Characteristics, Symptoms, and Treatment of Traumatic Brain Injuries, Exams of Nursing

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CBIS EXAM 400 ACTUAL EXAM QUESTIONS AND VERIFIED ANSWERS GUARANTEED A+ 2024 Nuerocognitive Issues Assoicated with Frontal Lobe - ANSWER- Emotional control, behavioral control, verbal expression, problem solving, decision making, social control, attention, motivation Acquired BI - ANSWER- An injury to the brain that is not hereditary, congenital or degenerative or induced by birth trauma TBI - ANSWER- An alteration in brain function or other evidence of brain pathology, casused by an external force Mild TBI Characteristics - ANSWER- Brief or no loss of consciousness for 0- 30mins, altered state of consciousness is most common and must be <24 hours, account for 75% of TBIs, 13-15 on the GCS, normal imaging, highest prevalence of maltreatment as 16-25% never seek care, often considered a concussion Moderate TBI Characteristics - ANSWER- Loss of consciousness for up to 24 hours, may appear on scans, skull fractures and bleeding are common, 9-12 on the GCS Severe TBI Characteristics - ANSWER- Loss of consciousness >24 hours, 3-8 on the GCS Likelihood of Additional Injury - ANSWER- 1 BI increases risk of 2nd by 3x and 2nd BI increases risk of 3rd by 8x! Most Frequent Cause of TBI - ANSWER- Falls How many people sustain a BI per year? - ANSWER- 2.5 million. 81% visit ED, 16% hsopitalized, 3% result in death How many people are living with effects of a TBI? - ANSWER- 13.5 million Likelihood of BI by gender - ANSWER- Men are 1.4x more likely than women Most common cause of TBI and death by age - 75+ - ANSWER- Falls! Most common cause of TBI and death by age - 0-3 - ANSWER- AHT! Most common cause of TBI and death by age - 20-24 - ANSWER- MVAs and Firearms Most common cause of TBI and death by age - 16-19 - ANSWER- MVAs! Functions of the Parietal Lobe - ANSWER- Sense of touch; differentiation of size, color, and shape; visual perception; spatial perception Functions of the Occipital Lobe - ANSWER- Visual functions Functions of the Frontal Lobe - ANSWER- Planning; organizing; problem solving; working memory; impulse control; decision making; personality; behavior; initiation; anticipation; self-monitoring; motor planning; emotions; awareness of abilities; attention; concentration; mental flexibility; speaking - all executive functions Functions of the Temporal Lobe - ANSWER- Hearing functions, memory, understanding language, organization and sequencing Functions of the Brain Stem - ANSWER- Breathing, HR, arousal, consciousness, sleep/wake functions, attention, concentration Transmits all sensory information from body to brain and movement signals from the brain to the body Contains sensory centers for hearing, touch, taste, and balance Even if the cerebral cortex is gravelly damaged, the brain stem can keep someone alive - or in a vegetative state Functions of the Cerebellum - ANSWER- Balance, coordination, skilled motor activity Reticular Activating System (RAS) - ANSWER- Part of the brain stem - collection of nerve fibers that modulate changed in arousal, alertness, concentration, and biological rhythms Can be turned down or up much like a light dimmer switch - i.e during a coma, it is turned down - if turned down too much, can result in death Medulla - ANSWER- Part of the brain stem- responsible for basic living functions such as breathing, HR, BP, swallowing, and vomiting Pons - ANSWER- Part of the brain stem- responsible for facial movements, facial sensation, hearing and coordinating eye movements Serves as a bridge between the cerebral cortex (thinking part of brain) and cerebellum (moving part of brain) Damage can cause decreased coordination and poor control of body movements Midbrain - ANSWER- Part of the brain stem - responsible for elementary forms of seeing and hearing, alertness, arousal Thalamus - ANSWER- Part of the diencephalon - major relay station for incoming and outgoing sensory information except for smell Hypothalamus - ANSWER- Part of the diencephalon - control center for hunger, thirst, sexual responses, endocrine levels, temperature regulation, hormone release "The conductor of the emotional orchestra" Functions of the Limbic System - ANSWER- Drives basic instincts, "animal-like" aspects of a human - if damaged can cause emotional responses that can become uncontrollable Amygdala - ANSWER- Part of the limbic system - responsible for emotional memories, closely tied to sense of smell "Fight of flight structure" Hippocampus - ANSWER- Part of the limbic system - responsible for the organization of memories Described at the pole in a closet - without pole, all clothing falls - without hippocampus memories become disorganized Basal Ganglia - ANSWER- Part of the limbic system - relays information from cerebral cortex to brain stem and cerebellum for movement, the checking system that comes to attention when things are