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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 ordegenerative or induced by birth trauma
TBI - ANSWER>>An alteration in brain function or other evidence of brainpathology, 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 onthe GCS
Severe TBI Characteristics - ANSWER>>Loss of consciousness >24 hours, 3-8 onthe 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 andFirearms
Most common cause of TBI and death by age - 16-19 - ANSWER>>MVAs! CARF - ANSWER>>Accreditation agency for post acute BI programs, residential,outpatient, vocational, home and community, stroke and pediatric programs - ensures quality of services through requirements for accreditation and surveys Joint Commission - ANSWER>>Accreditation agency for hospital based programs,may accompany CARF accreditation, ensures quality of services through requirements for accreditation and surveys Olmsted Decison - ANSWER>>Supreme court case stimulated by two women living in a nursing home in Georgia for community inclusion - resulted in federaland state initiatives to improve and normalize community living
Model Systems of Care 1987 - ANSWER>>Resulted in research projects for TBI bythe NIDDR, established rehab facilities to provide care and complete clinical research in the process
Dura Mater - hard plastic, top layer Nuerons vs Glial Cells - ANSWER>>Nuerons communicate electrical impulses throughout brain while Glial cells support and nourish Nuerons Synapse - ANSWER>>A junction between the axon of one neuron and the dendrite of another, allows for passing of communication fro, nueron to neuron 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 ofabilities; 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 someonealive - 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, andbiological rhythms
Can be turned down or up much like a light dimmer switch - i.e during a coma, itis turned down - if turned down too much, can result in death
Medulla - ANSWER>>Part of the brain stem- responsible for basic living functionssuch as breathing, HR, BP, swallowing, and vomiting
Pons - ANSWER>>Part of the brain stem- responsible for facial movements, facialsensation, 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 ofseeing and hearing, alertness, arousal
Thalamus - ANSWER>>Part of the diencephalon - major relay station for incomingand 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"
Associated with speaking, reading, and calculating Corpus Collosum - ANSWER>>Pencil-thick band that exhanges info between L and R hemispheres Afferent Signals - ANSWER>>Signals sent along the spinal cord through foremen magnum towards the central nervous system Efferent Signals - ANSWER>>Signals sent from the central nervous system to the rest of the body through the foramen magnum via the spinal cord Cervical Vertebrae - ANSWER>>Made up of 7 vertebrae, primary function to support and move the skull Thoracic Vertebrae - ANSWER>>Made up of 12 vertebrae, primary function is stability Lumbar Vertebrae - ANSWER>>Made up of 5 vertebrae, primary function is weight bearing Sacral Vertebrae - ANSWER>>Made up of 5 vertebrae, located at the base of the spine meeting the pelvis CT Scan - ANSWER>>X-ray used in conjunction with a computer, only capable of showing what the naked eye can see MRI - ANSWER>>Uses magnetic field in conjunction with a computer, a more detailed scan ideal for seeing soft tissue damage, can detect changes in bloodflow and track cellular activity
Blood Brain Barrier - ANSWER>>A filter within the red blood cells which allowsblood to enter the brain but blocks harmful substances from entering
Neuroplasticity - ANSWER>>The ability of the nervous system to change, grow, or compensate for an injury The brain can change and re-map! Based on the Hebbian Principle which states that every rehearsal of a skill strengthens memory trace in the brain *Hippocampus may contain stem cells which can generate new brain cells if optimized by therapy! Synaptogenesis - ANSWER>>A part of nueroplasticity - the formation of synapses between nuerons The more synapses there are the more efficiently nuerons can communicate! Nueroprotection - ANSWER>>Preventing secondary damage post injury 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 areestablished 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
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 toplacement 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 Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, and opioids Neuropathic Pain - ANSWER>>Pain relating to dysfunction of nervous system itself
- damage to actual nerves Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, opioids, anti- depressants, nerve blocks, trigger point injections, anti-convulsants, and epidural steroids Primary vs. Secondary Headaches - ANSWER>>Headache that as no idenfitiable cause vs one with an identifiable cause Acute vs. Chronic Headaches - ANSWER>>Short vs lasting atleast 15 days out of amonth for atleast 3 months, cannot be linked to withdrawal of medication and must have occurred within 14 days of TBI to be considered post traumatic head ache Tension Headache - ANSWER>>Described as bilateral head pain, "clamping", caused by head or neck muscle strain. Not associated with any other symptomsand does not worsen with PA.
