Understanding Traumatic Brain Injuries & Closed Head Injuries: Mechanisms, Recovery, Quizzes of Criminal procedure

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TERM 1 TBI stats (X) DEFINITION 1 - TBI is a contributing factor in a third (30.5%) of all injury- related deaths in the united states- 75% of TBIs that occur each year are concussions or other forms of mild TBI- the most common causes of concussions are cycling, football, playground, activities, basketball and soccer- risk of motor vehicle accidents is highest among 16-19 year olds TERM 2 most common cause of TBI in US DEFINITION 2 falls(#2 is motor vehicle accident) TERM 3 who is most at risk for TBI DEFINITION 3 1. children (0-4)2. adolescents (15-19)3. older adults (75+) (highest mortality rate) TERM 4 mechanisms of injury DEFINITION 4 do you have to hit your hear to have a TBIClosed head Injury (CHI)- impact to the head (head strikes solid object, solid object strikes head)- acceleration/deceleration injury ("whiplash" injury)- blast injuryPenetrating Head Injury- moving projectile penetrates the skull and enters the brain TERM 5 closed head injury: impact DEFINITION 5 impact occurs when head strikes solid object or a solid object strikes headmassof object and speedboth impact severitylarge mass slow speedlittle mass, high speedex:- lacrosse ball to the head TERM 6 closed head injury: acceleration/deceleratoin DEFINITION 6 - "whiplash" injury: car injury- no indirect impact to the head- can occur any time the head suddenly accelerates or suddenly deceleratesex:- rear ended but seat bel prevents head from being hit TERM 7 closed head injury: blasts DEFINITION 7 Primary injury: blast wave- caused by the intense pressure wave created by explosion- pressure compresses organs (air filled and fluid filled most impacted)factors influencing severity:- peak pressure of the initial blast wave- duration of blast wave- environment in which the explosion occurs (confine space or open area)--> confined space = more severe injury- distance from the source of the explosion- distance from the source of the explosionsecondary injuries:- sustained due to flying shrapnel and other objects--> shrapnel = projectile objects/debristertiary injuries:- sustained when the body being physically thrown from the blast TERM 8 Penetrating head injury DEFINITION 8 anytime an object breaks through the skull and enters the brain TERM 9 what really happening in the brain after impact? DEFINITION 9 - coup-contrecoup injury- rotational forces- Diffuse Axonal Injury (DAI) "sheering" injury- edema- neurometabolic cascade- neurotransmitter dysfunction- migraine = deep polarizing event, spreading depression TERM 10 cou-contercoup injury DEFINITION 10 injury to two opposite sides of the brain- one in the direction of the momentum- one in the opposite direction- injury is often frontal and occipital- bur can occur in any direction depending on the direction of the momentum- additionally the brain compresses contributing to Diffuse Axonal Injury TERM 21 moderate TBI DEFINITION 21 - LOC between 30 mins and 24 hours- GCS of 9-12- PTA: 1-24 hours- may have signs of injury on a brain scan- will have some long-term problems impacting work and daily routines TERM 22 severe TBI DEFINITION 22 - LOC greater than 24 hours --> coma- GCS 3-8- PTA 1-7 days- likely to have bruising and bleeding in addition to diffuse axonal injury- likely to have signs of injury on brain scan- will have long-term problems impacting work and daily routines TERM 23 coma DEFINITION 23 unconscious at least 6 hours- patient cannot be awakened by any sensory stimulation including pain- no sleep/wake cycle- body is so damaged is cannot function TERM 24 vegetative state DEFINITION 24 - patient is minimally arousible- movements are automatic/reflexive and do not reflect cortical involvement or cognition- may respond inconsistently to stimuli--> turn toward stimuli--> follow moving object- eyes are open; there is a sleep and awake cycle; respond to environmental stimuli- response may be generalized and not specific to stimuli- when a "vegetative state" lasts longer than 4 weeks it is considered a persistent vegetative state TERM 25 minimally conscious state DEFINITION 25 when they move past vegetative state before 4 weeks- patient responds inconsistently in a way that reflects cognition/cortical involvement--> answers simple yes/no questions--> follows simple commands (not consistently) TERM 26 rancho levels DEFINITION 26 developed in 1979hallmark, general progressions (someone may move forward and then backwards)- 8 (or 10) levels that represent typical patterns of recovery from TBI- patients may progress from one level to the next and alter revert to a previous level when over stimulated or fatigued- from level 3 up --> knowing the levels is important in planning therapyex: rancho level 3 - you can't plan therapy around higher level skills TERM 27 Rancho Level I (no response) DEFINITION 27 no response- TOTAL ASSISTANCEa person at this level will:- not respond to sounds, sights, touch or movement TERM 28 Rancho Level II (generalized response) DEFINITION 28 generalized response - TOTAL ASSISTANCE--> no purposeful or intentional effortsa person at this level will:- begin to respond to sounds, sights, touch or movement- respond slowly, inconsistently, or after a delay- responds in the same way to what he hears, sees or feels- responses may include chewing, sweating, breathing faster, moaning, moving, and/or increasing blood pressure TERM 29 Rancho Level III (localized response) DEFINITION 29 localized response -TOTAL ASSISTANCE--> start to see some response that demonstrates cortical cognitive activity--> very simple intentional movements (stimuli --> response) (no organized intent -- just responding to environment)** responding to environmentA person at this level will:- be awake on and off during the day- make more