not working as they should be i.e. restoring equilibrium Cerebellum - ANSWER- Governs a person's movements by controlling rate, direction, force and steadiness of movements Cerebral Cortex - ANSWER- Made up of right and left hemisphere and corpus collosum Functions of the Right Hemisphere - ANSWER- Holistic, visual spatial and , intuitive in nature Apoptosis - ANSWER- Process in which a brain cell self destructs if it is not working as it should be Experience Dependent Learning - ANSWER- Neural connections that are established which depend entirely on and are due to an environmental experience Autonomic Storming - ANSWER- Also called dysautonomia, autonomic hyperreflexia, sympathetic storming A disorder of the autonomic nervous system that involves failure of the sympathetic/parasympathetic components of the ANS. Characterized by resting tachycardia, labored breathing, gastroparesis, sweating irregularities, hypotension, constipation, and erectile disfunction 15-33% of TBIs sustainees experience AS Deep Vein Thrombosis (DVT) - ANSWER- Bloodclots Symptoms include shortness of breath, pain/discomfort that worsens with coughing or breathing, light headedness, dizziness, feeling faint, coughing up blood, rapid pulse Pulmonary Embolism (PE) - ANSWER- Occurs when a blood clot travels to the lungs- same symptoms for DVT Disinhibited Nuerogenic Bladder - ANSWER- Neurological impairment in CNS or PNS causing decreased bladder capacity, increased urgency, increased frequency and incontinence with intact bladder sensation Treatment for Bowel and Bladder Incontinence - ANSWER- Best when initiate early on - treatment includes exterior cathing and suppository schedules, toileting schedules, and close monitoring of intake UTI's extremely common due to cathing - risk of UTI is increased with use of in- dwelling catheters, especially if cognitive impairment is present Aspiration - ANSWER- Caused by dysphagia - when liquid enters into the lungs Commonly leads to aspiration pneumonia Specialized diets are often prescribed if there is a risk of dysphagia - may include thickened liquids and diets with altered consistency Seizures and TBI - ANSWER- Caused by an imbalance of nuerotransmitters or an abnormal and disorderly discharge of electrical activity in the cells of the brain TBI sustainees 22x more likely to die from a seizure than general population Immediate post TBI convulsions are most common but not believed to be a predictor of prolonged seizure disorder Seizures occurring 1 wk post TBI are strong predictor of future patterns Status Epilepticus - ANSWER- A seizure lasting longer than 5 minutes or seizures that occur close together, when one seizure occurs before fully recovering from previous seizure Associated with the following risk factors: penetrating TBI, severity of injury, hematomas, contusions, post traumatic amnesia lasting more than 24 hours, alcohol use, being a child or adolescent Cranial Nerve Damage - ANSWER- Associated with higher level severity BIs Cranial nerve 1 is most commonly injured, all are susceptible to injury due to placement near bony skull prominences Can heal and repair selves if stretched or bruised, tingling and pain can be a sign of repair Cranial Nerve Functions - ANSWER- I Olfactory (smell) II Optic (sight) III Occulomotor (eye movement) IV Trochlear (downward, inward eye movement) V Trigeminal (sense of touch in the face) VI Abducens (horizontal eye movement) VII Facial (facial expressions) VIII Auditory-Vestibular IX Glossopharyngeal (throat, taste, BP) X Vagus (heart, lungs, abdominal organs) XI Spinal Accessory (throat & neck muscles) XII Hyposglossal (speech) Nocioceptive Pain - ANSWER- Pain relating to damage to body tissue Can cause severe pain, decreased ROM, and increased spasticity Treated with NSAIDS, PT, and sometimes surgery Contractures - ANSWER- Shortening of tendons and muscles causing decreased ROM Treated with combination of meds, splinting, casting, PT, OT, etc. Hyperreflexia - ANSWER- Bladder emptying that is triggered easily, overactive and overresponsive reflexes Pressure Sores - ANSWER- Occur most often near bony prominences due to decreased mobility and lack of sensation Can be avoided by keeping skin clean and dry, turning schedules (every 2 hours), specialty cushion/mattress, and tilt in space W/Cs Stage 1 (non blanchable redness) Stage 2 (shallow open ulcer with red or pink wound bed or blister) Stage 3 (subcutaneous fat visible, may have undermining or tunneling) Stage 4 (exposed bone, muscle, or tendon) Unstageable (colorful wound bed) Deep Tissue Injury - ANSWER- Purple, maroon localized area caused by damage of underlying soft tissue Agnosia - ANSWER- Perceptual defecit associated with BI Inability to recognize Anosagnosia - ANSWER- Perceptual defecit associated with BI Inability to recognize own defecits or disabling condtion Somatoagnosia - ANSWER- Perceptual defecit associated with BI Inability to recognize body