PCBIS Study Guide
Acquired TBI -
Occurs after birth, is not hereditary, congenital, degenerative or induced by birth
trauma. The injury results in a change in neuronal activity, which affects the physical
integrity, metabolic activity, or the functional ability of nerve cells in the brain.
Traumatic Brain Injury -
An alteration in brain function, or other evidence of brain pathology caused by an
external force.
-Inertial forces
-Impact injuries (closed vs. open head injuries)
Characteristics of mTIBI -
Can either have brief or no loss of consciousness and its presentation may
demonstrate vomiting, lethargy, dizziness, and inability to recall what just happened.
Moderate TBI -
Will be marked by unconsciousness for any period of time up to 24 hours, will have
neurological signs of brain trauma, including skull fractures with contusion or bleeding. and
may have focal findings on an EEG or CT scan.
Severe TBI -
Marked by a period of loss of consciousness of 24 hours or greater.
Incidence of TBI in US -
17.1 per 100,000
(2.5 million people in 2010 sustained a TBI, of these 2.5 million:
-53,000 deaths (2%)
-284,000 hospitalizations (11%)
-2,214,000 emergency department visits (87%)
Chronic conditions caused or accelerated by TBI -
Epilepsy: TBI is a major cause of this as they are 1.5-1.7x more likely to develop it.
(35-65% of pts will experience this after one week post injury).
-SUDEP= sudden death in epilepsy (20x more likely than the general population)
CTE: Begins very slowly with deterioration in concentration, attention, memory, judgment.
best treatment is prevention. Develops from repeated blows from the head.
Alzheimer's Disease: The worse the TBI the more likely it is to occur. Any history of head
injury will double the risk for AD.
Neuroendocrine Disorders: Dysfunction of pituitary gland (30% of mod-severe), Growth
hormone deficiency/insufficiency (20% of Mod-Severe), low thyroid function (5%),
Gonadotropin (weakness, premature menopause).
1|Page
,Incontinence: TBI affects the cerebral structures that are controlling bladder storage and
emptying functions. "Neurogenic Bladder".
Standards for Rehabilitation Facilities -
Joint Commission Accreditation= gold standard for hospitals, home care agencies and
nursing care centers. Is awarded for 3 years, focuses on staff qualifications and competency,
patient rights, infection control, and use of data etc.
Commission on Accreditation of Rehabilitation Facilities (CARF)= has specific standards for
brain injury programs.
Ramifications of Olmstead Decision -
July 1999 the courts ruled that two women must be granted the option to live in the
community.
-Gradually challenged federal, state and local governments to develop more opportunities to
be served through cost-effective community based services.
-We must provide services in the most integrated setting possible/appropriate.
-Grants and initiatives to make living in the community a reality
-Resulted in person centered planning where individuals are supported to be as independent
as possible and participate in things that they choose.
The Model Systems of Care -
The TBI model systems develop a model system of care and maintain a standardized
national database for innovative analysis of treatment outcomes.
-Conduct research to demonstrate the course of recovery and outcomes
-Creates centers that must have a system including emergency care, acute neuro-trauma
management and rehabilitation.
-Tries to identify what treatments can improve rehabilitation outcomes, which are most
effective and which improve vocational outcomes. Additionally looks at predicting long-term
outcomes, and the relationship between cost of care and outcomes.
mTBI -
Also known as a concussion.
-Can come from contact sports, work-related injury and military conflicts.
-Need to pay close attention to the symptoms
-Incidence= 75% of all TBIs (1.1 million people each year).
-Definition= A traumatically induced physiologic disruption of brain function with one of the
following:
1. Any period of LOC
2. Any loss of memory before or after the incident
3. Any alteration in mental state
4. Focal deficits that do not exceed LOC of 30 mins, GCS of 13-15 and PTA not greater than
24 hours.
5. Normal brain structure on a CT/MRI
-Causes= acceleration-deceleration, strikes, blasts, diffuse axonal injury (axonal shearing).
2|Page
, -Symptoms: Cognitive changes (attention, multi-tasking, memory, emotional and behavioral
control), Frontal release (disinhibition, lability, depression), fatigue, affected sleep patterns,
changes in vision (eye movements, blurred vision, weak muscles)
*Headaches are the most common complaint and the primary reason for seeking medical
intervention.
