TBI

• young children- child abuse
• adolescents to young adult- risky activities
• older adults- falls

• MVA
• bicycling without helmet
• alcohol use

• force drives brain into contact with skull
• no skull fracture
• can occur with severe neck injury without direct trauma to skull (whip lash)

• skull fractures
• meninges are penetrated, brain exposed
• impact, gun shot, explosives

• 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

• swelling/edema causes inc ICP
• can also have hemorrhage which inc ICP
• vascular damage from contusion
• excitotoxicity from inc Ca

when axon is damaged, distal segement degenerates due to loss of axonal transport

mild TBI; difficulties with cognition or balance following direct/indirect head trauma

• neurophyschological assessment
• postural stability testing

post concussion syndrome: headache, fatigue, dizziness, personality changes, dec control of emotions

• difference bewtween MABRP and ICP
• if too low, risk of ischemia
• normal is 70-85
• inc by using IV fluid to inc blood volume

• normal is 15 mmHg
• step 1: hyperventilation
• step 2: manitol or hyperosmolar saline
• step 3: barbituate therapy (medically induced coma)

loss of recal of events immediately preceding injury

• 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

• difficulty/inability to form new memory
• dec attention abilities

• 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

no ability to learn new info

confused and agitated; unable to live in community, need structured non-distracting environment

can have carry over for re-learned tasks (previously known skills, but won't acquire new skills)

will have carry over for new skills, but takes some time

can become independent

• ext environment
• cognitive function (inc level of agitation/impulsiveness)
• balance (fall risk)

closed skills, discrete tasks, frequent feedback

open skills (variable environment, serial or continuous tasks, variable feedback)