PSY345H5 Lecture Notes - Lecture 9: Glasgow Coma Scale, Closed Head Injury, Brain Injury
Lecture 9: Brain Injury Continued & Autism
Friday, November 9, 2018
11:16 AM
Paper
o What is controversial dis issue?
• Include on 1 hand such + such + on other hand such + such
▪ Pros + cons associated w/ each
o Thesis statement
• Paper will argue in such + such the following apply
o What has to support this statement
Acquired Brain Injury Continued
o Non-traumatic
• When no physical force hits brain
o Traumatic brain injury
• Open head injury
▪ Typically bleeding bc of the trauma
▪ Very easy to notice, just like any other types of bleeding
• Closed head injury
▪ Concussions
▪ More difficult to tell right away
▪ Not bleeding, but do to internal pressure (internal bleeding resulting in greater
pressure in skull) + shearing (body accelerated forward, head stops + brain keeps
moving forward until frontal lobe hits skull, might be damage and might be shearing in
brain stem bc it is being pulled and brain suspended from brain stem - nervous fibres
stretched + this shearing causes brain damage)
o Brain injury evaluation Glasgow coma scale (1974) - h/ do we assess comas
• Main way assess comas + deal w/ neurological disorders --> v primitive - based upon
structured clinical observation of doctor
• Glasgow coma scale
▪ Use to measure patient's level of consciousness, i.e., h/ awake the patient is
▪ Look at 3 key categories
• Eye(s) opening
▪ 4 criteria
• Verbal response
▪ 5 criteria
• Best motor response
▪ 6 criteria
▪ Top score = expect response for person fully awake +in control = normal response
▪ Lowest score = no response = most indicative of deep vegetative state
▪ Structured protocol - can be done anywhere
▪ Depending on score know degree to which person is in a vegetative state that gives
some type of indication of effect of brain injury
• Shows degree of impairment
▪ Structure approach to assessment
▪ 4 steps
• Preliminary check
▪ Local factors
• Hearing impairment
• Observe patient
▪ Any spontaneous behs in any ?
▪ Last category = not testable
• If can't hear or can't open eyes
• Video --> watch the whole thing
o Statistics on traumatic brain injury (TBI) for causes
• Road traffic accidents (most) + sports + recreation = prominent - especially age group 15-34
and 25-34
▪ Most often, highly preventable
• Unknown/other
▪ Not traumatic but acquired, leaving substances like anti-freeze w/ children
• Brain toxicity --> brain damage
▪ Picking up child under 6 mths and neck shears
• Why is highest bars ages 15-24
▪ Risky beh in adolescents + early adulthood
• Drinking
• Driving fast
• Taking risks in sports + activities (hiking)
• Not wearing seatbelts
• Top figure - difference btw boys + girls
▪ Boys = higher rates/frequency for TBI
• Take bigger risks
• More aggressive
• More aggressive in sports + prone to violence compared to girls who tend to
play more co-operatively, even for same sports
o Symptoms of brain injury
• Divided into 4 cats
▪ Physical
• Some of more pronounced/obvious --> motor deficits:
▪ Paralysis
• Devised based on limbs
• Paraplegia --> 2 limbs = waist down
• Hemiplegia --> 1/2 body
• Quadplegia --> 4 limbs
▪ Abnormal muscle tone
▪ Ataxia/coordination
• Sensory deficits
• Visual/hearing loss
• Symptoms, eg headache, fatigue, pain etc.
• Dysphagia
▪ Trouble swallowing
▪ Often need to be tube fed, often leads to infections
• seizures
▪ Communicative
• Lang deficits:
▪ Expression
• Not only speech
▪ Comprehension
• Dysarthria
▪ Usually speech problems, usually heavy speech tone
• Dyslexia
▪ Trouble reading
• Dysgraphia
▪ Trouble writing
▪ Cognitive
• Not as obvious
▪ Not really mutually exclusive any of the below
• Impairment of:
▪ Mem
▪ Attention
▪ Perception
▪ Problem-solving
▪ Insight
▪ Safety awareness
▪ Self-monitoring
▪ Social judgement
▪ Behavioral/emotional - characteristic of indivs of beh/emotional problems for many
other reasons like child abuse
• Emotional lability
▪ Huge mood swings
▪ Or mood not congruent w/ beh cause
• Poor initiation
• Mood change
• Adjustment problems
• Aggressive outbursts
• Disinhibition
▪ Ex Inappropriate sexual beh
• Poor motivation
• Psychosis
o TBI Rehabilitation
• TBI Continuum of Care
▪ Emergency evaluation --> emergency department --> intensive care unit
• What's the key focus when someone shows up at emergency?
▪ Stabilize their life
• Is person breathing?
• h/ much they are bleeding?
• Stop the bleeding
• May monitor heart + BP
• ER is about keeping person alive
▪ If suspected brain injury --> transferred to specialty neurotrauma/multi-trauma
• Like CT scan, MRI, EEG
• If discovered closed head injury + bleeding in brain
▪ Cut out slice of skull to allow pressure to dissipate
• Could also install shunt, but a little more difficult bc internal
