Neuro- TBI/ABI 2:8 B

dizziness, disorientation, blurred vision, difficulty concentrating, alteration in sleep pattern, nausea, headache, loss of balance

bruising on surface of brain because small blood vessels hemorrhage at time of impact

blow to one side of head or severe trauma from MVA. Period of unconsciousness, then become alert but blood continues to leak therefore will deteriorate when hematoma enlarges

usually in older adults after falls, blood leaks and accumulates slowly. Symptoms mimic CVA and fluctuate

usually acceleration/deceleration b/c shearing of cortical blood vessels or beneath a fx

airway obstruction near downing, MI with hypoxic events, exposure to toxins, electrical shock (anything that decreases oxygen to brain) present as TBI with more global symptoms

Arousal and awareness

structural lesion caused by stroke, tumor, abscess, or trauma
Toxic/metabolic abnormalities (drug abuse, liver or renal failure or hypoglycemia or hyperglycemia
medications
anoxia (2nd to cardiac arret, SAH, concussion, DAI)

premorbid status= cognitive (intelligence, education, memory)
Personality= close relationships
Pre-exisiting condition

focal lesion, coup-countercoup injury, diffuse axonal injury, open vs closed

cervical flexion, sidelying, excessive hip flexion, coughing, activities that increase blood flow, blood pressure or intrathoracic or abdominal pressure or that decrease venous return (valsalva)

vomiting, headache, change in behavior or consciousness. or cushing's triad

decrease HR, increased BP and irregular respiration

-increased ICP, with increased change of herniation
-hypoxic ischemia injury= compromised circulation due to shifting structures, or airway obstruction, trauma to chest, massive blood loss, cardiac arrest.
-post traumatic seizures= more common older adults, open head injuries, subdural hematomas
-intracranial infection, cerebral artery vasospasm, obstructive hydocephalus
-neurochemical changes=diffuse axonal injury has a surge or neurotransmitters that destruct neurons

stress, poor nutrition, electrolyte imbalance, missed medications, flickering lights, infection, fever, anger worry and fear

vesticular stim techniques (fast spinning, irregular movements, acceleration/deceleration)

managing BP, sedation, removing CSF, ventriculoperitoneal shunting, keepig HOB 30-45 to increase cerebral venous drainage

lateral displacement or falx cerebral b/c lesion occupying space

midline shift, compressed third ventricle and hydrocephalus

no response

generalized response

localized response

confused-agitated

confused-inappropriate

confused-appropriate

automatic-appropriate

purposeful-appropraite

purposeful-appropriate: stand-by assisstance on request

purposeful-appropriate: modified independent

fixed and dialted pupil

flexed arms and extended LE

Extension of UE and LE

altered consciousness, post traumatic amnesia, orientation, memory deficits, decreased attention spasm, easily distractible with decreased safety awareness, perseveration (repeating a task without know doing) high level function deficits

sexual dis-inhibition, agitated, aggression, low frustrated tolerance, depression dependent and denial

increase patients level of arousal, patient function, patient education, family education and prevention of secondary impairment

prevent complications, increase level of interaction with environment, promote meaningful behavioral responses

chest PT, PROM and tone management, positioning, functional mobility, sensory stimulation

maintain functional capabilities

structure, prevent over stimulation, familiar and desireable activities, high success activities, pt and family education

maximize functional capabilities

focus on function and safety, follow command but decompensate if increase difficulty or decrease structure. Limited new learning, working towards consistent patient participation, motor deficits

wean from structure and prepare to become part of community

involve patients in decision making, emphasize judgment, driving and vocational rehab