Consequences of TBI and ICP
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Motor Impairments from TBI
- orthopedic complications
- decrease in strength
- impaired functional mobility
- poor coordination
- balance impairments
- problems with fine motor and hand function
- impairments in speech
Sensory impairments from TBI
Autonomic impairments from TBI
- sleep disturbances
Cognitive impairments from TBI
- difficulty learning
- problem solving
- safety awareness
Personality and Behavioral changes from TBI
- social and coping skill
- frustration, anger
- reduced insight
Lifestyle changes from TBI
- loss of independence
- unemployment and financial hardship
- lack of transportation
- lack of leisure and recreation opportunities
- difficulty w/ interpersonal relationships
- loss of roles
Any injury to the skull, brain tissue, AA, or CSF causes cerebral swelling w/ accompanying blood pressure increases. This results in ___________ intracerebral pressure.
fluids of the brain are non-compressible so once pressure begins to build intracerebral pressure increases rapidly. This is life threatening!
Higher ICP leads to ____ cerebral perfusion or a _____ cerebral perfusion pressure (CPP).
In a normal brain, when systemic BP rises, cerebral vessels....
constrict to maintain an even perfusion pressure
In a normal brain, when systemic pressure falls, cerebral vessels....
dilate to allow better flow, again to maintain even perfusion pressure
Normal ICP = ___ mmHg
At what level of ICP is treatment indicated for?
What ICP levels are considered fatal if prolonged in adults?
An ______ in ICP leads to more brain damage.
Signs and Symptoms of increased ICP
- fighting a ventilator
- fighting interventions by therapist
- CN palsy
- headache w/ nausea/vomiting
- mental status changes
- confusion, agitation, lethargy
What should the therapist do when signs and symptoms of increased ICP are present?
work closely w/ nurses and doctors in ICU and notify nurse in charge
How is ICP initially measured?
ICP is measured directly and continuously by what (placed where)?
calibrated device drilled intracranially
What are the 3 ways to monitor pressure?
- intraventricular catheter
- subarachnoid screw/bolt
- epidural sensor
catheter threaded into one of the lateral ventricles of the brain to monitor ICP
Which ICP monitor is most accurate?
Which ICP monitor has the advantage of allowing drainage?
The NIH recommends pts w/ intraventricular catheters keep the heads of their beds elevated ____ both for ________ and ______.
- 30-45 degrees
- measurement accuracy and safety in drainage
When the bag of the intraventricular catheter is placed at just the right height, what happens?
fluid will only drain if the pressure in the head is above the prescribed limit
consists of screw/bolt placed just through the skull in the space b/w the arachnoid and cerebral cortex to monitor ICP
placed into epidural space beneath the skull to monitor ICP; no fluid can be drawn from it
Which ICP monitor is least invasive?
Do's and Don't w/ Pts who have increased ICP
- check w/ nurse before therapy
- don't raise legs, turn on side, or move neck unnecessarily
- minimize prolonged procedures and monitor ICP while performing tasks
- only address necessary therapy needs (wound care, splinting, occasional chest PT)
- may need to move slowly, stay quiet, take breaks
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