CBIS Exam
* Glasgow Coma Scale (GCS) 3-8 -
Severe TBI; normal or abnormal structural imaging. LOC over 24 hours, post
traumatic amnesia over 7 days
* Glasgow Coma Scale 9-12 -
Moderate TBI; LOC over 30 minutes but less than 24 hours; alteration of
consciousness over 24 hours, post traumatic amnesia more than 1 day but less than 7 days
* Glasgow Coma Scale 13-15 -
Mild TBI; normal imaging; LOC 0-30 minutes, alteration of consciousness up to
24 hours, post traumatic amnesia up to 1 day
* 3 parts of neuron -
Cell body
Axon
Dendrites
* 2.5 million TBIs -
53,000 deaths (2%)
284,000 hospitalizations (11%)
2,214,000 ED visits (87%)
* Coup-contrecoup -
When the brain accelerates in one directions, it rebounds in the opposite direction
* Acquired Brain Injury -
An injury to the brain that is not hereditary, congenital, degenerative or induced
by birth trauma
* Traumatic Brain Injury -
An alteration of brain function or other evidence of brain pathology caused by an
external force
* Incidence -
Rate or range of occurrence
* Prevalence -
Number of people with a given condition at a specific point in time
* What determines the effects of brain injury? -
Injury severity
Age at injury
Alcohol misuse
Domestic violence
Service in military
Participation in sports
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,* Concussion -
Mild TBI caused by bump, blow or jolt to head that can change the way the brain
works (or a fall)
Can occur in any sport or recreation activity
Memory loss
May or may not lose consciousness
* 2.5 million people sustained TBI in 2010 -
* Brain Stem -
Top of spinal column
Central point for all incoming and outgoing information and basic life functions
* Limbic System -
Emotions and basic feelings
* Frontal Lobe Damage -
Executive function/personality
Lack of control of behaviors, poor short term memory and working memory
* Broca's Area -
Located in lower portion of motor cortex (left frontal-temporal lobe)
Expression- production of speech
* Wernicke's Area -
Located in left temporal parietal area
Receptive- understanding of speech
* Risk of TBI after first injury -
3x greater for 2nd injury
* Risk of TBI after second injury -
8x greater for 3rd injury
* Alcohol and TBI -
37%-51% of brain injuries
22% of drivers aged 15-20 involved in fatal MVAs had been drinking
56% not wearing seat belts
* Neurons -
Communicating cells
* Frontal Lobe -
Primary motor cortex and prefrontal cortex
Planning, organizing, problem solving, judgment, impulse control, decision making, working
memory, emotional control, motivation, verbal expression
* Occipital Lobe -
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, Visual stimuli processing
Brain Injury in Prisons -
2 million people in prisons have a brain injury not recognized, diagnosed or
treated
Female inmates convicted of violent crime are more likely to have sustained a pre crime TBI
or other form of physical abuse
Lost Productivity -
Loss of earning potential, payment of taxes and the re-investment of earnings into
the economy
Neurogenic Bladder -
Affected cerebral structures that control bladder storage and emptying functions
Incontinence
Spasticity -
Increase in muscle tone resulting in abnormal motor patterns
Faster stretch = stronger spasm
Monitor for sedating effects of meds
Dura Mater -
Outer layer of meninges; heavy covering
Bleed in this area: subdural hematoma
Arachnoid Layer -
2nd layer of meninges; similar to spider web
Bleed in this area: subdural hematoma
Pia Mater -
3rd layer of meninges; molds around sulci and gyri of brain
Synapse -
Junction between cells
Action Potential -
Electrical impulse fired
Brain stem areas -
Medulla
Pons
Midbrain
Cerebellum -
Lower back section of brain
Coordinates, modulates and stores all body movement
Occipital Lobes -
Primary visual center
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, Visual cortex connected to eyes by optic nerves
Interprets visual info (recognize size, color, light, motion, dimensions)
Occipital Lobe Damage -
Visual-pereptual-motoric distortions
Neuroplasticity -
Brain can adapt and reorganize due to environment around it or due to cell death
Nervous system changes itself, forms new connections and creates new neurons to
compensate for injury or adapt to changes in environment
Restorative approach
Polytherapies -
The use of more than one treatment method in a combined therapeutic approach;
may provide better results
Plasticity -
A change in the expression of genes or proteins related to neuroplasticity
Constraint Induced Movement Therapy -
Contrain unaffected limb for first 2 weeks post injury, plasticity in cortex
opposite stroke is eliminated
Encourages greater use of impaired limb
Axonal Shearing -
Axons are twisted and disconnected; functional abilities diminished
Tension type Headache -
Bilateral head pain; tight hat or vice clamping around head
Tx with NSAIDs and low load craniocervical mobilization
Cervicogenic Headache -
Head pain generated from cervical spine
Can provoke headache through movement or manipulation of neck
Tx with manual therapies or nerve injections
Post-traumatic Migraine -
Episodes of headaches with different phases
Prodrome-> aura -> headache -> post drome
Typically unilateral, throbbing, stabbing or sharp pain
Tx with triptans, NSAIDs, dark room, quiet environment
Neuralgia -
Pain caused by damage to nerve or structural change in nerve
Standard Precautions -
Hand hygiene, PPE, respiratory hygiene, safe injection and disposal of sharps,
