Brain Injury Exam Prep: Understanding Different Types, Causes, and Effects, Exams of Health sciences

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CBIS Exam Prep (2023 – 2024) Verified Solution lost productivity - one measure of the cost to society due to injury or disease; includes the loss of wages a person would have earned if they had not become unemployable due to disability, loss of taxes contributing to economy, costs to the government of supporting the individual, etc.; lost productivity costs DO NOT include cost of treatment and support post- injury or illness acquired brain injury (ABI) - An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma traumatic brain injury (TBI) - an alteration in brain function, or other evidence of brain pathology, caused by an external force traumatic impact - injuries resulting from contact (when head is struck by or against an object) traumatic intertial injuries - injury to the brain not caused by impact but as a result of inertial forces, such as acceleration-deceleration forces closed injuries - injury to the brain resulting in brain lacerations, contusions or intracerebral hemorrhage open injuries - injury to the head in which there is a breach of the skull or a breach of the meninges penetrating brain injury - any injury that involves the penetration of a foreign object, munitions, fragment, bone chip, etc. through the dura mater non-traumatic brain injury - damage to the brain caused by internal factors, such as oxygen or nutrient deprivation to brain cells, exposure to toxins, pressure from a tumor or blockage, or other neurological disorder coup-contrecoup injury - Coup injury: head injury that results from impact of a moving object--occurs at the site of impact Contrecoup effect: impact injury resulting from the moving head striking a stationary object--injury occurs at the side of the head opposite the point of impact primary injury - initial cause of damage to the brain, from which injury severity ratings are obtained secondary injury - pathophysiological events that occur following the initial primary injury to the brain loss of consciousness (LOC) - temporary altered state, unlike sleep, when a person is unresponsive to stimuli; usually due to trauma, stroke, or other injury risk factors for brain injury - injury severity age at injury alcohol misuse domestic violence service in the military participation in sports history of prior brain injury chronic traumatic encephalopathy (CTE) - a condition, diagnosed after death, relative to multiple concussions caused by significant force. A progressive degenerative disease, CTE is most often sustained by athletes participating in contact sports; may also be observed in domestic violence victims or abused children who have sustained numerous blows to the head neurogenic bladder - a secondary condition caused when a TBI affects the cerebral structures controlling bladder storage and emptying functions spasticity - involuntary, abnormal motor patterns; may interfere with a person's general functioning, self-care, and mobility activities of daily living (ADLs) - dressing, eating, showering, toileting, walking post-traumatic immune paralysis - acute period after sustaining significant bodily trauma, when the immune response is significantly impaired; frequently associated with the high prevalence of potentially life-threatening infections post-injury computed tomography (CT) - a cross-sectional series of X-rays used to view body organs, allowing medical professionals to view the scans in multiple individual layers; some scans can be reconstructed into a 3D image magnetic resonance imaging (MRI) - a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues within the body diffusion tensor imaging (DTI) - an MRI method that maps the diffusion of molecules, primarily water, in a person's body non-invasively acceleration-deceleration forces - sudden impact following a high velocity of speed, frequently resulting in brain injury post-traumatic amnesia - a state of confusion immediately following traumatic brain injury TBI Classification of Injury Severity: Mild TBI - Normal structural imaging LOC = 0-30 minutes Alteration of consciousness (AOC) = from a moment up to 24 hours Posttraumatic amnesia (PTA) = 0-1 day GCS = 13-15 TBI Classification of Injury Severity: Moderate TBI - Normal or abnormal structural imaging LOC > 30 minutes and < 24 hours AOC > 24 hr severity based on other criteria PTA >1 and <7 days GCS = 9-12 TBI Classification of Injury Severity: Severe TBI - Normal or abnormal structural imaging LOC > 24 hours PTA > 7 days GCS = 3-8 metabolic alterations - adverse chemical changes in the brain following head injury axonal shearing - a condition of damage to axons, as a result of being twisted and disconnected in a violent agitating