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CBIS EXAM REVISED STUDY GUIDE REVIEW 2026
1. Nuerocognitive Issues Associated with Frontal Lobe: Emotional control, behavioral control, verbal expression, problem solving, decision making,
social control, attention, motivation
2. Acquired BI: An injury to the brain that is not hereditary, congenital or degenerative or induced by birth trauma
3. TBI: An alteration in brain function or other evidence of brain pathology, caused by an external force
4. Mild TBI Characteristics: 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
5. Moderate TBI Characteristics: Loss of consciousness for up to 24 hours, may appear on scans, skull fractures and bleeding are common, 9-12 on the
GCS
6. Severe TBI Characteristics: Loss of consciousness >24 hours, 3-8 on the GCS
7. Likelihood of Additional Injury: 1 BI increases risk of 2nd by 3x and 2nd BI increases risk of 3rd by 8x!
8. Most Frequent Cause of TBI: Falls
9. How many people sustain a BI per year?: 2.5 million. 81% visit ED, 16% hospitalized, 3% result in death
10. How many people are living with effects of a TBI?: 13.5 million
11. Likelihood of BI by gender: Men are 1.4x more likely than women
12. Most common cause of TBI and death by age - 75+: Falls!
13. Most common cause of TBI and death by age - 0-3: AHT!
14. Most common cause of TBI and death by age - 20-24: MVAs and Firearms
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15. Most common cause of TBI and death by age - 16-19: MVAs!
16. CARF: 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
17. Joint Commission: Accreditation agency for hospital based programs, may accompany CARF accreditation, ensures quality of services through
requirements for accreditation and surveys
18. Olmsted Decision: Supreme court case stimulated by two women living in a nursing home in Georgia for community inclusion - resulted in federal
and state initiatives to improve and normalize community living
19. Model Systems of Care 1987: Resulted in research projects for TBI by the NIDDR, established rehab facilities to provide care and complete
clinical research in the process
20. Symptoms of Mild TBI: Headache, fatigue, seizures, nausea, numbness, poor sleep, light sensitivity, noise sensitivity, impaired hearing, blurred
vision, dizziness, loss of balance, neurological abnormality, in attentiveness, decreased concentration, poor memory, impaired judgment, slow processing speed, executive dysfunction, depres- sion, anxiety, agitation, irritability, aggression, impulsivity
21. Primary causes of Mild TBI: Traumatic intertial - brain moving inside skull Traumatic impact - head
hits directly
22. Early Treatment for Mild TBI: Relaxation techniques, rest, slow return to normal activity, and reduction of normal activity if symptoms recur
23. Persistent Post Concussive Symptoms (PPCS): Symptoms of Mild TBI last >1 month, occurs 10% of the time in Mild TBI cases
24. Chronic Traumatic Encephalopathy (CTE): Often cause by repeated blows to the head, is a progressive, degenerative condition
characterized by broken neurons which continually release tau protein cashing dementia over time Dittuse axonal injury -> tau protein release -> inflammation of the brain -> progressive dementia
25. Define Skull: Bony shell that protects the brain, has bony prominences inside which can worsen brain injury
26. Cerebral Spinal Fluid (CSF): Provides cushion to nerve tissue, produced by ventricles (4) which also store and circulation CSF through the
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38. Pons: Part of the brain stem- responsible for facial movements, facial sensation, 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
39. Midbrain: Part of the brain stem - responsible for elementary forms of seeing and hearing, alertness, arousal
40. Thalamus: Part of the diencephalon - major relay station for incoming and outgoing sensory information except for smell
41. Hypothalamus: Part of the diencephalon - control center for hunger, thirst, sexual responses, endocrine levels, temperature regulation, hormone
release "The conductor of the emotional orchestra"
42. Functions of the Limbic System: Drives basic instincts, "animal-like" aspects of a human - if damaged can cause emotional responses that
can become uncontrollable
43. Amygdala: Part of the limbic system - responsible for emotional memories, closely tied to sense of smell
"Fight of flight structure"
44. Hippocampus: Part of the limbic system - responsible for the organization of memories
