TBI Week 10 - Pop Quiz | Take the Quiz

Classifying Head Injuries: Which of the following statements regarding Closed Heads Injuries (CHI) are true:

CHIs are the most frequent cause of traumatic brain injury.

CHI is associated with diffuse axonal injury (DAI).

CHI primarily describes the penetration of the skull or meningeal layers.

The frontal and temporal lobes are particularly vulnerable to damage in CHI

Traumatic Brain Injuries are broadly classified as Closed Head Injuries (CHI) or Open Head Injuries (OHI). Closed Head Injuries mostly commonly result from a blunt blow (or jolt) to the head associated with acceleration and deceleration forces.

In a CHI, the brain often shifts or rotates in the skull, and this results in widespread damage (shearing, stretching and tearing) to the long connecting nerve fibres terms ‘axons’ (white matter).

The fronto-temporal regions of the skull feature many bony protrusions and sharp edges. As the cerebral regions that make contact with these protuberances during forceful impact, the frontal and temporal lobes are particularly vulnerable to damage.

Open Head Injury describes the penetration of the skull or meningeal layers of the brain e.g. from a gunshot.

Essentially, the GCS is a measure of consciousness. It’s usually taken at the scene (where the injury occurs) and again during the acute admission. It's scored from 3 to 15. A score of 3 indicates deep coma and a score of 15 indicates the patient is alert and responsive.

It is important to note GCS when you get a referral to see a patient with TBI, as it can give you a good idea of how they might present, and what their prognosis might be.

While classic or "true" aphasia (i.e. underlying deficits in phonology, syntax, semantics, morphology etc.) can result from TBI, it is uncommon (occurring in <5% of cases).

Post Traumatic Amnesia (PTA) is the period of time after a TBI where new memories cannot be formed or maintained consistently. The Westmead PTA Scale is a widely used measure of PTA. When administering the Westmead PTA, what is the criteria used to determine that a patient has emerged from PTA?

When the patient achieves >80% accuracy.

When the patient achieves 100% accuracy on 3 consecutive days.

When the patient achieves 100% accuracy.

When the patient achieves >80% accuracy on 5 consecutive days.

A patient is out of PTA when they achieve 100% (12/12) on the Westmead PTA on 3 consecutive days. Why do we need to know this? Length of PTA is an indicator of TBI severity (see the lecture notes for more detail here). Furthermore, a speech pathologist will typically defer any formal assessment until after a patient is out of PTA (though we may utilise informal assessment or therapy to monitor their recovery of communication during this time).