-Neck pain, dissiness and poor balance, disorders of the inner ear, CNS musculoscelatal
system or all.
Reducing Disability from mTBI -
-Patient education about symptoms and recovery
-Addressing the initial symptoms is critical to long-term recovery.
-Address initial symptoms that could create potential hazards for the individual (such as poor
balance) is crucial for long term outcome.
-Encourage an optimistic outlook, while promoting their physical safety and psychological
well-being.
-Slow resumption of normal activities (2-4 weeks).
PPCS incidence and treatment plans -
Post-Concussion Syndrome (PCS)- a controversial term because they don't want it
called a syndrome so the preferred term is persistent post-concussive symptoms (PPCS).
PPCS is the persistance of symptoms weeks to months after a mTBI. This is present in 10-
15% of mTBI patients.
Treatment= Symptom focused, needs to begin immediately, emphasize both functional
resolutions and compensations. Give optimistic and clear paths for positive outcomes.
CTE -
Diffuse axonal injury causes release of Tau proteins which create a chronic
inflammatory state leading to the degeneration of the CNS. Could also cause the development
of ALS with degeneration of the spinal cord and brain.
Brainstem -
Located at the top of the spinal column, relays information into and out of the brain. Is
the central point for all incoming and outgoing information and basic life functions.
-Medulla= basic living functions& reflex center (breathing, HR, BP).
-Pons= Facial movements, sensation, hearing and coordination of eye movements, also serves
to connect the cerebral cortex with the cerebellum.
-Midbrain= Seeing, hearing, alertness and arousal.
-contains centers for the senses of hearing, touch, taste and balance. *Not sight and smell.
Reticular Activating System -
RAS- located within the brain stem, modulates or changes arousal, alertness,
concentration and basic biological rhythms.
-Can be turned down after a coma and may cause a lack of awareness
-If RAS is turned down they may be unaware of their surroundings and unable to respond to
even simple commands.
3|Page
Acquired TBI -
Occurs after birth, is not hereditary, congenital, degenerative or induced by birth
trauma. The injury results in a change in neuronal activity, which affects the physical
integrity, metabolic activity, or the functional ability of nerve cells in the brain.
Traumatic Brain Injury -
An alteration in brain function, or other evidence of brain pathology caused by an
external force.
-Inertial forces
-Impact injuries (closed vs. open head injuries)
Characteristics of mTIBI -
Can either have brief or no loss of consciousness and its presentation may
demonstrate vomiting, lethargy, dizziness, and inability to recall what just happened.
Moderate TBI -
Will be marked by unconsciousness for any period of time up to 24 hours, will have
neurological signs of brain trauma, including skull fractures with contusion or bleeding. and
may have focal findings on an EEG or CT scan.
Severe TBI -
Marked by a period of loss of consciousness of 24 hours or greater.
Incidence of TBI in US -
17.1 per 100,000
(2.5 million people in 2010 sustained a TBI, of these 2.5 million:
-53,000 deaths (2%)
-284,000 hospitalizations (11%)
-2,214,000 emergency department visits (87%)
Chronic conditions caused or accelerated by TBI -
Epilepsy: TBI is a major cause of this as they are 1.5-1.7x more likely to develop it.
(35-65% of pts will experience this after one week post injury).
-SUDEP= sudden death in epilepsy (20x more likely than the general population)
CTE: Begins very slowly with deterioration in concentration, attention, memory, judgment.
best treatment is prevention. Develops from repeated blows from the head.
Alzheimer's Disease: The worse the TBI the more likely it is to occur. Any history of head
injury will double the risk for AD.
Neuroendocrine Disorders: Dysfunction of pituitary gland (30% of mod-severe), Growth
hormone deficiency/insufficiency (20% of Mod-Severe), low thyroid function (5%),
Gonadotropin (weakness, premature menopause).
1|Page
,Incontinence: TBI affects the cerebral structures that are controlling bladder storage and
emptying functions. "Neurogenic Bladder".