Described at the pole in a closet - without pole, all clothing falls - without hippocampus memories become disorganized
45. Basal Ganglia: Part of the limbic system - relays information from cerebral cortex to brain stem and cerebellum for movement, the checking system
that comes to attention when things are not working as they should be i.e. restoring equilibrium
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46. Cerebellum: Governs a person's movements by controlling rate, direction, force and steadiness of movements
47. Cerebral Cortex: Made up of right and left hemisphere and corpus collosum
48. Functions of the Right Hemisphere: Holistic, visual spatial and , intuitive in nature
Associated with art, shapes, music, and faces
49. Functions of Left Hemisphere: Linear, verbal-analytic, logical in nature
Associated with speaking, reading, and calculating
50. Corpus Collosum: Pencil-thick band that exchanges info between L and R hemispheres
51. Afferent Signals: Signals sent along the spinal cord through foremen magnum towards the central nervous system
52. Efferent Signals: Signals sent from the central nervous system to the rest of the body through the foramen magnum via the spinal cord
53. Cervical Vertebrae: Made up of 7 vertebrae, primary function to support and move the skull
54. Thoracic Vertebrae: Made up of 12 vertebrae, primary function is stability
55. Lumbar Vertebrae: Made up of 5 vertebrae, primary function is weight bearing
56. Sacral Vertebrae: Made up of 5 vertebrae, located at the base of the spine meeting the pelvis
57. CT Scan: X-ray used in conjunction with a computer, only capable of showing what the naked eye can see
58. MRI: Uses magnetic field in conjunction with a computer, a more detailed scan ideal for seeing soft tissue damage, can detect changes in blood
flow and track cellular activity
59. Blood Brain Barrier: A filter within the red blood cells which allows blood to enter the brain but blocks harmful substances from entering
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68. Disinhibited Neurogenic Bladder: Neurological impairment in CNS or PNS causing decreased bladder capacity, increased
urgency, increased frequency and incontinence with intact bladder sensation
69. Treatment for Bowel and Bladder Incontinence: Best when initiate early on - treatment includes exterior cathing and
suppository schedules, toileting schedules, and close monitoring of intake UTI's extremely common due to cathing - risk of UTI is increased with use of in-dwelling catheters, especially if cognitive impairment is present
70. Aspiration: Caused by dysphagia - when liquid enters into the lungs Commonly leads to
aspiration pneumonia Specialized diets are often prescribed if there is a risk of dysphagia - may include thickened liquids and diets with altered consistency
71. Seizures and TBI: Caused by an imbalance of neurotransmitters or an abnormal and disorderly discharge of electrical activity in the cells of the brain
TBI sustainees 22x more likely to die from a seizure than general population 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
72. Status Epilepticus: 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
73. Cranial Nerve Damage: Associated with higher level severity BIs
8 / 26 Cranial nerve 1 is most commonly injured, all are susceptible to injury due to placement near bony skull prominences Can heal and repair selves if stretched or bruised, tingling and pain can be a sign of repair
74. Cranial Nerve Functions: I Olfactory (smell)
IIOptic (sight)
III Occulomotor (eye movement)
IV Trochlear (downward, inward eye movement)
V Trigeminal (sense of touch in the face)
VI Abducens (horizontal eye movement)
VIIFacial (facial expressions)
VIII Auditory-Vestibular
IX Glossopharyngeal (throat, taste, BP)
X Vagus (heart, lungs, abdominal organs)
XI Spinal Accessory (throat & neck muscles)
XIIHyposglossal (speech)
75. Nocioceptive Pain: Pain relating to damage to body tissue
Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, and opioids
76. Neuropathic Pain: Pain relating to dysfunction of nervous system itself - damage to actual nerves
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86. Heterotrophic Ossification (HO): Formation of new bone around joints due to trauma or immobility Can cause severe pain, decreased ROM,
and increased spasticity Treated with NSAIDS, PT, and sometimes surgery
87. Contractures: Shortening of tendons and muscles causing decreased ROM
Treated with combination of meds, splinting, casting, PT, OT, etc.