motion second-impact syndrome (SIS) - Occurs when an athlete or individual sustains an initial concussion and then sustains a second head injury before symptoms from the first have fully resolved; can occur minutes, days, or weeks after the initial concussion; can be fatal or result in severe disability; may occur due to diffuse cerebral swelling or secondary to a subdural hematoma How long does it typically take for mTBI symptoms to resolve? What percentage of people experience persistent problems after that point? - Most symptoms resolve within 2-4 weeks. About 10%-15% of persons experience persistent problems after that point. physical/somatic symptoms of mTBI - Headache Fatigue Seizure Nausea Numbness Poor sleep Light sensitivity Noise sensitivity Impaired hearing Blurred vision Dizziness/loss of balance Neurologic abnormalities cognitive symptoms of mTBI - Inattentiveness Diminished concentration Poor memory Impaired judgment Slowed processing speed Executive dysfunction behavioral/emotional symptoms of mTBI - Depression Anxiety Agitation Irritability Aggression Impulsivity convergence insufficiency - a condition in which the eyes cannot focus effectively together, creating difficulty with reading, and triggering headaches frontal release - a syndrome resulting from damage to the frontal areas of the brain; characterized by disinhibition and abnormal behaviors occipital neuralgia - a condition caused by either direct trauma or secondary sensitization from recurring central headaches; usually associated with pain in the back of the head that worsens as the day progresses cervicalgia - simple neck pain; frequently associated with mTBI and when not treated swiftly, commonly causes both headaches and chronic pain syndromes trigeminal nucleus - bundle of sensory nerves; the largest of the cranial nerve nuclei; extends through the midbrain, pons, and medulla orthostatic hypotension - when a person's blood pressure drops quickly upon standing Benign Paroxysmal Positional Vertigo (BPPV) - a disorder of the inner ear resulting in positional vertigo, causing a spinning sensation; an episode of mild-to-extreme dizziness that is a result of a change of position of the head nystagmus - involuntary, rapid eye movements known to be a hallmark of BPPV; may be side-to-side, up-and-down, or rotary (horizontal/vertical/torsional) persistent post-concussive symptoms (PPCS) - a complex disorder following a concussion, lasting for weeks or months, consisting of symptoms such as headaches or dizziness; symptoms lasting longer than 4 weeks post mTBI predictive PPCS risk factors - Age > 40 Being female Traumatically injured Low SES History of substance misuse Pending litigation Previous psychiatric diagnoses disorder of consciousness (DOC) - a state of impaired consciousness as a result of an injury to the brain three levels of DOC from lowest to highest functioning - coma > vegetative state > minimally conscious state coma - a state of unconsciousness that can last for long periods of time, ranging from days to years; a condition caused by a severe brain injury or resulting brain swelling, leaving a patient unaware of their surroundings and unable to respond to even simple commands vegetative state - after a coma, a low level of consciousness in which a person appears awake but can only perform certain involuntary responses, not the more complex thoughts or actions associated with awareness such as following commands, planning, remembering, and communicating minimally conscious state - a condition of altered consciousness where the person displays some acknowledgment of self or environment physical management - Range of motion, orthotic use, positioning to keep the muscles and ligaments functional sensory stimulation - Focused presentation of different stimuli to gauge responses to sensory input and facilitate increased response consistency. DOC prevalence in the U.S. - Estimated that 315,000 people in the US present with a DOC. Of those, 35,000 present in a vegetative state and 280,000 present in a minimally conscious state. arousal vs awareness - Arousal refers solely to primitive, involuntary responsiveness to the world (e.g., generalized reflex responses to both internal/external stimuli)--maintained by RAS Awareness refers to an individual's ability to receive and process sensory information and use that info to relate in an intentional way to the outside world--required for voluntary responses to stimuli and regulated by higher cortical areas reticular activating system (RAS) - the RAS modulates or changes arousal, alertness, concentration, and basic biological rhythms Traumatic Inertial injury is caused by a. internal insult b. non-contact (brain moves within skull) c. neurotoxic poisoning d. Contact injury (struck by or against) - b. non-contact (brain