Acquired Brain Injury (ABI) and TBI

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Questions and Answers

Which of the following is the MOST accurate definition of an acquired brain injury (ABI)?

  • Impairments to the brain that are always permanent or progressive.
  • Damage to the brain resulting exclusively from congenital conditions.
  • Brain damage sustained after birth, irrespective of degenerative diseases.
  • Brain damage that occurs after birth and is not related to congenital or degenerative diseases. (correct)

In the context of traumatic brain injury (TBI), what differentiates a 'dynamic loading injury' from a 'static loading injury'?

  • Static loading is seen in coup-contrecoup injuries, whereas dynamic loading results in diffuse axonal injury.
  • Dynamic loading is more common and involves rapid acceleration and deceleration forces, while static loading involves slow mechanical force. (correct)
  • Dynamic loading involves a slow, sustained force, whereas static loading involves sudden impact.
  • Static loading always results in open head injuries, while dynamic loading results in closed head injuries.

What is the PRIMARY concern regarding intracranial pressure (ICP) in acute TBI management?

  • Ensuring ICP is within the normal range (5-15mmHg) to optimize cerebral perfusion and prevent secondary injury. (correct)
  • Elevating ICP to facilitate better oxygenation of brain tissue.
  • Maintaining ICP below 25 mmHg to prevent hypotension.
  • Ignoring ICP unless the patient has a craniectomy.

Which of the following BEST describes 'coup-contrecoup' in the context of head injuries?

<p>Two separate brain injuries, one at the point of initial impact and another on the opposite side of the brain. (D)</p> Signup and view all the answers

A patient presents with a Glasgow Coma Scale (GCS) score of 10. According to TBI severity classification, how would this be categorized?

<p>Moderate TBI (C)</p> Signup and view all the answers

Why is monitoring for 'storming' important in the acute phase of TBI?

<p>To identify signs of autonomic dysfunction, which can trigger stress responses that cannot be mediated in low-level comatose patients. (A)</p> Signup and view all the answers

During coma stimulation, what would be considered a POSITIVE response to sensory input?

<p>Calming effect (D)</p> Signup and view all the answers

What is the PRIMARY goal of behavior management in patients experiencing agitation following a TBI?

<p>To ensure the continuation of medically necessary treatment and provide a safe environment. (B)</p> Signup and view all the answers

Which of the following is LEAST likely to be a consideration in the acute phase of TBI management?

<p>Implementing strategies for return to work. (B)</p> Signup and view all the answers

A patient in a comatose state following a TBI is exhibiting decerebrate posturing. What does this indicate?

<p>Severe brain injury with likely damage to the brainstem. (C)</p> Signup and view all the answers

What is the PRIMARY focus of occupational therapy interventions for patients at Rancho Los Amigos (RLA) Levels I-III?

<p>Increasing state of consciousness and preventing contractures. (B)</p> Signup and view all the answers

Which of the following is the MOST important reason to provide family education early in the rehabilitation process after a TBI?

<p>To provide clear, concise information so they can participate in care and understand the recovery process. (B)</p> Signup and view all the answers

Following a TBI, a patient is experiencing increased muscle tone and contractures. Which intervention is MOST appropriate in the acute phase to address this?

<p>Serial casting and splinting combined with PROM exercises (B)</p> Signup and view all the answers

What is the significance of monitoring Cerebral Perfusion Pressure (CPP) in acute TBI, and what level is considered ideal?

<p>To evaluate brain perfusion; ideally &gt; 60 mmHg. (C)</p> Signup and view all the answers

What is the PRIMARY reason for using structured sensory stimulation programs with patients in a coma?

<p>To increase the patient's state of arousal and awareness (B)</p> Signup and view all the answers

Which of the following should be prioritized when positioning a patient with abnormal posture in side-lying?

<p>Using pillows between the knees and behind the back of the patient to maintain trunk alignment. (D)</p> Signup and view all the answers

A patient who has had a TBI is easily frustrated during therapy sessions and demonstrates impulsive behavior. What strategy would be MOST appropriate?

<p>Sessions/tasks should be short, task-specific, within the patients abilities. (B)</p> Signup and view all the answers

Why is a multidisciplinary approach essential in the rehabilitation of individuals with TBI?

<p>To provide comprehensive care addressing the diverse physical, cognitive, emotional, and social needs of the patient. (C)</p> Signup and view all the answers

In the context of visual and visual perception deficits following TBI, what is Vergence?

<p>The simultaneous movement of both eyes in opposite directions to maintain single binocular vision. (A)</p> Signup and view all the answers

Which of the following statements BEST reflects the role of occupational therapy in optimizing motor function after a TBI?

<p>Engaging patients in automatic gross motor activities and traditional exercises as cognition improves. (C)</p> Signup and view all the answers

What is the PRIMARY focus of intervention when using functional training with a TBI patient?