88. Hyperreflexia: Bladder emptying that is triggered easily, overactive and overresponsive reflexes
89. Pressure Sores: Occur most often near bony prominences due to decreased 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)
90. Deep Tissue Injury: Purple, maroon localized area caused by damage of underlying soft tissue
91. Agnosia: Perceptual defecit associated with BI Inability to
recognize
92. Anosagnosia: Perceptual defecit associated with BI Inability to
recognize own defecits or disabling condition
93. Somatoagnosia: Perceptual defecit associated with BI
11 / 26 Inability to recognize body part of structure
94. Apraxia: Perceptual defecit associated with BI
Absence of
95. Spatial Relations Disorder: Perceptual defecit associated with BI
Inability to perceive space between objects
96. Form Discrimination Disorder: Perceptual defecit associated with BI
Challenge with orientation and similar shapes
97. Vertical Disorientation: Perceptual defecit associated with BI
Diflculty with upright position and balance
98. Depth and Distance Perception Difficulty: Perceptual defecit associated with BI
Diflculty sensing depth and distance of an object in relation to oneself
99. Co-Commitance of SCI and TBI: 60% of patients with SCI also have a TBI
12,000 new cases of SCI per year
100. Complete vs Incomplete SCI: All feeling and control completely lost below level of injury vs partial feeling and control lost below level of
13 / 26 -Fatigue at a single point in time Fatigue Severity Scale -Impact of fatigue on daily functions Barrow Nuerological -Diflculty 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
112. Strategies to Increase Energy: Reduce work hours, take breaks, physical conditioning, addressing pain/anxiety/depression, modifying pace or
demands of task, reduce distraction, manage info overload
113. Narcolepsy: Sleep Disturbance
Sleeps for <1 hour at a time
114. Sleep Apnea: Sleep Disturbance
Upper airway obstruction which stops breath during sleep
115. Hypersomnia: Sleep Disturbance
Traumatic event of CNS
116. Limb Disorder: Sleep Disturbance
Periodic limb movements during sleep
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117. Insomnia: Sleep Disturbance
Periods of wakening and diflculty getting back to sleep
118. Treatment for Sleep Disturbance: Exercise, limiting fluid intake before bed, avoiding naps, relaxation, sleep hygiene, CBT, meds, and
CPAP
119. Sleep Disturbance Assesment Tools: Epworth Sleepiness Scale, Pittsburgh Sleep Quality index, Polysonography, Mutiple Sleep Latency Test
120. Causes of Sleep Disturbance: Change in circadian rhythms, depression, frequent napping, anxiety, pain, changes with REM
121. Aging and TBI: TBI exacerbates normal aging
increase likelihood of developing AD
122. Nuerocognitive Issues Associated with Frontal Lobe Damage: Emotional control, behavioral control, verbal expression,
problem solving, decision making, social control, motivation, and attention
123. Nuerocognitive Issues Associated with Partial Lobe Damage: Tactile performance, spatial orientation, academic skills, object
naming, visual attention and hand eye coordination
124. Nuerocognitive Issues Associated with Occipital Lobe Damage: Visual stimuli processing
125. Nuerocognitive Issues Associated with Temporal Lobe Damage: Memory, face recognition, selective attention, locating
objects, object catgorization, receptive language, emotional responses, lan- guage comprehension
126. Attention Heiarchy: 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)
127. Domains of Cognitive Functioning: Metacognition (self-awareness), executive functions, atten- tion, categorization, processing speed,
memory
128. Sensory memory: Holds a memory a few moments after perception
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142. Operation: Any that variable that temporarily alters ettectiveness of some stimulus of event as a reinforcer
143. Example of Intermittent Reinforcement: Slot Machine
144. Example of Continous Reinforcement: Soda Machine
145. Positive Reinforcement: A stimulus is added, likelihood of behavior increases
I.e. student gets As on report card and earns $
146. Positive Punishment: A stimulus is added, likelihood of behavior decreases
I.e. driver speeds, officer gives $100 ticket
147. Negative Reinforcement: A stimulus is removed, likelihood of behavior increases
I.e. child puts toy away, avoids being nagged by parent
148. Negative Punishment: A stimulus is removed, likelihood of behavior decreases
I.e. siblings fight over toy, parent takes away toy
149. Functionally Equivalent Altneratives to Behavior Modification: Prompting, Cuing, Shaping, Fading, Generalization and