part of structure Apraxia - ANSWER- Perceptual defecit associated with BI Absence of Spatial Relations Disorder - ANSWER- Perceptual defecit associated with BI Inability to perceive space between objects Form Discrimination Disorder - ANSWER- Perceptual defecit associated with BI Challenge with orientation and similar shapes Vertical Disorientation - ANSWER- Perceptual defecit associated with BI Difficulty with upright position and balance Depth and Distance Perception Difficulty - ANSWER- Perceptual defecit associated with BI Difficulty sensing depth and distance of an object in relation to oneself Co-Commitance of SCI and TBI - ANSWER- 60% of patients with SCI also have a TBI 12,000 new cases of SCI per year Complete vs Incomplete SCI - ANSWER- All feeling and control completely lost below level of injury vs partial feeling and control lost below level of injury Coma - ANSWER- Disorder of consciousness No arousal, no awareness, lasts weeks to months, impaired brain stem reflexes Vegetative State - ANSWER- Disorder of consciousness Arousal, no awareness, lasts months to years Minimally Conscious State - ANSWER- Disorder of consciousness Periodic limb movements during sleep Insomnia - ANSWER- Sleep Disturbance Periods of wakening and difficulty getting back to sleep Treatment for Sleep Disturbance - ANSWER- Exercise, limiting fluid intake before bed, avoiding naps, relaxation, sleep hygiene, CBT, meds, and CPAP Sleep Disturbance Assesment Tools - ANSWER- Epworth Sleepiness Scale, Pittsburgh Sleep Quality index, Polysonography, Mutiple Sleep Latency Test Causes of Sleep Disturbance - ANSWER- Change in circadian rhythms, depression, frequent napping, anxiety, pain, changes with REM Aging and TBI - ANSWER- TBI exacerbates normal aging increase likelihood of developing AD Nuerocognitive Issues Associated with Frontal Lobe Damage - ANSWER- Emotional control, behavioral control, verbal expression, problem solving, decision making, social control, motivation, and attention Nuerocognitive Issues Associated with Partial Lobe Damage - ANSWER- Tactile performance, spatial orientation, academic skills, object naming, visual attention and hand eye coordination Nuerocognitive Issues Associated with Occipital Lobe Damage - ANSWER- Visual stimuli processing Nuerocognitive Issues Associated with Temporal Lobe Damage - ANSWER- Memory, face recognition, selective attention, locating objects, object catgorization, receptive language, emotional responses, language comprehension Attention Heiarchy - ANSWER- Focused (turning to see someone behind you) -> Sustained (reading a book) -> Selective (studying with music) -> Alternating (reading recipe and cooking) -> Divided (driving and talking on the phone) Domains of Cognitive Functioning - ANSWER- Metacognition (self-awareness), executive functions, attention, categorization, processing speed, memory Sensory memory - ANSWER- Holds a memory a few moments after perception Short Term Memory - ANSWER- Enables memory recall lasting a few minutes to hours Working Memory - ANSWER- Temporary storage and active processing of information i.e. calculating change Long Term Memory - ANSWER- Permanent consolidation and storage of information Explicit Memory vs. Implicit Memory - ANSWER- Memory requiring conscious recall vs muscle memory Semantic Memory - ANSWER- Memories of words, ideas, and concepts Episodic Memory - ANSWER- Memories of personal experiences Procedural Memory - ANSWER- Memory of skills and tasks Compensatory Approach to Treatment vs. Restorative Approach to Treatment - ANSWER- Assumes certain functions cannot be recovered and focuses on strategies to "compensate" for losses vs. belief that repetition, exposure and experiential learning can change brain circuitry Coma-Emergent Agitation - ANSWER- Emerging from coma can case confusion, anger, hyperactive movements, heightened responses to external stimuli, poor cooperation and violence Can last up to 10 days Management of Coma-Emergent Agitation - ANSWER- Use consistent and familiar staff, environmental alteration to decrease triggers, provide familiar objects, reduce stimuli, establish predictable routines Stability Triangle - ANSWER- Model that suggests you must establish medical stability, develop stable activity plan and promote stable behavior in order to achieve stability ABA - ANSWER- Method of behavior change - discovers variables that predict behavior to modify antecedents to illicit behavior change 3 components - the environment, the individual, and the target behavior Organic Personality Disorder and TBI - ANSWER- Symptoms: Depression, emotional instability, irritability, impulsivity, changes in behavior prior to injury due to an organic impairment or disease of CNS 23% of people with TBI experience OPD Pseudo Bulbar Affect and TBI - ANSWER- Symptoms: Uncontrollable episodes of laughing or crying, catastrophic reactions A result of TBI or other nueroglogical disorder Substance