<p>Reestablishing routine self-care tasks and gradually increasing task complexity. (A)</p> Signup and view all the answers

What is the MOST important consideration when establishing consistent routines for a patient with TBI?

<p>Creating sequencing of steps (checklists, sequencing cards etc.). (A)</p> Signup and view all the answers

Which of the following is an essential aspect of family training and support in TBI rehabilitation?

<p>Encouraging family to follow the daily routine and provide clear concise information to the patient. (C)</p> Signup and view all the answers

In the later stages of TBI rehabilitation, what should be the PRIMARY focus regarding self-care skills?

<p>Restoring competence in self-maintenance skills (ADL/IADL). (B)</p> Signup and view all the answers

Which of the following strategies is MOST effective for increasing patient compliance with exercises?

<p>Integrating exercises into the patient’s daily routines and functional activities. (B)</p> Signup and view all the answers

A patient with a mild TBI reports persistent headaches, irritability, and difficulty concentrating. What should an occupational therapist recommend?

<p>Recommending vocational rehab and memory startegies. (D)</p> Signup and view all the answers

What is the PRIMARY purpose of using “time-outs” as a behavioral approach with TBI patients?

<p>To provide a break to reduce frustration. (A)</p> Signup and view all the answers

Which of the following is an example of a degenerative process that can lead to brain injury?

<p>Parkinson's Disease (A)</p> Signup and view all the answers

Which of the following is an example of a focal injury?

<p>Contusions, lacerations, intracranial hematomas (A)</p> Signup and view all the answers

Which of the following is a component of acute secondary effects of TBIs?

<p>Cerebral edema (C)</p> Signup and view all the answers

Which of the following is a component of indirect complications/sequelae from TBIs?

<p>Contractures (C)</p> Signup and view all the answers

Which of the following is a listed care setting of a TBI patient?

<p>ICU (B)</p> Signup and view all the answers

According to the Rancho Los Amigos Levels of Cognitive Functioning Scale, what level is 'Generalized Response'?

<p>Level 2 (C)</p> Signup and view all the answers

Which of the following is a possible indication when a patient requires a craniectomy?

<p>helmet for OOB, bone flap may not be replaced for 6 weeks-&gt;6-12 months (C)</p> Signup and view all the answers

Which of the following Glasgow Coma Scale responses is worth 4 points?

<p>Eyes open spontaneously (A)</p> Signup and view all the answers

Flashcards

Acquired Brain Injury (ABI)

Damage to the brain that occurs after birth, not congenital or degenerative.

Traumatic Etiologies of ABI

Falls, assaults, GSW, blows to the head causing acceleration/deceleration forces, projectile missiles, blast waves/explosion

Vascular Etiologies of ABI

Stroke (hemorrhagic, ischemic), brain bleeds (hematomas, hemorrhages), lack of oxygen (anoxia, cardiac arrest)

Diffuse Brain Injury

Caused by rapid movement of the head that stretches or shears long axons in brain/brainstem.

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Focal Brain Injury

Localized brain damage that occurs usually in the frontal or temporal lobes.

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Dynamic Loading Injury

Impact to head from direct blows or sudden movements causing acceleration and deceleration.

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Static Loading Injury

Slow mechanical force applied to the brain.

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Mild TBI: Structural Imaging

The severity of mild TBI based on imaging results.

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Moderate TBI: Loss of Consciousness

The severity of moderate TBI based on Loss of Consciousness.

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Severe TBI: Glasgow Coma Scale

The severity of severe TBI based on the Glasgow Coma Scale.

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Open Head Injury

Perforates cranial cavity and brain tissue

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Focal Injury

Damage is localized to area of brain where impact occurred

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Diffuse Injury

Caused by rapid movement of the head.

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Intracranial Pressure (ICP)

Increased pressure exerted on brain by extra tissue or fluid.

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Craniectomy Precautions

Helmet required for patients to get OOB; bone flap is temporarily removed.

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Polytrauma

Fractures often associated with TBI.

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Flexor Muscles and TBI

Muscle groups with a greater risk of contracture after TBI.

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TBI: Tx for Levels I-III

PROM, tone management, positioning

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Rancho Los Amigos Scale Level 1

unresponsive to touch, pain, auditory, verbal stim.

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Rancho Los Amigos Scale Level 2

inconsistent, non-purposeful responses and/or reactions to painful stim.

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Rancho Los Amigos Scale Level 4

heightened responses; disoriented, unaware of events, frequent inappropriate behavior, aggressive

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Behavior Goals After TBI

The primary goal of behavioral management after TBI.

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OT Interventions: Positioning

Monitor pt, expression, skin

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Coma

A state of complete unresponsiveness to both external & internal stimuli.

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Upright Positioning

Stimulating visual & vestibular systems.

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Family Support and Education

Will need info and support

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