Traumatic and Non-Traumatic Brain Injuries: Causes, Prevalence, and Consequences, Exams of Health sciences

Download Traumatic and Non-Traumatic Brain Injuries: Causes, Prevalence, and Consequences and more Exams Health sciences in PDF only on Docsity! CBIS Exam (2023 – 2024) With Complete Solution Acute Brain Injury - An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma Traumatic Brain Injury - An alteration in brain function, or other evidence of brain pathology, caused by an external force 2 Mechanisms *trauma impact * traumatic inertial forces Non-traumatic brain injury - Lack of O2, decreased nutrients to cells, exposure to toxins, pressure from tumor or blockage or other neuro disorder ABI Prevalence - 2nd most prevalent disability in U. S. * 13.5 million Americans Children & TBI - * non-accidental trauma cause of 80% of deaths in children under 2yo * 2/3 of children under 3yo that are abused have TBIs *falls cause 1/2 of TBI in 0-14yo domestic violence - 67% of women in domestic violence had TBI symptoms Mild TBI - *concussion *LOC > 30 min *loss of memory >24hrs *CGS 13-15 *normal CT or MRI *any AMS at time of incident Moderate TBI - *LOC up to 24hrs *neuro signs of brain trauma * CGS 9-12 *may have focal findings on CT Severe TBI - *LOC <24hrs *GCS 3-8 Screens for TBI - ACE - acute concussion eval HELPS WARCAT - warrior administered retrospective casualty assessment tool TBIQ - traumatic brain injury questionnaire ImPACT OSU TBI ID JCAHO (Joint Commission) - The non-profit organization that assists healthcare facilities by providing accreditation 3 year award CARF (Rehabilitation Accreditation Commission) - The Organization that oversees the accreditation of brain injury programs 3 year award TBI Act of 1996 - Federal Legislation "To expand efforts to identify methods of preventing TBI, to expand biomedical research efforts or to minimize the severity of dysfunction as a result of such an injury, and to improve the delivery & quality of services through the State Demonstration projects." HRSA - Health Resources Services Administration - Money to states to improve integration services, establish policy & procedure financial support CDC - Center for Disease Control - Carries out projects to reduce incidence of TBI Rehabilitation act of 1973 - Set foundation for state vocational rehab system, a federal/state supported system of services which assists persons with disabilities who are pursuing meaningful careers Diffuse axonal injury - Severe brain injury caused by extreme shearing forces Persistent post concussive symptoms - A complex disorder following a concussion, lasting for weeks or months, consisting of symptoms such as headaches or dizziness, Nausea, post Trumatic amnesia and GCS of 13/14 Must be diagnosed by neuropsychologist Somatization - The expression of psychological distress through physical symptoms Chronic traumatic encephalopathy - CTE - Rare, progressive, degenerative condition of central nervous system that is seen and repetitive brain trauma Dementia, memory loss, aggression, confusion, depression Hebbian Learning - Neurons that fire together, wire together Experience independent learning - " use it or lose it" Synaptogenesis - The process by which neurons form new connections Disorders of consciousness - Coma, Vegetative State, minimally conscious state Coma - * no evidence of arousal *buccofacial- limitations and performing purposeful movement of lips, cheeks, tongue, larynx and pharynx central cord syndrome - Presents as weakness & numbness in arms * results from fall in with neck in hyperextention or with arthritis or spondylosis * bowel/bladder issues * able to walk however unable to grasp things Brown-Sequard Syndrome - 1 side of spinal cord injured Ipsilateral paralysis, loss of light touch sensation on side of lesion, loss of pain & temperature sensation on contralateral side Anterior cord syndrome - Loss of muscle control, pain & temperature sensation below lesion No loss of proprioception or touch sensation posterior cord syndrome - Strength with no proprioception cognition - A complex collection of mental activities such as attention, perception, comprehension, remembering and language Domains of cognition - Attention, categorization, memory, processing speed, executive functions, metacognition Attention - Divided, alternating, selective, sustained, focused Attention process training program (APT) - Process specific approach to cognitive rehab. Hierarchy organized by difficulty Categorization - Important in the speed of processing, problem-solving, and other higher order cognitive processes. * BI pt tend to categorize by single attribute only Stages of Memory - Encoding, Storage, Retrieval Long term memory - Explicit vs implicit Executive Functions - * complex cognitive processes that involve reasoning, planning, judgment, initiation and abstract thinking Cognitive rehab approaches - *approach in systemic manner *analyzing problems *consider alternative solutions *prioritizing solutions *review outcomes Metacognition (n) - Awareness of thoughts 3 levels of metacognition - 1) awareness of deficits 2) awareness of functional implications 3) awareness to set realistic goals Anosognosia - Diminished self awareness and failure to recognize a personal disability Cognitive Rehab - Compensatory Approach - *assumes some cognitive functions can't be recovered *focus on development of strategies *functional application is important Cognitive Rehab - Restorative Approach - *repeated exposure & repetition through experience *therapeutic