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CBIS EXAM - COMPLETE
STUDY GUIDE
Thalamus - Acts as a relay station for incoming & outgoing sensory information except ** for smell. Person if injured will have severe attention and concentration problems, difficulty with memory storage, retrieval, weakened mental stamina, decrease sensory information, reacting to stress, excessive/weakened emotional responses, disorders in eating, drinking, sleeping, & sexual functioning. Hypothalamus - Control center for hunger, thirst, sexual response, endocrine levels, and temperature regulation. It involved with Fight or flight, anger, fatigue, memory, and calmness. Connected to pituitary gland, manages release of hormones. Damage to: hormonal, endocrine, or neurochemical can be devastating. Limbic System - It involves basic elementary drives, emotions, and survival instincts. Damage to this area can affect emotional perceptions, feelings, and responses to the world and oneself. A person may feel that they have lost control of self. Hippocampus - Associated with memory, consolidating short term memories into long term & organizing and retrieval stored memories. if Damage can make new learning impossible. Amygdala - Structure closely tied to emotional memories & reactions (aggression, fight or flight) The _________ evaluates emotional responses. Hipp and __________ are directly tied to smell. All sensory invoke memory but Smell & taste are most powerful with emotional recollection. Influences fear & aggression.
Cerebellum - Tree of life' This coordinates, modulates, and stores all body movement. This governs a persons every movement. It monitors impulse from the motor and sensory centers (brainstem, basal ganglia, sensorimotor cortex) to help control direction, rate of force, and steadiness of a person's movements. Helps develop and story motor skills. Basal Ganglia - This helps handle physical movements by relaying information from the cerebral cortex to the brain stem and cerebellum. Broca's area - If a person has trouble speaking after a brain injury, what part of the brain was likely injured Working memory, motor outputs, initiation of behavior, - Which of the following functions are found in the frontal lobe Proprioception - Function is not associated with parietal lobe Frontal lobe-Right Hemisphere - If a patient presents with left sided weakness in their lower extremity, which area of the brain was most like affected. Cerebrospinal Fluid - The ventricles manage Protection, Support, Nourishment - Identify the 3 main functions of the meninges Medulla - What part of the brain that controls vital to life (breathing & heart rate). Dendrites, Axon, Cell body - The 3 main components of the neuron Wernicke's area - The inability to understand what is said to him. What affected area.
CNS - Brain & Spinal cord PNS - Autonomic system (sympathetic & parasympathetic) Somatic system PNS two divisions - 1. Somatic: (controls skeletal muscles & voluntary functions)
- Autonomic: ( controls smooth & Cardiac muscle, maintains homestasis) PNS Somatic system - Afferent Nerves: (sensory neurons into CNS) Efferent Nerves: (Motor neurons from CNS to muscles and glands): makes responses, motor, action Contact injury/head struct by or against an object - Primary injury mechanism: Closed- Open Non-contact injury/Brain moves in skull - Rotational/angular and acceleration/deceleration Internal Insult - Severe reduction in blood flow hemorrhage due to clotting. Performance - Repetition of a task leading to an immediate improvement in completing a motor skill. Guidance - Care provider physically assists with tasks completion to achieve the desired movement. Massed practice - Practice in sequence/repeatedly time Distributed practice - practiced spaced out over time Blocked practice - practice sequence in same order with other tasks.
Random Practice - Tasks mixed in with the task person is trying to learn. Focused attention - Requires selection of one sources of information while withholding responses to irrelevant stimuli Sustained attention - Ability to maintain attention to complete a task accurately and efficiently over a period of time. Selective attention - Ability to maintain attention in the presence of distractions Alternating attention - Ability to shift between tasks that demands different behavioral or cognitive skills. Divided attention - Ability to shift to simultaneously to multiple task demands while maintaining speed and accuracy. Ideomotor Apraxia - Inability to perform a task on command or imitate gestures. (break down between thought and movement) Shaping - Reinforcement can be used to increase the likelihood of a behavior occurring more often in the future. Fading - One learns to produce the same response under gradually changing conditions, in a manner. Providing gradually less support either from the environment or individuals to display the target behavior Discrimination - The ability to discriminate which behaviors are appropriate and which are not in a given situation Constitutional law - Based on the US Constitution law, as well as as the constitution of the states where the person lives. Statutory Law - Enacted by congress or state legislature in the form of individual statutes, together form a code.