movements than before- react more specifically to what he sees, hears, or feelsfor ex: he may turn toward a sound, withdraw from pain and attempt to watch a person move around the rom- react slowly and inconsistently- begin to recognize family and friends- follow some simple directions such as "look at me" or "squeeze my hand"- being to respond inconsistently to simple questions with "yes" and "no" head nods TERM 30 Rancho Level IV (confused-agitated) DEFINITION 30 confused and Agitated- MAXIMAL ASSISTANCE--> agitation--> restlessness (uncomfortable with sensory, auditory and visual input) (try to escape bc they don't understand whats going on)A person at this level may:- be very confused and frightened- not understand what he feels or what is happening around him--> no idea why they are being kept in the room or who the people around them are- overreact to what he sees, hears, or feels by hitting, screaming, using abusive language or thrashing about --> this is because of confusion- no filter- not pay attention or be able to concentrate for a few seconds- have difficulties following directions TERM 31 Rancho Level V (confuse-inappropriate-non- agitated) DEFINITION 31 confused and inappropriate - MAXIMAL ASSISTANCE--> inappropriate = they won't go to lunch because its time for lunch - they don't follow any organized pattern --> follow some instructions and simple daily activities- -> NON-agitateda person at this level may:- be able to pay attention for only a few minutes- be confused and have difficulty making sense of things outside himself- have a very poor memory,- try to fill gaps in memory by making things up (confabulation)- may get stuck on an idea or activity (perseveration)and need help switching to the next part of the activity TERM 32 Rancho Level VI (confused-appropriate) DEFINITION 32 confused and appropriate- MODERATE ASSISTANCE--> can attend for 30 min-- > some self care routines--> able to follow a schedulea person at this level may:- be somewhat confused because of memory and thinking problems- he will remember the main points from a conversation but forget/confuse details--> ex: may remember he had visitors but forgot what they talked about- know the month and year unless there is a severe memory problem- follow a schedule with some assistance but becomes confused by change in routine- pay attention for about 30 minutes - has trouble concentrating when it is nosy or when the activity involves many steps--> ex: at an intersection he may be able to step off the curb, watch for cars, watch traffic light wan d walk at the time time- brush his teeth, get dressed, feed himself, ect. with help- know when he needs to use bathroom- do or say things too fast - without thinking first- know that he is in hospital because of an injury but will not understand all of the problems he is having- more aware of physical problems than thinking problems- associate his problems with being in the hospital and think that he will be fine as zoo on he goes home TERM 33 Rancho Level VII (automatic appropriate, minimal assistance) DEFINITION 33 automatic and appropriate - minimal assistancea person at this level may:- follow a set schedule- be able to do routine self care without help - if physically ableex: can dress or feed himself independently - have problems in new situations and may become frustrated or act without thinking first- have problems planning, starting and following through with activities- have trouble paying attention in distracting or stressful situationsex: family gatherings, work, school, church or sports events- not realize how his thinking and memory problems may affect future plans/goals --> therefore he may expect to return to previous work/lifestyle- continue to need supervision because of decreased safety awareness and judgement - he still does not fully understand the impact of his physical or thinking problems- think slower in stressful situation- be inflexible or rigid - may seem stubborn (however his behaviors are related to brain injury)- be able to talk about doing something but will have problems actually doing it TERM 34 Rancho level VIII (appropriate and purposeful, supervision-level assistance) DEFINITION 34 purposeful and appropriate - supervision and level assistancea person at this level may:- realize that he has a problem in his thinking and memory- begin to compensate for his problems- be more flexible and less rigid in his thinkingex: may be able to come up with several solutions to a problem- be ready for driving or job training evaluation- be able to learn new things at a slower rate- still become overloaded with difficult, stressful or emergency situations- show poor judgement in new situation and may require assistance- need some guidance to make decisions- have thinking problems that may not be noticeable to people who did not know the person before injury TERM 35 attention (x) DEFINITION 35 - eye contact- tracking- sustained attention- selective attention TERM 46 language evaluation: discourse DEFINITION 46 - evaluate for basic language skills (aphasia)- evaluate higher level discourse skills--> topic maintenance--> cohesion and cohesiveness of discourse- very concrete, very sequential, can't take other persons perspective TERM 47 organization evaluation and treatment DEFINITION 47 - sorting tasks of increasing difficulty- sequencing steps of an activity- sequencing alphabetically or by other attribute (size, cost, ect)- categorization- flexibility of thinking : organization items in multiple ways(game blink - seeing if cards have anything in common --> matching my color, shape or number --> switching between categories) TERM 48 planning/following a plan DEFINITION 48 - begin with simple, concrete plans about daily needs (how to get help, when to use the bathroom)--> help patient both verbalize the plan and follow through with the plan- use schedule, calendar, journal, logbook to predict future events and make decisions about daily routines- help patient outline steps to an activity then follow the written plan- provide structure for patient to think about long- term planning TERM 49 insight DEFINITION 49 work with neuropsychologist to identify underlying cause of decreased insight--> denial?