exercise to re-establish/strengthen specific cog skills Principles of Cognitive Rehab - *tx of impairments must be hierarchical *basic cognition skills first *target attention, perception, categorization, abstract thinking, & memory Stability Triangle - Extinction - When a previously reinforced response no longer produces a consequence, leading to an eventual decline in rate continuous reinforcement - the reinforcement of each and every correct response intermittent reinforcement - reinforcement for some responses and not for others Topography - What a behavior looks like physically Behavior TX Approach - 1) assess behavior 2) define target behavior 3) collect data 4) change behavior Consequences - 4 types Branches of Neuropsychology - Experimental - intact/healthy brain Clinical - brain with lesions dual diagnosis - the client with both substance abuse and another psychiatric illness Axis I disorders - Clinical disorders *major depressive disorder is most common Axis II - Personality disorders and intellectual disabilities Major Depressive Episode - At least 2 wks which a person has loss of interest or depressed mood accompanied by 4 additional symptoms: Change in appetite, change in weight, decreased energy, feelings of worthlessness, suicidal ideation manic episode - At least 1 wk where a person is noticeably elevated, expansive or irritable mood and 3 additional symptoms: extremely amplified self-esteem, decrease desire for sleep, grandiose ideas, distractibility, risky activities bipolar I disorder - One or more manic episodes bipolar II disorder - One or more depressive episode followed by one or more hypomanic episode cyclothymic disorder - Chronic fluctuation mood disturbance including both depressive and hypo manic states Schizophrenia - Disorder lasting for at least 6mo with minimum of a 1 month phase of symptoms that include: delusions, hallucinations, incoherent speech, Catalonia or avolition. personality disorders - 23% of TBI pts Organic personality disorder Frontal Lobe Syndrome - Symptoms of other psychiatric disorders including depression, psychosis, mood disorders and other various conditions however the patient does not recognize these conditions * The difference between frontal lobe injury and regular depression is the patient's ability to recognize and acknowledge the deficit SUD interventions - Screens for SUD - *AUDIT - alcohol use disorder identification test *CAGE: yes or no questions *CRAFFT: screen for adolescents *ASSIST: alcohol, smoking and substance use involvement screening test Cranial Nerves - concomitant spinal cord injury - Present of co-occurring spinal cord injury and brain injury *60% of SCI pt's Visual Functions - Individuals with disabilities education act (IDEA) - Federal education mandate to provide free appropriate public education and special education and support services to children with eligible disabilities Military Primary Injury - Direct impact from over-pressure wave. Compressed air filled organs, catapults body diagnostic indicators for SBS - Bleeding from brain Brain swelling Bleeding in eyes Long term disabilities in SBS - Behavioral problems, learning disabilities, blindness, deafness, seizures, cerebral palsy Individual Education Plan - IEP - Student's academic goals based upon assessment and the method to obtain these goals via specially designed instruction and related services Timeline: 60 days to complete assessment and hold IEP meeting Military Secondary Injury - Debris impacts head or body Military tertiary injury - Body impacts ground or object Military Quaternary Injury - Inhalation of toxic gases or substance Military acute concussion evaluation (MACE) - TBI screening developed by defense and veterans BI center. Provides gross measures of cognitive domain TBI military prevalence - mTBI only 56% mTBI & PTSD 44% Community integrated rehabilitation (CIR) - Post acute brain injury rehabilitation programs designed to support persons with brain injury in the community. Can include neural behavioral programs, residential programs, day treatment programs and home based programs Neural behavioral programs - For Severe behavioral disturbances that require 24 hour supervision. Residential community program - For those that cannot participate as outpatient, require 24 hour supervision or support Comprehensive holistic treatment/day treatments - There is a need for intensive services and can benefit from improved awareness Home based program - Client is able to resign at the home and able to self direct care Care management - Continuous system of care for a particular condition Case management, life care planning, advocacy and public policy, support groups case management - A way of managing unique and high risk conditions often associated with costly acute care and hospital stay. Case Manager Functions - Educator, coordinator, research, communicator, collaborator, clinician, utilization manager, transition planner, leader, quality manager, negotiator, advocate, risk manager 6 Domains if Case Management - Processes and services, resource utilization in management, psychosocial and economic support, rehabilitation, outcomes and ethical and legal practices Life care planning - A lifelong needs assessment of the needed goods and services required for a person with brain injury to move the most independent life possible. The plan should've called blueprints for families Must utilize evidence based standard of care LCP plan - Should be continually monitored and revised when the persons health needs or situation