Standards for Rehabilitation Facilities -
Joint Commission Accreditation= gold standard for hospitals, home care agencies and
nursing care centers. Is awarded for 3 years, focuses on staff qualifications and competency,
patient rights, infection control, and use of data etc.
Commission on Accreditation of Rehabilitation Facilities (CARF)= has specific standards for
brain injury programs.
Ramifications of Olmstead Decision -
July 1999 the courts ruled that two women must be granted the option to live in the
community.
-Gradually challenged federal, state and local governments to develop more opportunities to
be served through cost-effective community based services.
-We must provide services in the most integrated setting possible/appropriate.
-Grants and initiatives to make living in the community a reality
-Resulted in person centered planning where individuals are supported to be as independent
as possible and participate in things that they choose.
The Model Systems of Care -
The TBI model systems develop a model system of care and maintain a standardized
national database for innovative analysis of treatment outcomes.
-Conduct research to demonstrate the course of recovery and outcomes
-Creates centers that must have a system including emergency care, acute neuro-trauma
management and rehabilitation.
-Tries to identify what treatments can improve rehabilitation outcomes, which are most
effective and which improve vocational outcomes. Additionally looks at predicting long-term
outcomes, and the relationship between cost of care and outcomes.
mTBI -
Also known as a concussion.
-Can come from contact sports, work-related injury and military conflicts.
-Need to pay close attention to the symptoms
-Incidence= 75% of all TBIs (1.1 million people each year).
-Definition= A traumatically induced physiologic disruption of brain function with one of the
following:
1. Any period of LOC
2. Any loss of memory before or after the incident
3. Any alteration in mental state
4. Focal deficits that do not exceed LOC of 30 mins, GCS of 13-15 and PTA not greater than
24 hours.
5. Normal brain structure on a CT/MRI
-Causes= acceleration-deceleration, strikes, blasts, diffuse axonal injury (axonal shearing).
2|Page
, -Symptoms: Cognitive changes (attention, multi-tasking, memory, emotional and behavioral
control), Frontal release (disinhibition, lability, depression), fatigue, affected sleep patterns,
changes in vision (eye movements, blurred vision, weak muscles)
*Headaches are the most common complaint and the primary reason for seeking medical
intervention.
-Neck pain, dissiness and poor balance, disorders of the inner ear, CNS musculoscelatal
system or all.
Reducing Disability from mTBI -
-Patient education about symptoms and recovery
-Addressing the initial symptoms is critical to long-term recovery.
-Address initial symptoms that could create potential hazards for the individual (such as poor
balance) is crucial for long term outcome.
-Encourage an optimistic outlook, while promoting their physical safety and psychological
well-being.
-Slow resumption of normal activities (2-4 weeks).
PPCS incidence and treatment plans -
Post-Concussion Syndrome (PCS)- a controversial term because they don't want it
called a syndrome so the preferred term is persistent post-concussive symptoms (PPCS).
PPCS is the persistance of symptoms weeks to months after a mTBI. This is present in 10-
15% of mTBI patients.
Treatment= Symptom focused, needs to begin immediately, emphasize both functional
resolutions and compensations. Give optimistic and clear paths for positive outcomes.
CTE -
Diffuse axonal injury causes release of Tau proteins which create a chronic
inflammatory state leading to the degeneration of the CNS. Could also cause the development
of ALS with degeneration of the spinal cord and brain.
Brainstem -
Located at the top of the spinal column, relays information into and out of the brain. Is
the central point for all incoming and outgoing information and basic life functions.
-Medulla= basic living functions& reflex center (breathing, HR, BP).
-Pons= Facial movements, sensation, hearing and coordination of eye movements, also serves
to connect the cerebral cortex with the cerebellum.
-Midbrain= Seeing, hearing, alertness and arousal.
-contains centers for the senses of hearing, touch, taste and balance. *Not sight and smell.
Reticular Activating System -
RAS- located within the brain stem, modulates or changes arousal, alertness,
concentration and basic biological rhythms.
-Can be turned down after a coma and may cause a lack of awareness
-If RAS is turned down they may be unaware of their surroundings and unable to respond to
even simple commands.
3|Page