Fading - Learns to produce the same response under gradually changing conditions. Providing gradually less support either from the environment or from another individual to display the target behavior. Shaping - Reinforcement can be used to increase the likelihood of a behavior occurring more often in the future. Discrimination - When individual responds differently to similar stimuli Biomedical model - Uses objectives, clear-cut, standardized measures, and experts, causes, and prognosis. (neg: can look at people only with conditions) Functional model of Disability - This is most individualized and personal model of disability and is the current concept of person centered care. Person centered care Principles - Autonomy, Beneficence, No-maleficence, Fidelity, Justice, Veracity. SCI & TBI co-occurring - 60% 1# cause of TBI for 0-4 - Falls 1# cause of TBI for 20+ 24 - car accidents. 1# cause of TBI for 75yrs - Falls Levels of Blast injuries - Primary, Secondary, Tertiary, and Quarternary Model system of care - Acute Care Rehab; Post-Acute Rehab; Long term home and community. Temporal Lobe - Center for Language, hearing, and also memory
Coma emergent agitation - 33-70% PPACA Patient Protection and affordable Care Act - Federal law enacted in 2010 to mandate health insurance. Explicit Memory - Conscious Recall; Semantic Memory - Words, Ideas, Concepts Under Explicit Memory Episodic Memory - Personal experiences Under Explicit Memory Procedural Memory - Skills and and tasks Under Implicit Memory Chronic Traumatic Encephalopathy - Diffuse Axonal Injury, Tau Protein, Inflammation, Progressive Dementia Continuous Reinforcement - Produces less variability in topography of behavior Utilized to promote acquisition of behavior Behavior is highly sensitive to extinction Thick of piece work or soda machines intermittent Reinforcement - Produces greater variability in topography of behavior Utilized to promote generalization and maintenance of behavior Behavior is highly resistant to extinction Think hourly pay and slot machines Positive Reinforcement - When the arrival or delivery of stimulus following a response make that response more likely to occur in the future. Negative Reinforcement - When the Removal of a stimulus following a response makes that response more likely to occur.
Gender/Sexuality: - Out comes between men and women; Mod to Severe TBI, females have a 1.3 X higher mortality rate and 1.6 X poor outcome compared to males. Male & Female out-comes - Male receive 2:1 TBI than females. Females were observed to have 85% Worse outcome than men. In sports concussion females more 1.7 often than males. Brain Maturation: - 3-5 years, 8-10 years, 14-15 years; 17-19 years, and 21-22 years. Emergency room visits each year for TBI, - ½ million are for those age of 0-14 years. 0-4 years due to falls, 15-19 years being struck by something. IDEA: - Federal education mandate requiring public schools to provide a free appropriate education (FRAPE) through the use of special ed services to children with disabilities. 504 accommodation plan - Protects the rights of others with disabilities. Shaken Baby Syndrome: - Birth to 5 years old SBS or AHT+ Head abuse trauma. 50-80% of deaths due to head trauma is children less than 2 years old. 57% children under 1 year of age. 60% were boys and 40% were girls. Family System Theory - Families are the experts. FST is grounded in the notion that that the whole is greater than the sum of its parts. FST takes a positive view of the family and every member has strengthens and capacity to solve problems and make changes. Caregivers - 40% of caregivers reported anxiety and depression of caring
Cognitive Behavioral Therapy: - CBT suggests that people experience an Activating event (A) uses an existing Belief to draw conclusions about that event (B) Experience emotions or enact behaviors as a Consequence of that belief (C). 1. CBT says neither individuals nor families are in control of activating events
- Individuals and families are in control of their beliefs about what events mean 3. Changing beliefs will result in a change in feelings and outcomes. Prevalence of PTSD in military: - 44% MEB: Medical Evaluation Board: - Physical determines if service members is able to meet medical retention standards. This is an informal process. PEB: Physical Evaluation Board: - This is a formal fitness for duty and disability dermination, and eligibility for disability compensation. Patients' Bill of Rights: - Most states have mandated certain rights for individuals in a treatment program. Accreditation agencies may dictate how bill of rights be displayed. Bill of rights should be displayed in prominent place in the program. 2. Participants have all rights as citizen under the law 3. Written guarantee of basic rights. Power of Attorney and Guardianship: - Guardianship is legally-enforceable arrangement under which one person (guardian) has the legal right and duty to care for another (ward). Exploitation: - Is the use of a dependent individual's property illegally or without the consent of the individual. Exploitation includes the expenditure of funds, Usually, the act is considered exploitation if done for profit or other advantage. Abuse: - The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. This also includes the deprivation
Prevent pressure scores - Re-position every two hours, special cushions, keep skin clean and dry. Metabolic Syndrome: - Combination of medical disorders that increase risk for Diabetes, & cardiovascular disease. This is marked by abdominal obesity, insulin resistance, high blood pressure, & dyslipidemia. Primary headaches - Has no specific cause Secondary headaches - May have identifiable cause that can be determined Chronic Headache - Occurs at least 15 days per month for at least 3 months. Neuralgia - Type of pain that is caused by damage to a nerve or structural change in a nerve. Neuromia - When a nerve becomes entrapped in scar tissue. Physical fatigue - Associated with muscle weakness or changes in peripheral nervous system. Physiological Fatigue - Results from depletion of energy, hormones, neurotransmitters, or reduced numbers of neural connections due to TBI. Primary Fatigue - Results from injury or disease. Secondary Fatigue - Relates to factors that may exacerbate fatigue: pain, sleep disturbance, and stress. Thrombus - A mass of platelets that form in blood vessels Embolus - Thrombus that broken off the blood vessel wall and circulating in the body.