cleansing of equipment, isiolation
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* Glasgow Coma Scale (GCS) 3-8 -
Severe TBI; normal or abnormal structural imaging. LOC over 24 hours, post
traumatic amnesia over 7 days
* Glasgow Coma Scale 9-12 -
Moderate TBI; LOC over 30 minutes but less than 24 hours; alteration of
consciousness over 24 hours, post traumatic amnesia more than 1 day but less than 7 days
* Glasgow Coma Scale 13-15 -
Mild TBI; normal imaging; LOC 0-30 minutes, alteration of consciousness up to
24 hours, post traumatic amnesia up to 1 day
* 3 parts of neuron -
Cell body
Axon
Dendrites
* 2.5 million TBIs -
53,000 deaths (2%)
284,000 hospitalizations (11%)
2,214,000 ED visits (87%)
* Coup-contrecoup -
When the brain accelerates in one directions, it rebounds in the opposite direction
* Acquired Brain Injury -
An injury to the brain that is not hereditary, congenital, degenerative or induced
by birth trauma
* Traumatic Brain Injury -
An alteration of brain function or other evidence of brain pathology caused by an
external force
* Incidence -
Rate or range of occurrence
* Prevalence -
Number of people with a given condition at a specific point in time
* What determines the effects of brain injury? -
Injury severity
Age at injury
Alcohol misuse
Domestic violence
Service in military
Participation in sports
1|Page
,* Concussion -
Mild TBI caused by bump, blow or jolt to head that can change the way the brain
works (or a fall)
Can occur in any sport or recreation activity
Memory loss
May or may not lose consciousness
* 2.5 million people sustained TBI in 2010 -
* Brain Stem -
Top of spinal column
Central point for all incoming and outgoing information and basic life functions
* Limbic System -
Emotions and basic feelings
* Frontal Lobe Damage -
Executive function/personality
Lack of control of behaviors, poor short term memory and working memory
* Broca's Area -
Located in lower portion of motor cortex (left frontal-temporal lobe)
Expression- production of speech
* Wernicke's Area -
Located in left temporal parietal area
Receptive- understanding of speech
* Risk of TBI after first injury -
3x greater for 2nd injury
* Risk of TBI after second injury -
8x greater for 3rd injury
* Alcohol and TBI -
37%-51% of brain injuries
22% of drivers aged 15-20 involved in fatal MVAs had been drinking
56% not wearing seat belts
* Neurons -
Communicating cells
* Frontal Lobe -
Primary motor cortex and prefrontal cortex
Planning, organizing, problem solving, judgment, impulse control, decision making, working
memory, emotional control, motivation, verbal expression
* Occipital Lobe -
2|Page
, Visual stimuli processing
Brain Injury in Prisons -
2 million people in prisons have a brain injury not recognized, diagnosed or
treated
Female inmates convicted of violent crime are more likely to have sustained a pre crime TBI
or other form of physical abuse
Lost Productivity -
Loss of earning potential, payment of taxes and the re-investment of earnings into
the economy
Neurogenic Bladder -
Affected cerebral structures that control bladder storage and emptying functions
Incontinence
Spasticity -
Increase in muscle tone resulting in abnormal motor patterns
Faster stretch = stronger spasm
Monitor for sedating effects of meds
Dura Mater -
Outer layer of meninges; heavy covering
Bleed in this area: subdural hematoma
Arachnoid Layer -
2nd layer of meninges; similar to spider web
Bleed in this area: subdural hematoma
Pia Mater -
3rd layer of meninges; molds around sulci and gyri of brain
Synapse -
Junction between cells
Action Potential -
Electrical impulse fired
Brain stem areas -
Medulla
Pons
Midbrain
Cerebellum -
Lower back section of brain
Coordinates, modulates and stores all body movement
Occipital Lobes -
Primary visual center
3|Page
, Visual cortex connected to eyes by optic nerves
Interprets visual info (recognize size, color, light, motion, dimensions)
Occipital Lobe Damage -
Visual-pereptual-motoric distortions
Neuroplasticity -
Brain can adapt and reorganize due to environment around it or due to cell death
Nervous system changes itself, forms new connections and creates new neurons to
compensate for injury or adapt to changes in environment
Restorative approach
Polytherapies -
The use of more than one treatment method in a combined therapeutic approach;
may provide better results
Plasticity -
A change in the expression of genes or proteins related to neuroplasticity
Constraint Induced Movement Therapy -
Contrain unaffected limb for first 2 weeks post injury, plasticity in cortex
opposite stroke is eliminated
Encourages greater use of impaired limb
Axonal Shearing -
Axons are twisted and disconnected; functional abilities diminished
Tension type Headache -
Bilateral head pain; tight hat or vice clamping around head
Tx with NSAIDs and low load craniocervical mobilization
Cervicogenic Headache -
Head pain generated from cervical spine
Can provoke headache through movement or manipulation of neck
Tx with manual therapies or nerve injections
Post-traumatic Migraine -
Episodes of headaches with different phases
Prodrome-> aura -> headache -> post drome
Typically unilateral, throbbing, stabbing or sharp pain
Tx with triptans, NSAIDs, dark room, quiet environment
Neuralgia -
Pain caused by damage to nerve or structural change in nerve
Standard Precautions -
Hand hygiene, PPE, respiratory hygiene, safe injection and disposal of sharps,
cleansing of equipment, isiolation
4|Page
