SCI TBI Adult Reflexes - Bryan Truong

Which of the following is NOT a symptom of increased intracranial pressure?

• Decreased responsiveness

• Vomiting

• Decreased blood pressure

• Decreased heart rate

Answer explanation

Martin/Kessler pg 426

Signs/Symptoms of ICP:

(1) decreased responsiveness

(2) impaired consciousness

(3) severe headache

(4) vomiting

(5) papilledema (swelling of both optic discs in your eyes due to increased intracranial pressure (intracranial hypertension).

(6) irritability

(7) changes in vital signs (inc BP/dec heart rate)

Which Glasgow Coma Scale Score coincides with a moderate TBI?

• > 15

• <9

• 13-15

• 9-12

Answer explanation

- Glasgow Coma Scale is a neurological assessment tool used initially after injury to determine arousal and cerebral cortex function.

- A total score of 8 or less correlates to severe brain injury or coma

- Scores 9 to 12: moderate brain injury

- 13 to 15: Mild brain injury

Which of the following Rancho Los Amigos Levels of Cognitive Functioning is correctly matched?

• Confused-Inappropriate - Patient shows goal-directed behavior, but is dependent on external input or direction.

• Automatic-Appropriate - Patient is able to recall and integrate past and recent events and is aware of and responsive to the environment.

• Generalized Response - Patient appears to be in a deep sleep and is completely unresponsive to any stimuli.

• Confused-Agitated - Patient reacts specifically, but inconsistently to stimuli.

Answer explanation

SB pg 275

A scale used to describe the cognitive and behavioral patterns found in brain injury patients as they recover from injury.

Which of the following is classified as a Secondary Brain Injury?

• Coup Lesion

• Subdural Hematoma

• Coup-Contrecoup Lesion

• Fall

Answer explanation

- Primary Brain Injury: Initial injury to the brain sustained by impact.

- Skull penetration, skull fractures, contusion to grey and white matter.

- Secondary Brain Injury: Brain damage that occurs as a response to the initial injury.

- Hematomas, hypoxia, ischemia, increased ICP

When conducting a deep tendon reflex test of the Achilles Tendon, what spinal level is being tested and what is the normal response?

• L3-L4: Dorsiflexion of the foot

• S1-S2: Plantar Flexion of the foot

• L3-L4: Plantar Flexion of the foot

• S1-S2: Dorsiflexion of the foot

Answer explanation

Scorebuilders pg 231

DTR testing: elicit a muscle contraction when the muscle's tendon is stimulated due to the reflex arc involving the spinal or brain stem segment that innervates the specific muscle.

Achilles Tendon

Spinal Level: S1-S2

Procedure: In sitting, flex the foot at the ankle putting the Achilles on stretch; strike the Achilles tendon above the foot

Normal Response: Plantar Flexion of the foot

Which of the following occurs below the L1 spinal level and causes flaccidity, areflexia, and impairment of bowel and bladder function?

• Anterior Cord Syndrome

• Posterior Cord Syndrome

• Cauda Equina Injury

• Brown-Sequard Syndrome

Answer explanation

Scorebuilders page 266

Which one of the following individuals would be most at risk for a traumatic brain injury?

• 75 year old male

• 65 year old obese female

• 25 year old male athlete

• 75 year old female

Answer explanation

O'Sullivan pg 818

- Older adults (>75) are at greatest risk (Men > Women by 29%)

- Infants (0-4 months)

- Older adolescents/young adults (14-24)

Which of the following does NOT  influence the outcome of a TBI patient?

• Low GCS score

• Age

• ASIA impairment scale

• Substance abuse

Answer explanation

Martin/Kessler pg 423

(1) amount of immediate damage from impact or insul

(2) Low initial scores on GCS

(3) cumulative effects of secondary brain damage

(4) premorbid cognitive characteristics (intellect, education, memory)

(5) presence or absence of substance abuse

(6) age at the onset of injury

(7) pre injury personality (quality of interpersonal relationships/work history)

Which of the following is NOT considered an open injury?

• Contusion

• Gunshot Wound

• Skull Fragments

• Direct Trauma

Answer explanation

Open injury: an injury of direct penetration through the skull to the brain.

Closed injury: An injury to the brain without penetration through the skull.

According to the ASIA classification of SCI, what are the key muscles for the C6 level?

• Wrist Extensors

• Elbow Flexors

• Finger Flexors

• Wrist Flexors

Answer explanation

Scorebuilders pg 267