moves within skull) An Open Head injury is typically a. Primarily diffuse b. primarily focal c. Neither focal nor diffuse d. About evenly focal and diffuse - b. primarily focal With Secondary Injury a. We obtain injury severity rating b. The etiology is mechanical damage c. We obtain surveillance data d. A cascade of pathophysiological events begins - d. A cascade of pathophysiological events begins The risk of a second injury after the initial injury is a. 3x greater b. 8x greater c. 2x greater d. No different until after the second injury - a. 3x greater Those with the greatest risk for second impact syndrome if they are returned to play while still neurologically at risk are a. athletes under the age of 24 b. high school football players c. female athletes d. male athletes - a. athletes under the age of 24 This percent of the population is living with disability from brain injury: a. 4.5% b. 7% c. 8.5% d. 10% - a. 4.5% Note: 8.5% = living with brain injury in the general population What is the ratio of men to women who suffer brain injury - 2:1 Secondary injury includes a. mechanical damage b. etiology c. metabolic imbalance d. a and b e. all of the above - c. metabolic imbalance The accrediting body of choice for brain injury rehabilitation is a. LTAC b CARF c. JCAHO d. ACRM - b. CARF Appropriate treatment strategies for Coma-Emergent Agitation may include a. Consequence or learning based programming b. Medications c. Environmental Management d. Behaviorally Based interventions e. a, b, and c f. b, c, and d - f. b, c, and d The Rehabilitation Act of 1973 is the foundation for a. Vocational Rehabilitation b. Section 504 Accommodation Plans c. Individual Education Plans d. Answer A and B e. Answers B and C - d. Answer A and B The percent of persons with SCI who also have TBI a. 25% b. 40% c. 60% d. 75% e. 80% - c. 60% The limbic system is comprised of a. hippocampus and amygdala b. thalmus and hypothalmus c. frontal and temporal lobes d. occipital and parietal lobes e. A and D - a. hippocampus and amygdala A compound or strategy that limits neuronal death following injury and/or enhances recovery a. Apoptosis b. Excitotoxicity c. Neuroplasticity d. Neuroprotection - d. Neuroprotection This describes when a neuron cannot maintain its resting potential resulting in repeated firing a. apoptosis b. excitotoxicity c. neuroplasticity d. neuroprotection - b. excitotoxicity Diagnosing Frontal Lobe Deficits versus Depression has to do with a. the individual's ability to recognize and acknowledge the deficits b. outcomes on the GCS c. results of CT d. thorough family history e. all of the above - a. the individual's ability to recognize and acknowledge the deficits These medications are typically recommended by Urologists for incontinent bladder management a. anti-biotics b. anti-epileptics c. NSAIDS d. histamine blockers e. Anti-cholinergics - e. Anti-cholinergics Convulsions occur within 7 days following the injury and are purported to occur as a direct result of the trauma , with approximately 50% occurring within 24 hours of impact and is a strong risk factor for post-traumatic epilepsy a. Immediate Post Traumatic Convulsions b. Early Post-Traumatic Seizures c. Status Epilepticus d. Late Post-Traumatic Seizures - b. Early Post-Traumatic Seizures Damage to this area of the brain most likely responsible for disorders of consciousness - Reticular activating system C-O-L-D-E-R stands for a. Character-Occurrences-Location-Disorder-Exacerbation-Results b. Coping-Occurrences-Location-Duration-Exacerbation-Results c. Character-Onset-Location-Duration-Exacerbation-Relief d. Character-Onset-Location-Duration-Exacerbation-Results e. Chronic-Onset-Location-Duration-Exacerbation-Relief - c. Character-Onset-Location- Duration-Exacerbation-Relief *Refers to the headache review of systems a. X-ray b. CT c. MRI d. DTI - b. CT This non-invasive method of stimulating the brain using electromagnetic induction is used as a treatment modality for depression, stroke, migraines and Parkinson's disease a. Constraint induced therapy b. Epley Maneuver c. Magnetic Resonance d. Transcranial Magnetic Stimulation - d. Transcranial Magnetic Stimulation A headache that occurs at least 15 days per month for at least 3 months is considered a. Migraine b. Primary c. Secondary d. Chronic - d. Chronic Abnormal, usually permanent condition of joints characterized by decreased range of motion, often in flexed position, and fixation due to wasting away and shortening of muscle fibers and loss of skin elasticity a. contractures b. heterotopic ossification c. hyperreflexia d. spasticity - a. contractures What is DVT? - Deep vein thrombosis: a blood clot in any deep veinous part of the circulatory system The science of prediction and change of socially significant behaviors is