Use Disorder (SUD) and TBI - ANSWER- Involves continued use of substance despite health, psychological or social consequences Exacerbates effects of TBI including memory, judgment, behavior, and generalization impairments 12% of people 16 and older with TBI used a month prior to injury Use of substances before injury increase risk of reusing x10 As many as 50% of users will use again after injury Screening Tools for SUD - ANSWER- ASSIST, CAGE, AUDIT, CRAFFT 4 Quadrant Treament for SUD and TBI Co-Committance - ANSWER- Quadrant 1 - low severity TBI and SUD - receive treatment in acute medical setting - brief intervention Quadrant 2 - high severity TBI and low severity SUD - receive treatment in TBI rehab - education, screening, and brief intervention Quadrant 3 - low severity TBI, high severity SUD - receive treatment in SUD treatment setting - screening, accommodations and linkage Quadrant 4- high severity TBI and SUD - receive treatment in TBI and SUD treament setting - integrated program to treat both Biomedical Model of Diability - ANSWER- Concerned with changing the individual and treating the problem (TBI) Functional Model of Disability - ANSWER- Aimed at adapting the functions of individuals for meaningful participation in life, focused on person centered care Environmental Model of Disability - ANSWER- Addressing physical and social environments to meet the needs of an individual Sociopolitical Model of Disability - ANSWER- Goal is inclusion, civil rights, and equal social status - places accountability on society Religious/Moral Model of Disability - ANSWER- Disability is a result of sin Person Centered Care - ANSWER- Encourages individual participation in rehab and hold the individual accountable for their progress. Physicians, healthcare professionals, and family are considered tools and allies. Focuses on participation in the process as opposed to immediate "progress." Encouraging self awareness and autonomy improves outcomes. Components of Therapeutic Relastionships - ANSWER- Autonomy -empowering the indivdual Beneficence- preventing harm Non-Maleficience - do no harm Fidelity - keeping a promise Justice - equality and fairness Veracity- truth and honesty Use person first language, humaneness, open communication, questions vs directives, and a non-judgmental approach! Latrogenesis - ANSWER- Due to.a physician or therapist, inadverdently induced problem or disease Extenders - ANSWER- Unlicensed, non-certified staff that operate under the supervision of a licensed clinician that are specially trained Culture - ANSWER- Any group that shares a theme or issue; can include language, food, clothing, music, art, dance, etc. Sociorace - ANSWER- Recognizes the social and historical aspects of a group of people; providing info about customs, norms, and social aspects of the group Universalism - ANSWER- Loyalty and concern for others without regard to national or other allegiances disability i.e. preferential seating, increased time, verbal testing, note takers, etc. Can be carried into higher education but may not have a formal 504 plan.. A result of section 504 of Rehabilitation Act of 1973 that prohibits discrimination based on disability Individualized Education Plan (IEP) - ANSWER- Written for specialized academic instruction, can be used by students in public school until age 21 - all public schools MUST provide services outlined in IEP by law Individualized Transition Plan (ITP) - ANSWER- Section of an IEP that outlines transition goals and services and how to achieve goals from transition to high school into real world. All students with IEP must have an ITP by age 16 Abusive Head Trauma (AHT) and Shaken Baby Syndromes Statistics - ANSWER- AHT is most common cause of TBI in 0-5 year olds, boys most commonly abused Accounts for 58% of TBIs in boys compared to 42% in girls Most often committed by a male caregiver - 56% of offenders are biological fathers Outcomes: 75-80% experience LT disability, 40% have severe defecits and 15- 30% die Common Stressors for Families - ANSWER- Caregiver Burden is reported by 90% of caregivers! Stressors include catastrophe and unexpected responsibility in the acute phase; added unfamiliarity, confusion, uncertainty, and pressure in the rehab phase; and isolation and distress post discharge. Relief Strategies for Use with Families - ANSWER- Developing realistic goals, facilitating optimism, education about resources, and encouraging use of school supports Keep families informed, use active listening, validate and normalize, keep conversation positive, refer to resources, consider cultura competence Family Systems Theory - ANSWER- Families are considered to be the experts, every family has their own way of communication and functioning that will influence reception of rehab Assumes that families have the strength and capacity to solve problems and be successful Family Centered Services - ANSWER- The survivor, family and provider