuse Axonal Injury (DAI), (TBI)

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A person experience strong rotational forces (car collision),brain tissue can be twisted or stretched causing damage to the axons of neurons.

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Acquired Brain Injury (ABI)

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An injury to the brain that has occurred after birth not relating to hereditary, congenital, degenerative or induced by birth trauma. Any injury that is non traumatic Can be from a car accident or assault, near drowning, stroke, tumor, electric shock, lightening strike, anoxic or hypoxic brain injury.

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Second Impact Syndrome (TBI) aka (recurrent traumatic brain injury)

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Occurs when a person sustain a second (tbi) before the symptoms of the first (tbi) have healed. The second (tbi) will cause swelling and widespread damage. Death occurs rapidly L/T effects are muscle spasms, emotional changes, hallucinations, difficulty thinking and learning.

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Penetrating Injury (TBI)

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Occurs from the impact from a bullet, knife that forces hair, skin bone from the patient into the brain. "A through-and-through" injury if an object enters the skull goes thru the brain, exits the skull. Results in 91% firearms related deaths caused by bullet wounds, the single largest causes of death from TBI.

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Shaken Baby Syndrome (TBI)

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A violent criminal act Forceful movements causing blood vessels in the skull to rupture and bleed. Causes seizures, lifelong disability, coma & death

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Signs/symptoms of Shaken Baby Syndroms

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Irritability, changes in eating patterns, tiredness, difficulty breathing, dialeted pupils, seizures,vomiting

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Locked in Syndrome (TBI)

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Neurological condition which a person cannot physically move any part of the body except the eyes.

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Anoxic brain Injury (ABI)

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Occurs when the brain doesn't receive oxygen. Cells in the brain need oxygen survive and function. Types: Anoxic Anoxia-- no oxygen to the brain Anemic Anoxia--injury from blood clot not carrying enough oxygen Toxic Anoxia--injury from toxins or metobolities that block oxygen in the blood from being used.

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Hypoxic brain injury (ABI)

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Brain receives some but enough oxygen. also call (Ischemic Insult) A critical reduction in blood flow or low blood pressure leading to a lack of blood flow to the brain.

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Open Head Injury

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Skull fractures: depressed skull fracture compound skull fracture basilar skull fracture battles sign racoon eyes diastatic skull fracture cribiform plate fracture

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Closed Head injury

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The person receives an impact from an outside force, the skull does not fracture or displace. Brain has no place to expand As brain swells. it expands into available opening of the skull & impairs function ex: eye sockets

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Traumatic Brain Injury (TBI)

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A alteration in brain function caused by an external force.

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Types of Brain Injury

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Diffuse Axonal Injury (TBI) Shaken Baby Syndrome (TBI) Concussion (TBI) Locked in Syndrome (TBI) Contusion (TBI) Anoxic brain injury (ABI) Coup-contre-coup injury (TBI) Second Impact Syndrome Hypoxic brain injury (ABI) Open and Closed Head injuries Penetrating injury (TBI)

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Concussion

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Can be caused by a direct blow to the head, gunshot wounds, violent shaking of the head or force from a whiplash. Is a physical injury to the brain causing disruption of normal physical function. A trauman resulting in changes to physial or cognitive abilities. May not result in loss of consciousness My not show up on a CT Ex: CTE's in sports

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Types of concussion

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Grade 1: Confused, conscious, symtons clear in 15 minutes Grade 2: Conscious, develops amnesia Grade 3: Loss consciousness, signs & times

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TBI levels of Severity (DAI)

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Mild, Moderate, Severe

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Mild Traumatic Brain Injury (Concussion) (DAI)

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Majority of TBI's are rated mild. A patient loses consciousness for 15 minutes or less. Memory loss about the trauma event. Feel dazed disoriented or confussed

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MTBI symptons

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Headache, fatigue, sleep disturbance, irritability, sensitivity to light and noise balance problems, concentration, attention span, speed of thinking,memory problem, nausea, depression/anxiety, mood swings.

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Symptons Functional changes

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Coordinating balance, walking, blurred vision, headaches, speaking and swallowing,, lack of bowel & bladder control, motor impairments, seizures, changes in sensory perception, sleep patterns, sexual functions, personality changes, trouble communicating, memory, depression, mood swings, disoriented, forgetful, difficulty forming sentences or choosing vocabulary, act inappropriately, struggle with reasoning, focus and logic

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MBTI new imaging technologies

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Positron Emission Tomography (PET) Single Photon Emission Computerized Tomography (SPECT) Functional Magnetic Resonance Imaging (fMRI) Diffuse Tensor Imaging (DTI)

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Mild (DAI)

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Neurons begin to die leading to missed communication amongst neurons in the brain

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Moderate Traumatic Brain Injury (DAI)

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A (brief)loss of consciousness from 15 minutes to a few hours. Few days or weeks of confussion, impaired long term memory. Reduced problem-solving abilities Lower social inhibition Attention perception problems CAN MAKEN A GOOD RECOVERY WITH TREATMENT AND LEARN COMPENSATION FOR THEIR DEFICITS.

