Download Acute Brain Injury: Definitions, Mechanisms, and Management - Exam Questions and Answers and more Exams Neurobiology in PDF only on Docsity!
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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.
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 *LOC > 30 min *loss of memory >24hrs *CGS 13- *normal CT or MRI
*any AMS at time of incident
Moderate TBI - ANSWER>>*LOC up to 24hrs *neuro signs of brain trauma
- CGS 9- *may have focal findings on CT
Severe TBI - ANSWER>>*LOC <24hrs *GCS 3-
Screens for TBI - ANSWER>>ACE - acute concussion eval HELPS WARCAT - warrior administered retrospective casualty assessment tool TBIQ - traumatic brain injury questionnaire ImPACT OSU TBI ID
JCAHO (Joint Commission) - ANSWER>>The non-profit organization that assists healthcare facilities by providing accreditation 3 year award
CARF (Rehabilitation Accreditation Commission) - ANSWER>>The Organization that oversees the accreditation of brain injury programs 3 year award
TBI Act of 1996 - ANSWER>>Federal Legislation "To expand efforts to identify methods of preventing TBI, to expand biomedical research efforts or to minimize the severity of dysfunction as a result of such an injury, and to improve the delivery & quality of services through the State Demonstration projects."
HRSA - Health Resources Services Administration - ANSWER>>Money to states to improve integration services, establish policy & procedure financial support
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
Spasticity - ANSWER>>Damage to upper motor neuron
*buccofacial- limitations and performing purposeful movement of lips, cheeks, tongue, larynx and pharynx
central cord syndrome - ANSWER>>Presents as weakness & numbness in arms
- results from fall in with neck in hyperextention or with arthritis or spondylosis
- bowel/bladder issues
- able to walk however unable to grasp things
Brown-Sequard Syndrome - ANSWER>>1 side of spinal cord injured Ipsilateral paralysis, loss of light touch sensation on side of lesion, loss of pain & temperature sensation on contralateral side
Anterior cord syndrome - ANSWER>>Loss of muscle control, pain & temperature sensation below lesion No loss of proprioception or touch sensation
posterior cord syndrome - ANSWER>>Strength with no proprioception
cognition - ANSWER>>A complex collection of mental activities such as attention, perception, comprehension, remembering and language
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
- awareness of functional implications
- 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
Major Depressive Episode - ANSWER>>At least 2 wks which a person has loss of interest or depressed mood accompanied by 4 additional symptoms: Change in appetite, change in weight, decreased energy, feelings of worthlessness, suicidal ideation
manic episode - ANSWER>>At least 1 wk where a person is noticeably elevated, expansive or irritable mood and 3 additional symptoms: extremely amplified self- esteem, decrease desire for sleep, grandiose ideas, distractibility, risky activities
bipolar I disorder - ANSWER>>One or more manic episodes
bipolar II disorder - ANSWER>>One or more depressive episode followed by one or more hypomanic episode
cyclothymic disorder - ANSWER>>Chronic fluctuation mood disturbance including both depressive and hypo manic states
Schizophrenia - ANSWER>>Disorder lasting for at least 6mo with minimum of a 1 month phase of symptoms that include: delusions, hallucinations, incoherent speech, Catalonia or avolition.
personality disorders - ANSWER>>23% of TBI pts Organic personality disorder
Frontal Lobe Syndrome - ANSWER>>Symptoms of other psychiatric disorders including depression, psychosis, mood disorders and other various conditions however the patient does not recognize these conditions
- The difference between frontal lobe injury and regular depression is the patient's ability to recognize and acknowledge the deficit
SUD interventions - ANSWER>>
Screens for SUD - ANSWER>>*AUDIT - alcohol use disorder identification test
*CAGE: yes or no questions *CRAFFT: screen for adolescents *ASSIST: alcohol, smoking and substance use involvement screening test
Cranial Nerves - ANSWER>>
concomitant spinal cord injury - ANSWER>>Present of co-occurring spinal cord injury and brain injury *60% of SCI pt's
Visual Functions - ANSWER>>
Somatoagnosia - ANSWER>>Lack of awareness of body structure and body part relationships
Meninges - ANSWER>>
Vestibular conditions - ANSWER>>*labrynththine concussion *post-traumatic Ménière's disease *basilar skull fx *vestibular migraine *perilymphatic fistula *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
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
Section 504 of Rehabilitation Act - ANSWER>>Equal treatment, and appropriate education for people with disabilities Preferential seating, extended time on exams, test in quiet, rest breaks, shortened assignments, books on CD
Individuals with disabilities education act (IDEA) - ANSWER>>Federal education mandate to provide free appropriate public education and special education and support services to children with eligible disabilities
Military Primary Injury - ANSWER>>Direct impact from over-pressure wave. Compressed air filled organs, catapults body
diagnostic indicators for SBS - ANSWER>>Bleeding from brain Brain swelling Bleeding in eyes
Long term disabilities in SBS - ANSWER>>Behavioral problems, learning disabilities, blindness, deafness, seizures, cerebral palsy
Individual Education Plan - IEP - ANSWER>>Student's academic goals based upon assessment and the method to obtain these goals via specially designed instruction and related services Timeline: 60 days to complete assessment and hold IEP meeting
Military Secondary Injury - ANSWER>>Debris impacts head or body
Military tertiary injury - ANSWER>>Body impacts ground or object
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
3 legacy measures
Quality of Life Mesures - ANSWER>>The quality of life scale is a valid instrument used to measure life satisfaction, usually in conjunction with a health issue of some kind. One of the most frequently used is the SF 36, a self report patient questionnaire
RETURN TO WORK (RTW) - ANSWER>>Gold standard in measuring success of rehabilitation. 4 models: comprehensive integrated day treatment, vocational case coordination, resource facilitation, supported employment
Wehmans model of supported employment - ANSWER>>Emphasizes use a vocational rehab professionals Real job and real pay
Comprehensive integrated day treatment - ANSWER>>Individual and group therapy as well as vocational trials and supported employment Hi employment rates
Vocational Case Coordination (VCC) - ANSWER>>Hospital based involment, work trials, employer education and temporary work support, supported employment
Supported Employment - ANSWER>>Supported employment competitive employment with ongoing support services
Resource Facilitation Model - ANSWER>>A professional is identified as the resource facilitator Relationship is defined as a partnership Meet every 2 weeks
Employment specialist - ANSWER>>Provide services such as assessment, job development, on the job training and support, case management and long term follow along
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