are partners in healthcare. Care should be tailored to individuals and family strengths and values. Cognitive Behavioral Family Theory - ANSWER- A - Activating Event - family has no control (medical deicisions and the accident itself) B- Belief - family has control over (i.e. "this will be the end of our family" vs "we can do this") C- Consequence of Belief - family has control over (feeling hopeless vs seeing progress and feeling encouraged) Brain Injury Family Interventions (BIFI) - ANSWER- 90-120 minute sessions focused on familial support for families of individuals with BI Session focuses may include what's normal after BI, coping strategies and loss etc. Primary Blast Inury vs. Secondary Blast Injury - ANSWER- Caused by direct impact from over-pressure wave, compresses air filled organ or catapults body backwards vs energized debris and explosive fragments that impact on head or body Tertiary Blast Injury - ANSWER- Body impacts the wall, ground, or object Quarternary Blast Inury - ANSWER- Inhalation of toxic gases or substances Mild TBI and PTSD - ANSWER- This severity of TBI has highest rate of co-mittal PTSD at 44% Components of Return to Military Duty - ANSWER- Medical Evaluation Board - physician informally determines if a soldier can meet medical retention standards Physical Evaluation Board - a formal fitness for duty and disability determination and eligibility for compensation Screening and Testing for Military Related TBI - ANSWER- Military Acute Concussion Evaluation, Nuerobehavior Symptom Inventory, State Strait Axiety Inventory, The ANAM Simple Reaction Time and Continuous Performance Subtests, Repeatable Battery for the Assessment of Nueropsychological Status Early Measures - ANSWER- Abbreviated Injury Scale, Loss of Consciousness, JFK Coma Recovery Scale, Measure of PTA, GCS Extended Scale Acute Meaures - ANSWER- FIM, Functional Assessment Measure, Dsaibility Rating Scale, Level of Cognitive Functioning Scale Popular Post-Acute Measure - ANSWER- Mayo-Portland Adatibility Inventory - measures physical, cognitive, social, behavioral, and emotional defecits associated with BI *can measure participation Post Acute Measures - ANSWER- Craig Handicap Assessment and Reporting Technique - objective measure of community participation Participation Assessment with Recommended Tools Objective - measures frequency of activity engagement * both can measure participation Required Aspects of Outcome Tools - ANSWER- Must measure baseline and post intervention, should be reliable/valid/widely accepted When choosing an outcome measure consider cost, expertise and training required to administer, timing and common data elements Common Data Elements - ANSWER- A data element that is common to multiple data sets across different studies Sequentially vetted, standardized report forms that streamline data collection structure and material development Return to Work (RTW) - ANSWER- The gold standard of TBI rehab progress and outcomes 10-40% of TBI sustainees return to work, numbers are variable due to varying definitions of "full time work" Barriers to RTW - ANSWER- Older age, severe injury, minority race, lack of social support, decreased employment education prior to injury, history of substance abuse, significant defecits Rehab Act of 1973 and Vocational Rehabilitation - ANSWER- Provided federal grants to states to operate comprehensive programs of vocational rehab State VR Services and Supports - ANSWER- Assessment, vocational counseling, guidance and referreal to needed services, rehab technology, on the job training, job placement, and supported employment 4 Approaches to VR - ANSWER- Minimal intervention ->education/prep -> advocacy level services -> workplace supports Supported Employment - ANSWER- Individualized support for persons with disabilities and long term barriers to work.a sustainable, paid job in the open labor market Vocational Case Coordinator - ANSWER- Follows individual on a long term basis to ensure success with employment. Provides support via assessment, job development, on the job training and case management Acute Brain Injury - ANSWER- An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma Traumatic Brain Injury - ANSWER- 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 - ANSWER- Lack of O2, decreased nutrients to cells, exposure to toxins, pressure from tumor or blockage or other neuro disorder ABI Prevalence - ANSWER- 2nd most prevalent disability in U. S. * 13.5 million Americans Children & TBI - ANSWER- * 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 - ANSWER- 67% of women in domestic violence had TBI symptoms Mild TBI - ANSWER- *concussion Somatization - ANSWER- The expression of psychological distress through physical symptoms Chronic traumatic encephalopathy - CTE - ANSWER- Rare, progressive, degenerative condition of central nervous system that is seen and repetitive brain trauma Dementia, memory loss, aggression, confusion, depression