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  1. populations at risk for TBI
    • young children- child abuse
    • adolescents to young adult- risky activities
    • older adults- falls
  2. risk factors of TBI
    • MVA
    • bicycling without helmet
    • alcohol use
  3. closed injury
    • force drives brain into contact with skull
    • no skull fracture
    • can occur with severe neck injury without direct trauma to skull (whip lash)
  4. open injury
    • skull fractures
    • meninges are penetrated, brain exposed
    • impact, gun shot, explosives
  5. primary injury
    • due to forces exerted at time of injury
    • coup: site of initial contact
    • counter-coup: impact on opposite sd due to recoil (contusion, swelling, blood clots)
    • diffuse axonal injury- shearing and tensile forces; white matter injury greater predictor of mortality and disability
  6. secondary injury
    • swelling/edema causes inc ICP
    • can also have hemorrhage which inc ICP
    • vascular damage from contusion
    • excitotoxicity from inc Ca
  7. Wallerian degeneration
    when axon is damaged, distal segement degenerates due to loss of axonal transport
  8. concussion
    mild TBI; difficulties with cognition or balance following direct/indirect head trauma
  9. evaluating athlete w/ concussion off-site
    • neurophyschological assessment
    • postural stability testing
  10. concussion sequelae
    post concussion syndrome: headache, fatigue, dizziness, personality changes, dec control of emotions
  11. cerebral perfusion pressures
    • difference bewtween MABRP and ICP
    • if too low, risk of ischemia
    • normal is 70-85
    • inc by using IV fluid to inc blood volume
  12. managing ICP
    • normal is 15 mmHg
    • step 1: hyperventilation
    • step 2: manitol or hyperosmolar saline
    • step 3: barbituate therapy (medically induced coma)
  13. retrograde amnesia
    loss of recal of events immediately preceding injury
  14. posttraumatic amnesia
    • loss of recall of period between injury and time of functional recovery
    • indication of injury severity
    • no carryover of tasks requiring learning during this period
  15. anterograde amnesia
    • difficulty/inability to form new memory
    • dec attention abilities
  16. poorer prognosis of TBI
    • 90% of pts who die do so within 48 hrs
    • uncontrolled ICP is primary cause of death
    • injury severity
    • long duration of LOC
    • loss of papillary reflexes
    • acute hemispheric swelling
    • mid-line shift
    • epilepsy developing within 7 days
    • older age
    • lower education
  17. Rancho Level I-V
    no ability to learn new info
  18. Rancho level IV
    confused and agitated; unable to live in community, need structured non-distracting environment
  19. Rancho level VI
    can have carry over for re-learned tasks (previously known skills, but won't acquire new skills)
  20. Rancho level VII
    will have carry over for new skills, but takes some time
  21. Rancho level VIII
    can become independent
  22. factors affecting safety for TBI pt
    • ext environment
    • cognitive function (inc level of agitation/impulsiveness)
    • balance (fall risk)
  23. poor learning ability post TBI
    closed skills, discrete tasks, frequent feedback
  24. good learning ability post TBI
    open skills (variable environment, serial or continuous tasks, variable feedback)
Card Set
clin path 7
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