DAI is the predominant Tonsillar – tonsils of

Traumatic Brain o
MOI in individuals c
o
cerebellum  foramen
Injury severe to moderate TBI
and m/c cause of
magnum
o Uncal/Tentorial – occurs
 Alteration of brain immediate loss of in the tentorium cerebelli
function/other evidence of brain consciousness o Central – central part of
pathology caused by an o Shear forces  diffuse brain herniates 
external force axonal injury  Wallerian brainstem
Prevalence degeneration  NT o Subfalcine – Into the falx
 Falls (32%) release  Glutamate cerebri
 MVA/traffic accidents (19%) toxicity (facilitates liquid Impairments – more diffused than CVA
 Struck by/against events (18%) eme in the brain)  Neuromuscular
 Assaults (10%) – GSW, violence  DAI o Paresis
 M/c in 0-4 y/o o Common in the o Abnormal tone
 Death and hospitalization parasagittal white matter o Motor function
common in 65 y/o and above of the cerebral cortex o Postural control
MOI and Pathophysiology (m/c), corpus callosum,  Decorticate –
Primary Injury pontine-mesencephalic denotes severe TBI
 Direct trauma to parenchyma junction adjacent to sup  Decerebrate –
o Shaken Baby Syndrome cerebellar peduncles more severe TBI,
o Results in contusions, o Common in high-speed all limbs are
lacerations, and MVAs and sports-related extended
intracerebral hematomas, TBI  Cognitive
can be seen in CT and o Acceleration/deceleration o Arousal level – measured
MRI scans cause disruption of c GCS
o Generally focal neurofilaments c/in the  13-15 –
 Ant temporal poles axon  Wallerian mild/concussion
 Frontal poles degeneration  9-12 - moderate
 Lat and inf Secondary Injury – c/in 24-48 hrs  8 and below –
temporal cortices  Cascade of biochemical, comatose (Does
 Rapid acceleration/deceleration cellular, and molecular events not open eyes,
of the brain that evolve over time does not make
o Shear, tensile,  Injury-related hypoxia, edema, sound, does not
compression forces in the ↑ ICP follow command)
brain  (N) ICP: 5-20 cm H2O
o Results in Diffuse Axonal  ↑ ICP  herniation of brain
Injury (tissue tearing of
the axons), microscopic
 traumat day <7 days  Disorders of
ic days Consciousness
amnesi Scale (DOCS)
a  Ranchos Los
GCS 13-15 9-12 8 and Amigos Level of
below Cognitive
Imagin Norma Normal Normal Functioning – pt
g l or or may plateau at any
abnorm abnorm
level
al al
 Box 19.4
PTA evaluation - Galveston Orientation  Moderate-Severe, Active Stage
and Amnesia Test (GOAT) o Box 19.5
 >48.5 have higher o Outcome Measures
 >34 days – good overall  Berg’s Balance
recovery as per GOS Scale
o Plan of Care
 >27 days likely to be employed
 Risk of secondary
 >53 days likely to live s
impairment is
assistance
o Attention reduced
PT Management
o Concentration
 Moderate-Severe, Acute
o Memory
o Examine pt
o Learning
 Arousal - GCS,
o Executive Functions
attention, cognition
 Neurobehavioral  Integument
o Agitation/Aggression integrity
o Disinhibition  Sensory integrity
o Apathy  Motor function
o Emotional lability  ROM
o Mental inflexibility  Reflex integrity
Mild Modera Severe  Ventilation and
te respiration/gas
LOC 0-30 >30 >24 hr exchange
min min - o Outcome measures
<24 hr  Coma Recovery
AOC Brief >24 hr >24 hr Scale-Revised
 24
(CRS-R) –
hr
evaluated once/wk
Post- 0-1 >1 and >7