--> impaired reasoning?may not be able to reason through consequences of having a brain injury--> agnosia?they can't recognize their deficits TERM 50 executive functioning: self-regulation and self-advocacy DEFINITION 50 - make abstract or implied ideas explicit and concrete- establish a set of expectations ("rules")--> have the patient help identify their own rules when ever possible--> make list specific to that patient- review 'rules' frequently- set up tasks that give the patient an opportunity to use the rules- use 'rules' as a mechanism for self assessment TERM 51 executive functioning: inhibition DEFINITION 51 - should be directly addressed in therapy- identify areas where impulsivity is a problem- set up tasks that will temp the patient's weakness, then provide structure so they can be stressful- examples:--> don't say this word--> TMI lists TERM 52 high level cognitive skills, executive functioning DEFINITION 52 - find out what the person is having difficulty with- focus on functional daily tasks and skills that generalized to difficult activities--> attention--> executive functioning--> planning-- > problem solving--> flexibility of thinking- therapy includes less drill and may look like "just talking" TERM 53 common complaints DEFINITION 53 - can't -- it's just too big- i can't figure out how to get myself dressed in the morning- i can't get anywhere on time (often many hours late)- he used to take care of things on his own, now I have to ask him to do everything- my space is a mess and i can't get organized- if someone interrupts me, i have to start over from the beginning- i can't concentrate if there is too much noise, or too much going on around me TERM 54 what is concussion? DEFINITION 54 concussion is a mild traumatic brain injury (mTBI)- caused by physical forces but diagnosed by the symptoms- no test to prove diagnosis of concussion- every brain is different, every injury is different, every concussion is different TERM 55 symptoms of concussion DEFINITION 55 defined by 5 domains of symptoms:1. encephalopathy:slowed thinking, disorientation, dizziness, sleepiness2. vestibular:vertigo, imbalance, ataxia, impaired eye tracking3. migraine:headache, sensitivity to lights4. amnesia:transient global amnesia5. affective:mania, depression TERM 56 risk factors for concussions DEFINITION 56 increased likelihood of concussion- for individuals who have had:1 previous concussion are twice as likely to have a second2 previous concussions are up to 4x as likely to have another3 previous concussions are up to 9x as likely to have another- gender: girls are treated more often for concussions than boys- factor that MAY influence severity and recovery from concussion --> a history of developmental disorder psychiatric disorder, or migraines increases recovery time --> sleep/fatigue, dehydration, illness, medications, revering from a concussion TERM 57 the developing brain DEFINITION 57 - brains (frontal lobe) continue to develop until the age of 25- high school students take longer to recover from concussions than college age athletes- high school students have more severe symptoms than college age athletes TERM 58 second impact syndrome DEFINITION 58 - RARE but life threatening- massive, sudden post-concussion cerebral swelling- seems to occur most often in younger athletes- changes in brain after first injury, make the second injury catastrophic(videos on powerpoint) TERM 59 post concussion syndrome (PCS) DEFINITION 59 - traditional thinking: PCS is diagnosed when concussion symptoms persist beyond 3 months--> headaches, anxiety, depression- new recognition that many of the symptoms that persist after the initial recovery period may not be rooted in the actual injury TERM 60 problem with post concussion syndrome DEFINITION 60 - in some cases, ultra conservative treatment may be the cause of symptoms- in some cases the benefits that comes with the injury are more advantageous that recovery- in some cases there are distorted perception of what is normal--> the good old days effect, anxiety sensitivity--> the solution: educational consoling and cognitive restructuring TERM 71 oral prep phase DEFINITION 71 - not required for all foods- is under volitional control- all "exits" from the oral cavity are sealed to prevent lossskills:- mastication:food is chewed into smaller pieces and mixed with saliva- bolus formation:chewed up food is collected in the middle of the tongue- oral clearance:required tongue strength and coordination to remove extra food from teeth, ect. TERM 72 oral phase DEFINITION 72 - controlled transfer of food from oral cavity to pharynx- tongue movement in this phase is driving force behind swallowskills:- respiration inhibited/airway closed- anterior to posterior (A/P) transfer- lingual pulsion- oral clearance: requires tongue strength to clear food format he tongue and palate TERM 73 pharyngeal anatomy DEFINITION 73 - upper esophageal sphincter/cricopharyngeous- epiglottis- valleculae- pyriform sinuses- laryngeal vestibule- glottis- pharyngeal constrictors- thyroid cartilage- hyoid bone TERM 74 pharyngeal phase DEFINITION 74 1. pharyngeal constriction2. hyoid excursion3. epiglottic inversion4. laryngeal closure5. airway protection6. crico- pharyngeal opening TERM 75 Esophageal phase DEFINITION 75 - The upper esophageal sphincter relaxes to let food pass- constrictor muscles of the pharynx andrelaxation of thelower esophageal sphinctersequentially push the bolus of food through the esophagus into the stomach- larynx and pharynx then return back to their relaxed positions