a. Neuropsychiatry b. Neuropsychology c. Applied Behavioral Analysis d. Cognitive Rehabilitation - c. Applied Behavioral Analysis This branch of neuropsychology uses specialized testing procedures to relate behavior changes to lesion sites and specific brain mechanisms a. Experimental b. Clinical c. Restorative d. Compensatory - b. Clinical "The individual's capacity to change behaviors in order to adapt to changes in their internal or external environment" describes this Principle of Cognitive Rehabilitation a. Neuroplasticity b. Adaptability c. Restorative d. Compensatory - b. Adaptability Which of the following is considered a dual diagnosis? a. CVA and diabetes b. Anoxia and hypoxia c. TBI and bipolar disorder d. All of the above - c. TBI and bipolar disorder There is a direct relationship between behavior problems and psychiatric symptoms and a. Caregiver stress b. Development of SIADH c. Brown-sequard syndrome d. Akathisia - a. Caregiver stress Depression post TBI is associated with injury to a. Frontal lobe b. Basal ganglia c. Limbic system d. A and c e. All of the above - e. All of the above This is a screening tool used to assess misuse of alcohol or other drugs a. CAGE b. imPACT c. CHART d. HELPS - a. CAGE According to the 4 Quadrant Model of Opportunities for Substance Misuse Intervention for Persons with a TBI, a person who falls in Quadrant I (Low/Low Severity) would be addressed by a. Integrated programming b. Education, screening, brief intervention, and linkage c. Screening, accommodation, and linkage d. Screening and brief intervention - d. Screening and brief intervention Continued substance use despite health, psychological, or social consequences best describes a. Substance misuse b. Substance use disorder c. Psychoactive substance misuse d. Hazardous use - b. Substance use disorder Shaken baby syndrome would be classified as a. Traumatic impact injury b. Traumatic inertial injury c. Open brain injury d. Non-traumatic injury - b. Traumatic inertial injury Which is the most true regarding outcomes for children with AHT/SBS? a. More than 70% survive with long term disability b. More than 50% die as a result of the injury c. Approximately 30% survive with no disability d. There are no published outcomes for AHT/SBS - a. More than 70% survive with long term disability The specific battery for neuropsychological testing most prescribed by the Department of Defense for service members with a mTBI is a. MACE b. ANAM c. Neurobehavioral Symptom Inventory (NSI) d. None. The DoD does not prescribe specific batteries for neuropsych testing - d. None. The DoD does not prescribe specific batteries for neuropsych testing What percent of service members with mTBI also have PTSD? a. 37% b. 44% c. 56% d. 75% - b. 44% Comprehensive Holistic treatment is most likely provided via a. Polytrauma rehabilitation centers b. Community integrated rehabilitation c. WRAMC d. VA clinic - b. Community integrated rehabilitation Cognitive Behavioral Family Theory a. Integrates the primary tenants of A-B-C b. Is grounded in the notion that the whole is greater than the sum of its parts c. Has been widely embraced in the field of childhood disability and pediatric populations d. Encompasses a set of skills rather than personality traits - a. Integrates the primary tenants of A-B-C Family Centered Services a. Integrates the primary tenants of A-B-C b. Is grounded in the notion that the whole is greater than the sum of its parts c. Has been widely embraced in the field of childhood disability and pediatric populations d. Encompasses a set of skills rather than personality traits - c. Has been widely embraced in the field of childhood disability and pediatric populations attention and verbal memory, but no differences in relative cognitive decline, over a 2 to 5 year period Treatment for spasticity - Treatment of spasticity should include different therapeutic interventions. In addition to medications, OTs and PTs address secondary complications of spasticity such as prevention of contractures and skin breakdown and provide interventions addressing positioning. Spasticity definition, symptoms, and outcomes - A motor disorder characterized by a velocity-dependent increase in tonic stretch with exaggerated tendon reflexes resulting from excitability of the stretch reflex - the faster an individual's extremity is moved the stronger the spasm will be; occurs due to UMN damage Symptoms: increased muscle tone, exaggerated tendon reflexes, clonus Outcomes: weakness and loss of dexterity along with impairment in muscle control, which affects functional independence Thrombus vs. embolus - A thrombus is a mass of platelets and/or fibrin that forms in a blood vessel (I.e. a blood clot). An embolus is often a piece of thrombus that has broken free and then circulates within