changes. Special needs trust - A legal arrangement in financial agreement that allows a person with a brain injury to receive income without reducing their eligibility for the public assistance disability benefits provided by Social Security, supplemental security income, Medicare or Medicaid Types of special needs trusts - First party SNT, third-party SNT, Inter vivos (during life) SNT, pooled trust/community trust Social security act of 1935 - Provided cash benefits & health care plans for individuals who are aged, disabled, and those with low income. Medicare - Four part insurance program established as part of the Social Security act Medicaid - Provide healthcare for people with low income, chronic illnesses, and disabilities black private help insurance Medicare Part A - No cost Covers hospitalizations, SNF, home health and hospice Medicare Part B - Premium is charged This covers doctors appointments and outpatient Medicare Part C - Premium charged Optional cost saving managed care plan Medicare Part D - Prescription drug coverage Omnibus Budget Reconciliation Act (OBRA) - Authorizes the establishment of home and community based Medical services State Children's Health Insurance Plan (CHIP) - Covers uninsured kids Affordable Care Act - Mandate on individuals and employers to obtain or provide health insurance by 2014 or face penalties Early Measures Outcomes - GCS, Abbreviated Injury Scale (AIS), LOC, JFK Coma Recovery Scale (JFK CRS-R), Post-traumatic amnesia (PTA), GOS Abbreviated Injury Scale (AIS) - 1 time measure of severity Ranges 1 (minor) - 6 (unsurvivable) JFK Coma Recovery Scale - Extended DOC 23 subscales, good for emerging consciousness Measures of Post-Traumatic Amnesia - Longer the PTA, the more likely a person will have long term issues No formal scoring process Glasgow Outcome Scale - 1-item descriptive outcome measure with 5 categories: Dead, vegetative, severely disabled, moderately disabled and good recovery Measures in Acute Rehabilitation - Functional Independence Measure (FIM/FAM), Disability Rating Scale (DRS), Rancho Los Amigos Functional Independence Measure (FIM) - 18-item, 7-level scale that assesses severity of disability in performing basic life activities Clinical tool Disability Rating Scale (DRS) - 8 item assessment of impairment, disability & handicap or participation Research tool Post-Acute Measures - Craig Handicap Assessment& Reporting Technique (CHART), Mayo Portland Adaptability Inventory (MPAI-4), Participation Assessment with Combined Tools- Objective (PART-O) Craig Handicap Assessment & Reporting Technique (CHART) - 32 questions and 6 domains More for outpatient or home health Measures participation Objective measure of a persons engagement in societal roles limbic system - emotion and memory Mammalian brain Houses basic elemental drives, emotions and survival instincts Hippocampus - Associated with memory Amygdala - Ties emotional memories and reactions Primary motor cortex - The section of the frontal lobe responsible for voluntary movement Prefrontal cortex - part of frontal lobe responsible for thinking, planning, and language Primary sensory cortex - Regions of the cerebral cortex that initially process information from the senses Broca's area - Dysarthritic speech. Halted, labored speech Wernicke's area - Can fluently talk but it won't make sense Major descending tracts spinal cord - Anterior corticospinal tract, lateral corticospinal tract, rubrospinal tract, tectospinal tract Major ascending tracks spinal cord - Fascuculus cuneatus and faniculus, lissauers tract, anterior and posterior spinocerebellar tracts, spinothalamic tract, spinoreticular tract, spinotectal tract Antidepressants - Prozac, Elavil, Norpramin antispasmodics - Probanthine, baclofen Antipsychotics - Zyprexa, Seroquel, Haldol Antihypertensives - Inderol, Beta Blockers Stimulants (medication) - Ritalin, Adderal Antiseizure Drugs - Dilantin, Tegretol, Depakote Visual analog scale for fatigue (VAS-F) - 2 subscales: Energy subscale and fatigue subscale Fatigue severity scale (FSS) - Used to assess the behavioral consequences of fatigue in the impact of fatigue on daily functioning Seven point scale Borrow neurological institute fatigue scale - 10 items rated on a seven point scale Lower the number the less of a problem Global fatigue index (GFI) - Self reported measure of four domains of fatigue including severity, distress, impact on activity and timing of fatigue Score range 1 to 50 (higher the # higher the fatigue) basal ganglia - Receives info from cortex, processes info then sends back to cortex On alert for when something goes wrong Regulates activities of motor & premotor cortex Occipital neuralgia - Type of migraine Starts in the back and worsens throughout day Somatization - Unconscious process which psychological distress is expressed in physical symptoms secondary gains - benefits from being ill, such as attention pneumocephalus - gas or air in cavity of cranium pseudobulbar affect - "Emotional incontinence" Laughing when they are sad or crying when they are happy May co-occur with depression Applied behavioral analysis - The science of prediction & change of socially significant behaviors. Goal: to discover variables that reliably influence behavior and use this info to either predict or promote behavior change Functional analysis - Methods of direct observation with in the field of behavior analysis and are conducted by a board certified behavior analysis to pinpoint the potential function or purpose of a behavior the experimental manipulation