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Severe Traumatic Brain Injury (DAI)

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Affects less than 10% of patients. Loss of consciousness of 6 hours or longer after injury. Coma SUBCGROUPS: Persistent Vegetative state Coma Vegetative State Minimally Responsive State Akinetic Mutism Locked-in Syndrome

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Rancho Los Amigos Scale

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A on-going behavior evaluation toolfrequently used after TBI. Doesn't require patient cooeration. Response is measured based on patient response and external information. Tracks cognitive, behavioral & emotional changes during healing. Levels 1 - 10, 1= lowest level measures functionality , no response to light, touch (deep sleep) 10=can handle several tasks

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JFK Coma Recovery Scale

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Measures everything. hearing, vision, movement to determine long-term prognosis.

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Standard Diagnostic Tests

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Xray CT Scan MRI

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Neuropsychological Assessment

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Occurs after the patient enters into a rehab program Evaluates multiple aspects of the mind, basic hand, eye coordination, higher level thinking and cognitive thinking. Helps determine effective plan of care.

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CT Scan (Computerized Tomography)

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Provides information about spinal & brain damage better than X-ray. Cross-sectional images of accuracy. Most commonly used diagnostic test to check for mild TBI

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MRI (Magnetic Resonance Imaging)

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Uses strong magnetic field and radio ways to generate computer generated images. It can identify blood clots, swelling, skull fractures that compress the brain and the spinal cord. Gives more detail than a CT scan not visible on CT.

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Axonal Shearing

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When the brain's axon's, (main channels of communication are stretched to the point of breaking, causing damaged brain cells to die.

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Brain Herniation (brain hematoma)

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Rising pressure inside the brain or hematoma causing parts to shift out of place. A large brain bleed or hematone can cause herniation.

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Cerebral Atropy

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Loss of neuron cells in the brain and the connection between them. It can be caused by stroke, TBI or other traumatic diseases.

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Hematoma

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A pool of bood or bruise inside the skull caused by damage blood vessels can increase pressure inside the brain.

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Hemorrhage

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Internal or external bleeding caused by a damage to a blood vessel

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Intracranial Pressure Monitoring

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Monitoring of the pressure inside the skull using a threaded catheter or a sensor.

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Shock

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Body response to loss of blood to the brain which can indirectly injure brain tissue.

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3 stages of Consciousness

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Minimally Conscious, Vegetative State, Coma

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Minimally Conscious State

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Any small, consistently identifiable and deliberate behavior or action by the patient.

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Vegetative State (Semi-Coma)

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When patients eyes are open but not always aware of themselves or their surroundings.

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Coma (Comatos)

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A deep state of unconsciousness, no response to stimuli, no voluntary actions. Coma can be induced to give brain time to heal.

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Sympathetic Storming

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An elevated stress response that occurs in 1/3rd of TBI patients

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Cerebellum injuries results in:

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Gross & fine motor skills, voluntary motor skill, balance, equilibrium coordination, postural control, eye movement.

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Frontal Lobe injuries results in: (seat of intelligence)

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Sequencing, decision making, attention, personality, problem-solving, verbal expression, lack of spontaneity, emotions, movement initiation.

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Temporal Lobe injuries results in: (data base of memory's)

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Spoken words, selective attention, sexuality, inhibition, aggression, identification, categorization, facial recognition and locating objects

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Parietal Lobe injuries results in: (interprets the senses)

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Higher level of function: Object classification (naming objects), tactile processing, sensations, academic skills decrease. Cognitive abilities decrease, directional understanding, hand/eye coordination and spatial orientation.

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Occipital Lobe Injuries results in: (interprets the senses)

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Vision defects, locating objects, color identification, hallucinations, word blindness, movement perception, reading/writing, visual processing.

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Brain Stem injuries results in:

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Body temperature regulation, heart rate regulation, breathing, balance, movement, swallowing, vertigo, nausea.

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Neurotrasmitters

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The release of toxic material from dead axons into the extra cellular space more axons and neurons to die over 24 to 48 hours.

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Brain

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The most complex part of the human body (3lbs) Most fragile organ in the body. Same texture as gelaton.

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Neuron process

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1. Neurons are a nerve cell that sends signals to and from the body. 2. Each neuron has a nerve fiber called the AXON 3. Axon (nerve fiber) connects neurons with each other and provide connections to dendrites. 4. Dendrites extend out from the cell body to other nerve cells 5. Cell Body has axons and dendrites

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Recovery requests

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Gets lots of rest Avoid activities that may cause another injury to the head Ask doctor when is it safe to drive Write things down Help needing to relearn skills lost Take only approved medications from doctors No alcohol

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Leading causes of TBI

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Falls: 40.5% Unknown: 19% Motor Vehicle: 14.3% Struck by/Against: 15.5% Assaults: 10.7% Outcome: deaths, hospitalization, emergency depart visits.

SHS 350 Traumatic Brain Injury (TBI) – Flashcards

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