the bloodstream Degrees of spinal cord injury - Complete injury: no motor or sensory function below the level of injury Incomplete injury: functioning of sensory and possibly some or much motor sensation below the level of injury Common neurobehavioral complications of brain injury - Aggression Agitation/irritability/poor frustration tolerance Apathy Denial of deficits/poor self-awareness Disinhibition Eating disturbances Flat affect/restricted emotions/inability to recognize emotions Impulsivity Lability or emotional instability Poor initiation Poor judgment and reasoning Psychosis (rare) Is consequence (or learning) based programming indicated in the early stages of recovery as individuals emerge from coma? - No - not indicated as learning new information is unlikely. This phase is generally short in duration when medication and environmental based management are provided. What is dual diagnosis? - Dual diagnosis refers to the relationship of a set of symptoms, which are or resemble symptoms of a known psychiatric disorder. TBI with the addition of subsequent psychiatric disorders would be considered a dual diagnosis. General principles of ethical standards in rehabilitation - Respect, beneficence, autonomy, non-discrimination, loyalty, truthfulness, competence, compliance, confidentiality Abuse, neglect, & exploitation - Abuse = the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. This includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well- being. Neglect = a failure to provide for the basic needs of a dependent individual Exploitation = the use of a dependent individual's property illegally or without the consent of the individual; includes the expenditure of funds This model highlights the progression of an individual in establishing his or her own cultural experiences a. Bio-social b. Racial/cultural identity development c. Socio-political d. Socio-institutional - b. Racial/cultural identity development Supported employment model - Emphasizes the use of a vocational rehabilitation professional (employment specialist or job coach) to provide intensive individualized assistance to help the person with TBI with gaining and maintaining employment in a real job for real pay in the community. Job coaching can improve work outcomes for persons with TBI. Tools used to measure participation following TBI - Craig Handicap Assessment and Reporting Technique - Short Form (CHART-SF) Mayo-Portland Adaptability Inventory-4 Participation Index (M2P2) Participation Assessment with Recombined Tools - Objective (PART-O) Community enfranchisement - the extent to which the person feels he or she has options and control over participation, feels a part of the community and feels valued In children, the post brain injury period of development is termed a. Concomitant b. Accelerated c. Therapeutic d. Latent - d. Latent Maturation of frontal executive functions occurs at ages a. 3-5 b. 8-10 c. 14-15 d. 17-19 - d. 17-19 Overall rapid growth in all areas of the brain occurs at ages a. 3-5 b. 8-10 c. 14-15 d. 17-19 - a. 3-5 After the initial recovery/rehabilitation phase post brain injury, children are best served by a. Return to school with accommodations b. Proper identification, collaboration of professionals, ongoing supports and services c. Residential treatment services before return to school d. Physical therapy, occupational therapy, and speech therapy - b. Proper identification, collaboration of professionals, ongoing supports and services Which is the most true regarding abusive head trauma? a. Occurs most commonly between the ages of 0-1 b. More common in girls than boys c. Abuser is most likely non-biological parental figure d. Shaken baby syndrome is not considered AHT - a. Occurs most commonly between the ages of 0-1 The ability to maintain attention is the presence of distraction is a. Focused b. Sustained c. Selective d. Alternating e. Divided - c. Selective The ability to maintain attention to complete a task accurately and efficiently over a period of time is a. Focused b. Sustained c. Selective d. Alternating e. Divided - b. Sustained The ability to select one source of information/stimuli while withholding responses to irrelevant stimuli is a. Focused b. Sustained The following are examples of academic accommodations that may be written into a 504 Accommodation Plan EXCEPT: a. Extended time on tests/assignments b. Note taker for lectures c. Provision of tests in a student's native language (other than English) d. Dictation of written assignments e. Preferential seating - c. Provision of tests in a student's native language (other than English) Which of the following statements is false? a. A student with a TBI causing social-emotional and behavioral disability can be suspended for suspendable offenses b. Schools must consider the