Ataxia - Lack of muscle coordination of voluntary movements Apraxia - Inability to perform purposeful action: Complete SCI - No motor or sensory function below the level of injury Incomplete SCI - Function of sensory and possible some motor sensation below level of injury. Personality disorders - 23% of this disorder have TBI Children and Young adults - Prognosis is worse than adults. Chroeiform - Continuous rapid unpredictable movements. Athetoid - Writing movement. Anosognosia - lack of awareness of a limb. Somatoagnosia - Lack of awareness of body structure. Four term Contingency - A=Antecedent, B= Behavior/response, C=Consequence. 2/3 of people receiving rehabilitation for TBI or treatment for substance misuse - Both have history of TBI and Substance misuse. High risk Drinking - Men, more than 4 drinks a day or 14 drinks in a week women, more than 3 drinks a day or 7 drinks a week. Substance misuse: CAGE - Cut, Annoyed, Guilty, Eye opener,: two or more 'yes' is trouble with substance misuse.
Episodic memory - Personal, autobiographical recollections of experiences Explicit Memory - consciously recall : or known as semantic memory or episodic memory Implicit Memory - Memory with out recall: or known as procedural (skills & tasks) Target Behavior - Must be defined in objective and measurable terms so that it can be examined in a consistent and systematic manner Behavior program element contingency - Establishing Operation: Discriminative Stimulus: Response/Behavior: Consequence: Extinction: - A particular response never produces a reinforcer The disappearance of a previously learned behavior when the behavior is no longer reinforced Task Analysis - A list of very specific steps involved in completing a task Shaping - A technique in which successively closer approximations to the target response are reinforced until the target response occurs Fading - The process by which one learns to produce the same response under gradually changing
conditions, in a manner implied by the same name of the procedure Clinical neuropsychology - Brains with lesion: Testing is used to related behavior changes to lesion sites Experimental neuropsychology - Intact Brains: Testing is used to study health brains thought out life time. Blocked - Practice sequence in same order with other tasks. in which the task person is tying to learn Serial Practice order - Practice in the same order Open Environmental learning - The environment is variable and changing Closed Environmental learning - The environment is the same minimal to no change or distractions. Contextual change - Motor skills should be performed effectively in multiple and new environments. Massed Practice - Practice in sequence/repeatedly time. Parts practiced - Break a task into components Mental tasks - Steps are reviewed mentally before physically practicing the task Basic Principles to Enhance Neuroplasticity - Use it or lose it , Salience is important, Reward or feedback, Use it and improve it, Age must be addressed, Environment, Be specific, Transference, and Fun Olmstead Act - This challenged state, local, federal gov to develop more opportunities for persons with disabilities to be served through cost-effective community based services. This act
synapses within a grouping of neurons, the greater the speed and efficiency with which those neurons communicate. Emergence from MCS: - Functional communication, object use. Emergence from DOC: - 1. Functional communication as evidenced by verbal or gestural yes/no
- Functional use of two or more objects (hairbrush or cup).
- Quadrant: - TBI Rehabilitation Program & Service Setting: Substance Misuse Address by Education, Screening, Brief interventions & Linkage. SUD= Low Severity
- Quadrant: - Substance use Disorder Treatment Setting: TBI Addressed by Screening, Accommodation & Linkage. SUB= High Severity TBI= Low severity *Age 3-5: - (Most brain Maturation birth to 5 years old). Research indicates that Male caregivers of female relative with TBI displayed - More distress on clinical inventories than any other gender combination Racial/Cultural identity Development Model (R/CID): - Conformity, Dissonance, Resistence & Immersion, Introspection, Integrative Awareness. Multiculturalism - Promoting cultural diversity as a core principle while insisting on equality and respect of all cultural groups Multicultural psychology - Looking at the effects of culture on the way people think, act, and feel.
Sociorace - Social history of groups, which then informs about customs, norms and potentially the psychosocial aspects of the group or population of individuals. Ethnicity, Race, Sociorace make up - Culture sexual intimacy = P(A) LISSIT: - Permission, Affirmation, Limited Information, Specific Suggestions, Intensive Therapy The National Institute of Neurologist Disorders and Stroke (NINDS). - Makes grants for research CDC - studies (Where and how people get injured and what happens to them afterwards; it also conducts education/awareness campaign on safety) The US department of Health and Human Services - Makes grants to state government agencies and Protection and Advocacy organizations to improve access to services for people with brain injury and their families Purpose of Neuropsychological Assessment: - Determine the nature and extent of cognitive deficits and psychiatric disorders
- Determine the presence of a neurologically disorder
- Understand how the specific cognitive deficits contribute to problems with ADL's
- Establish baseline
- Assist in TX planning
- Make recommendations for modification in the community Role of the Neurologists: Acute Trauma Unit: - Brief mental status assessment; provide valuable information to treatment team on goals, and track patients recovery & education to family. Role of the Neurologists: Rehabilitation Program: - Extensive and comprehensive assessments (results in Diagnosis,