Craniomandibular Headache - ANSWER>>Associated with temporal-madibularjoint, often causes difficulty with eating and talking
Cervicogenic Headache - ANSWER>>Generated from the cervical spine, clinicaldiagnosis in made with the use of nerve block
Migraines - ANSWER>>Located on one side of head or the other; lasts 4-72 hours;worsens with heat, light and exercises
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, overactiveand overresponsive reflexes
Pressure Sores - ANSWER>>Occur most often near bony prominences due todecreased 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 damageof 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 aTBI
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
-Fatigue at a single point in time Fatigue Severity Scale -Impact of fatigue on daily functionsBarrow Nuerological -Difficulty level of maintaining energy and alertness Global Fatigue Index- 4 Domains of Fatigue severity Causes of Fatigue Questionairre -physical and mental activities that cause fatigue and to what extent Strategies to Increase Energy - ANSWER>>Reduce work hours, take breaks, physical conditioning, addressing pain/anxiety/depression, modifying pace ordemands of task, reduce distraction, manage info overload
Narcolepsy - ANSWER>>Sleep Disturbance Sleeps for <1 hour at a time Sleep Apnea - ANSWER>>Sleep Disturbance Upper airway obstruction which stops breath during sleep Hypersomnia - ANSWER>>Sleep Disturbance Traumatic event of CNS Limb Disorder - ANSWER>>Sleep Disturbance 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>>Visualstimuli 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)
Management of Coma-Emergent Agitation - ANSWER>>Use consistent and familiar staff, environmental alteration to decrease triggers, provide familiarobjects, reduce stimuli, establish predictable routines
Stability Triangle - ANSWER>>Model that suggests you must establish medicalstability, 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 Behavior Change Process - ANSWER>>Assess behavior -> define target behavior ->collect data -> change behavior
Operation - ANSWER>>Any that variable that temporarily alters effectiveness of some stimulus of event as a reinforcer Example of Intermittent Reinforcement - ANSWER>>Slot Machine Example of Continous Reinforcement - ANSWER>>Soda Machine Positive Reinforcement - ANSWER>>A stimulus is added, likelihood of behavior increases I.e. student gets As on report card and earns $ Positive Punishment - ANSWER>>A stimulus is added, likelihood of behavior decreases I.e. driver speeds, officer gives $100 ticket
Negative Reinforcement - ANSWER>>A stimulus is removed, likelihood of behvaior increases I.e. child puts toy away, avoids being nagged by parent Negative Punishment - ANSWER>>A stimulus is removed, likelihood of behavior decreases I.e. siblings fight over toy, parent takes away toy Functionally Equivalent Altneratives to Behavior Modification -ANSWER>>Prompting, Cuing, Shaping, Fading, Generalization and Discrimination
Nueropsychology Assessment Process - ANSWER>>Medical record review ->clinical review -> standardized testing -> report and feedback
Assessment short in acute settings but more in depth when post acute Cognitive Rehab Process - ANSWER>>Cognitive Education (awareness of defecits) -> Cognitive Training (restoring cognitive/psych defecits) -> Strategy Training(compensatory approaches) -> Functional Training (real-world application)
Areas of the Brain Associated with Increased Psychiatric Co-morbidity - ANSWER>>Left frontal gray matter reduction, lateral and medial frontal lobe lesions, amygdaloid and hippocampus lesions, basal ganglia lesions, changes inbalance and production of nuerotransmitters. (Dopamine, glutamate, serotonin)
Depression and TBI - ANSWER>>Symptoms: changes in appetite, weight gain,suicidal ideations, depressed mood, tiredness
Risk Factors: change in socioeconomic status , preinury pathologies