relationship between disability and misbehavior if the student is removed from school longer than 10 days c. A student who chooses a private school cannot receive additional services through their public school d. Counseling can be provided through the school to address adjustment to disability e. answers A and C - c. A student who chooses a private school cannot receive additional services through their public school Which of the following is not true about SBS/AHT? a. SBS/AHT causes bleeding on the brain b. SBS/AHT causes brain swelling c. SBS/AHT causes bleeding in the eyes d. 70-85% of children die from SBS/AHT e. 70-85% of children who survive will have long term disabilities - d. 70-85% of children die from SBS/AHT The term "Common Data elements" refers to: a. Relating to function, specifically to real skills and abilities needed for life b. A measure that measures consistently when applied to different individuals, at different times and in different situations c. A measure that has withstood substantial rigor in the scientific community to be endorsed for use without being subject to question d. Specific standards for data being captured in the research community to standardize data collection and to facilitate data sharing e. The degree to which an instrument measure what it is intended to measure - d. Specific standards for data being captured in the research community to standardize data collection and to facilitate data sharing Validity - The degree to which an instrument measure what it is intended to measure A Special Needs Trust (SNT) often used in the case of a settlement from a lawsuit and referred to as a "Medicaid Payback Trust" best describes the following: a. First Party SNT b. Second Party SNT c. Third Party SNT d. Inter Vivos SNT e. Pooled Trust - a. First Party SNT Legal competency is determined by a. A court or Judge b. the Interdisciplinary Team c. Primary Physician d. Power of Attorney e. Guardian - a. A court or Judge Which of the following contributes the development of pressure sores? a. Restless sleep or insomnia b. Good nutrition c. Antibiotic therapy d. Excessive cardiovascular activity e. Dependence on others for mobility needs - e. Dependence on others for mobility needs The most effective means of reducing the level of disability experienced by a person with mTBI is: a. Medication management of symptoms b. Rest until symptoms resolve c. Early intervention d. Comprehensive therapy e. Return to work - c. Early intervention Which group of caregivers exhibits higher levels of stress over the lifetime of an individual with brain injury? a. Male partners (husbands) of individuals with brain injury b. Parents of individuals with brain injury c. Individuals with brain injury d. Children of individuals with brain injury e. Female partners (wives) of individuals with brain injury - b. Parents of individuals with brain injury Which of the following is NOT considered part of the treatment plan for Persistent Post Concussive Syndrome? a. Current coping strategies b. Psychological response to previous injuries c. Results of CT scans d. Neuropsychological assessment e. Psychiatric history - c. Results of CT scans Which cognitive impairment should be addressed first when providing cognitive intervention? a. Anosognosia b. Impaired attention c. Impaired short-term memory d. Impaired long-term memory e. All of the above - a. Anosognosia A Power of Attorney a. always indicates durable, broad powers b. provides written instructions to physicians regarding life saving measures c. is a legal arrangement where an individual has a legal duty to care for another individual d. is a legal document appointing another to make legal or financial decisions on their behalf when they become incapacitated e. is appointed through probate court - d. is a legal document appointing another to make legal or financial decisions on their behalf when they become incapacitated Psychiatric symptoms may occur at the end of formal rehabilitation and may interfere with community re-entry. Which of these factors plays a role in determining the duration of symptoms? a. stressors related to living with a disability b. employment status c. military status d. gender e. level of education - a. stressors related to living with a disability Which of the following statements is false? a. exploitation is the use of a dependent individual's property in an illegal manner or without consent b. neglect is failure to give a dependent individual the financial assistance they requested c. staff without knowledge of abuse, neglect, and exploitation may face criminal and civil action if they fail to report it d. A and C e. B and C - e. B and C The first stage of the case management service process is a. plan b. monitor c. assess d. coordinate d. facilitate - c. assess