Hebbian Learning - ANSWER- Neurons that fire together, wire together Experience independent learning - ANSWER- " use it or lose it" Synaptogenesis - ANSWER- The process by which neurons form new connections Disorders of consciousness - ANSWER- Coma, Vegetative State, minimally conscious state Coma - ANSWER- * no evidence of arousal * no response to internal or extrnal stimuli * May have reflexive response * resolves in 2 to 4 weeks Vegetative state - ANSWER- Transition of severely brain damaged patients from a coma to wakefulness without awareness Can be months to years in this state Minimally conscious state - ANSWER- condition in which someone has brief periods of purposeful actions and speech comprehension Emergence from DOC - ANSWER- Requires at least one criteria: * functional communication by verbal or gestural Y/N response * functional use of 2 or more objects Automatic dysfunction syndrome - ANSWER- Episodes of: dystonia (abnormal muscle tone), tachycardia, diaphoresis (sweating), hyperthermia, hypertension, tachypnea (rapid breathing) *occurs in 15%-33% of severe TBI Sleep Complications - ANSWER- Hypogenic hallucinations - vivid dream like auditory, visual, or tactile sensations on experiences between sleep and wake Cataplexy - feature of narcolepsy. Sudden loss of muscle tone. Consciousness remains clear, memory not impaired and respirations intact Immediate post Trumatic convulsions (seizures) - ANSWER- LOC & involuntary movements within seconds of impact *can be asymmetrical, short period of AMS & retrograde amnesia Early post Trumatic seizures - ANSWER- *occurs within the first week *results from primary direct effect of trauma *risk factors: severe TBI, depressed skull fx , penetrating head injury, sub dural hematoma, entercerebral hematoma, epidural hematoma, portable contusion Late post Trumatic seizures - ANSWER- * within 18 to 24 months however can be years later * also called post dramatic epilepsy * strongest risk factors are missile wounds, multiple contusions, multiple craniotomies tension headache - ANSWER- nonmigraine headache in which pain is felt in all or part of the head *Trigeminal nerveC1-C3 nerve roots, occipital nerves Cervicogenic Headache - ANSWER- Generated primarily from the cervical spine *C1 -C2 periorbital region *C2 - C3 parietal & frontal regions *C3 - C4 upper thoracic & lateral cervical region Craniomandibular Headache - ANSWER- * subtype of tension headache that can cause difficulty with eating and talking Nocioceptive pain - ANSWER- Pain related to peripheral nerves neuropathic pain - ANSWER- Pain associated with primary lesion neuralgia - ANSWER- nerve pain Neuromas - ANSWER- Nerve endings adhered to scar tissue Hydrocephalus ex vacuo - ANSWER- Appearance of increased CSF in atrophy. Intracranial pressure normal, brain smaller Domains of cognition - ANSWER- Attention, categorization, memory, processing speed, executive functions, metacognition Attention - ANSWER- Divided, alternating, selective, sustained, focused Attention process training program (APT) - ANSWER- Process specific approach to cognitive rehab. Hierarchy organized by difficulty Categorization - ANSWER- 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 - ANSWER- Encoding, Storage, Retrieval Long term memory - ANSWER- Explicit vs implicit Executive Functions - ANSWER- * complex cognitive processes that involve reasoning, planning, judgment, initiation and abstract thinking Cognitive rehab approaches - ANSWER- *approach in systemic manner *analyzing problems *consider alternative solutions *prioritizing solutions *review outcomes Metacognition (n) - ANSWER- Awareness of thoughts 3 levels of metacognition - ANSWER- 1) awareness of deficits 2) awareness of functional implications 3) awareness to set realistic goals Anosognosia - ANSWER- Diminished self awareness and failure to recognize a personal disability Cognitive Rehab - Compensatory Approach - ANSWER- *assumes some cognitive functions can't be recovered *focus on development of strategies *functional application is important Cognitive Rehab - Restorative Approach - ANSWER- *repeated exposure & repetition through experience *therapeutic exercise to re-establish/strengthen specific cog skills Principles of Cognitive Rehab - ANSWER- *tx of impairments must be hierarchical *basic cognition skills first *target attention, perception, categorization, abstract thinking, & memory Stability Triangle - ANSWER- Extinction - ANSWER- When a previously reinforced response no longer produces a consequence, leading to an eventual decline in rate continuous reinforcement - ANSWER- the reinforcement of each and every correct response intermittent reinforcement - ANSWER- reinforcement for some responses and not for others Topography - ANSWER- What a behavior looks like physically Behavior TX Approach - ANSWER- 1) assess behavior 2) define target behavior 3) collect data 4) change behavior Consequences - ANSWER- 4 types Branches of Neuropsychology - ANSWER- Experimental - intact/healthy brain Clinical - brain with lesions dual diagnosis - ANSWER- the client with both substance abuse and another psychiatric illness Axis I disorders - ANSWER- Clinical disorders *major depressive disorder is most common Axis II - ANSWER- Personality disorders and intellectual disabilities *benign paroxysmal positional vertigo (BPPV) *B vestibular hypofunction *central vertigo Olmstead Decision - ANSWER- A ruling made by the US Supreme Court requiring the provision of community based services with such services are available and not opposed by the patient in question, As opposed to being institutionalized. TBI model systems of care - ANSWER- *16 centers in US * developing and demonstrating a model system of care for persons with TBI *Emphasizing continuity and Comprehensiveness of care * maintaining a standardized national database for innovative analysis of TBI treatment and outcomes Peak Maturation Milepost - ANSWER- Most brain maturation occurs from birth to 6 years. Injury in that time frame may be the most devastating time for injury to occur ages 3-5 - ANSWER- *period of rapid brain growth *perfecting ability to form images, use words, place things in serial order, beginning problem solving Ages 8-10 - ANSWER- *sensory and motor systems maturing *frontal executive systems begin accelerated development *begin to perform operational functions Ages 14-15 - ANSWER- *maturation of visuo-auditory and somatic systems *review formal operations and find flaws & create new ones Ages 17-19 - ANSWER- *maturation of frontal executive functions *questions information, reconsiders & forms new hypothesis AHT/SBS - ANSWER- most common in infants and young children 0-5years More common for boys to be victim mTBI Adolescents - ANSWER- Student athletes with concussion must be evaluated, treated, and followed -up by health care professionals Second Impact Syndrome - ANSWER- Can occur when an athlete sustains an initial concussion and then sustains a second head injury before the symptoms from the first have fully resolved Tenet I - ANSWER- Current physical brain is related to the past physical state of our brain Tenet II - ANSWER- Our psychological state is the result of a 3 part constant reciprocally interacting relationship Moral Model of Disability - ANSWER- Oldest model Disability is result of sin, evil or character flaw Biomedical Model of Disability - ANSWER- Uses objective, clear-cut, standardized measures and expert to provide finding characteristics, causes, prognosis and treatment 2 demential (normal vs. illness) Environmental Model of Disability - ANSWER- Environment, social and physical can cause, defined or exaggerate a disability Prejudice, discrimination stigma lies with the environment and not the disability Functional Model of Disability - ANSWER- Most individualized and personal model (patient centered care) Extend in consequences for disability in consideration of person specific interest and participation Emphasizes DMEs sociopolitical model of Disability - ANSWER- Minority group for independent living model Disability is collective concern of society Societies responsibility for accommodating patient rather than the patient accommodating to society Six principles of person centered care - ANSWER- Autonomy, beneficence, non- maleficence, fidelity, justice, veracity Beneficence (Definition) - ANSWER- The clinicians obligation to do good for the patient Fidelity - ANSWER- Clinician should keep promises made Veracity - ANSWER- The clinician to be truthful and professional interactions Case management, life care planning, advocacy and public policy, support groups case management - ANSWER- A way of managing unique and high risk conditions often associated with costly acute care and hospital stay. Case Manager Functions - ANSWER- Educator, coordinator, research, communicator, collaborator, clinician, utilization manager, transition planner, leader, quality manager, negotiator, advocate, risk manager 6 Domains if Case Management - ANSWER- Processes and services, resource utilization in management, psychosocial and economic support, rehabilitation, outcomes and ethical and legal practices Life care planning - ANSWER- 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 - ANSWER- Should be continually monitored and revised when the persons health needs or situation changes. Special needs trust - ANSWER- 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 - ANSWER- First party SNT, third-party SNT, Inter vivos (during life) SNT, pooled trust/community trust Social security act of 1935 - ANSWER- Provided cash benefits & health care plans for individuals who are aged, disabled, and those with low income. Medicare - ANSWER- Four part insurance program established as part of the Social Security act Medicaid - ANSWER- Provide healthcare for people with low income, chronic illnesses, and disabilities black private help insurance Medicare Part A - ANSWER- No cost Covers hospitalizations, SNF, home health and hospice Medicare Part B - ANSWER- Premium is charged This covers doctors appointments and outpatient Medicare Part C - ANSWER- Premium charged Optional cost saving managed care plan Medicare Part D - ANSWER- Prescription drug coverage Omnibus Budget Reconciliation Act (OBRA) - ANSWER- Authorizes the establishment of home and community based Medical services State Children's Health Insurance Plan (CHIP) - ANSWER- Covers uninsured kids Affordable Care Act - ANSWER- Mandate on individuals and employers to obtain or provide health insurance by 2014 or face penalties Early Measures Outcomes - ANSWER- GCS, Abbreviated Injury Scale (AIS), LOC, JFK Coma Recovery Scale (JFK CRS-R), Post-traumatic amnesia (PTA), GOS Abbreviated Injury Scale (AIS) - ANSWER- 1 time measure of severity Ranges 1 (minor) - 6 (unsurvivable) JFK Coma Recovery Scale - ANSWER- Extended DOC 23 subscales, good for emerging consciousness Measures of Post-Traumatic Amnesia - ANSWER- Longer the PTA, the more likely a person will have long term issues No formal scoring process Glasgow Outcome Scale - ANSWER- 1-item descriptive outcome measure with 5 categories: Dead, vegetative, severely disabled, moderately disabled and good recovery Measures in Acute Rehabilitation - ANSWER- Functional Independence Measure (FIM/FAM), Disability Rating Scale (DRS), Rancho Los Amigos Functional Independence Measure (FIM) - ANSWER- 18-item, 7-level scale that assesses severity of disability in performing basic life activities Clinical tool Disability Rating Scale (DRS) - ANSWER- 8 item assessment of impairment, disability & handicap or participation State vocational rehabilitation services - ANSWER- Part of rehabilitation act of 1973 Vocational rehab counselors Services are time - Limited about 90 days Assessment, vocational counseling, guidance in referral to needed services, vocational training and on the job training, personal assistance services, rehab technology, job placement and supported employment Based on IPE WHO biopsychosocial model - ANSWER- Participation, disability, activities, activity limitations and participation restrictions ICF classifications - ANSWER- Classifies an individuals health state in regard to bodily function and structure, activities and participation Activities, participation, activity limitations and participation restriction National Institutes of Health (NIH) - ANSWER- Award grants to conduct basic and applied research on developing new methods for more effective diagnosis, therapies and continuum of care mortality rates - ANSWER- 37x more likely to die from seizures 12x more likely to die from septicemia 4x more likely to die from pneumonia 29% of death from circulatory problems CT Scan - ANSWER- Standard test for head injuries Can determine: skull fx, hemorrhaging, blood clot, brain swelling or foreign object penetration Glial cells - ANSWER- Noncommunicating cells which support and nourish the neurons Reticular activating system (RAS) - ANSWER- Modulates or changes arousal, alertness, concentration in basic biological rhythms Functions like a dimmer switch Medulla oblongata - ANSWER- Controls breathing, heart rate, blood pressure, swallowing, vomiting, sneezing Pons - ANSWER- Essential for facial movements, facial sensation, hearing in coordinating Eye movements Midbrain - ANSWER- Involved in elementary forms of seeing and hearing. Plays vital role in alertness and arousal Diencephalon - ANSWER- Master really center for forwarding information, sensations and movement. sometimes considered part of the limbic system Thalamus - ANSWER- Acts as a major relay station for incoming and outgoing sensory information. Injury to can cause: attention and concentration problems, difficulty with memory storage and retrieval, weekend mental stamina, decreased sensory information Hypothalamus - ANSWER- Control center for hunger, thirst, sexual response, endocrine levels and temperature regulation Involved in flight or fight reaction's Works as the conductor of a person's emotional orchestra limbic system - ANSWER- emotion and memory Mammalian brain Houses basic elemental drives, emotions and survival instincts Hippocampus - ANSWER- Associated with memory Amygdala - ANSWER- Ties emotional memories and reactions Primary motor cortex - ANSWER- The section of the frontal lobe responsible for voluntary movement Prefrontal cortex - ANSWER- part of frontal lobe responsible for thinking, planning, and language Primary sensory cortex - ANSWER- Regions of the cerebral cortex that initially process information from the senses Broca's area - ANSWER- Dysarthritic speech. Halted, labored speech Wernicke's area - ANSWER- Can fluently talk but it won't make sense Major descending tracts spinal cord - ANSWER- Anterior corticospinal tract, lateral corticospinal tract, rubrospinal tract, tectospinal tract