Discrimination
150. Nueropsychology Assessment Process: Medical record review -> clinical review -> standard- ized testing -> report and feedback
Assessment short in acute settings but more in depth when post acute
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151. Cognitive Rehab Process: Cognitive Education (awareness of defecits) -> Cognitive Training (restoring cognitive/psych defecits) -> Strategy
Training (compensatory approaches) -> Functional Training (real-world applica- tion)
152. Areas of the Brain Associated with Increased Psychiatric Co-morbidity: Left frontal gray matter reduction, lateral and
medial frontal lobe lesions, amygdaloid and hippocampus lesions, basal ganglia lesions, changes in balance and production of nuerotransmitters. (Dopamine, glutamate, serotonin)
153. Depression and TBI: Symptoms: changes in appetite, weight gain, suicidal ideations, depressed mood, tiredness
Risk Factors: change in socioeconomic status , preinury pathologies MOST COMMON co-morbid psychiatric illness
154. Organic Personality Disorder and TBI: Symptoms: Depression, emotional instability, irritability, impulsivity, changes in behavior prior to
injury due to an organic impairment or disease of CNS 23% of people with TBI experience OPD
155. Pseudo Bulbar Affect and TBI: Symptoms: Uncontrollable episodes of laughing or crying, cata- strophic reactions
A result of TBI or other nueroglogical disorder
156. Substance Use Disorder (SUD) and TBI: Involves continued use of substance despite health, psychological or social consequences
Exacerbates ettects of TBI including memory, judgment, behavior, and generalization impairments 12% of people 16 and older with TBI used a month prior to injury Use of substances before injury increase risk of reusing x As many as 50% of users will use again after injury
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166. Latrogenesis: Due to.a physician or therapist, inadverdently induced problem or disease
167. Extenders: Unlicensed, non-certified statt that operate under the supervision of a licensed clinician that are specially trained
168. Culture: Any group that shares a theme or issue; can include language, food, clothing, music, art, dance, etc.
169. Sociorace: Recognizes the social and historical aspects of a group of people; providing info about customs, norms, and social aspects of the group
170. Universalism: Loyalty and concern for others without regard to national or other allegiances
171. Multiculturalism: A social-intellectual movement promoting cultural diversity as a core principle while insisting on equality and respect for all
cultural groups
172. Academic Intelligence: Ability to solve problems in an academic, classroom setting
173. Practical Intelligence: Ability to solve practical life problems in everyday settings
174. Social Intelligence: A distinct set of skills necessary in order to successfully navigate the environment
175. Emotional Intelligence: The ability to monitor and identify emotions, both one's own and others' and the use of emotional info to guide thinking
and behavior
176. The Process of Racial and Cultural Identity Development: Conformity -> Dissonance
-> Resistance and Immersion -> Introspection -> Integrative Awareness
177. Worldview: How you perceive your relationship to the world, can greatly influence a person's life
Should be considered when treatment planning
178. Benign Neglect: An attitude or policy of ignoring an often delicate or undesirable situation
179. Males vs. Females and TBI: Men experience TBI 2:1 compared to women
20 / 26 RTW rates 26.6% for men vs 4.4% for women- may be due to womens' increased responsibility in the home and at work For women TBI often causes depression, PTSD, sexual diflculty, increased symptamology over time, and body image concerns
180. Primary and Secondary Causes of Sexual Dysfunction: Nueroendocrine changes, hypothalamus and pituitary damage
Physical changes, cognitive impairments, emotional and behavioral changes, marital dysfunction, social isolation, financial stress, role changes, and decreased communication
181. Brain Peak Maturation Periods: 3-5 years old - rapid overall growth 8-10 years old - rapid
sensory motor growth, executive functions begin to develop 14-15 years old- rapid growth of visual spatial, somatic systems, and auditory *TBI disrupts normal developmental milestone progression
182. Individuals with Disabilites Education Act (IDEA): Made free and appropriate education available to all children with disabilities,
ensures access to public education and related services
183. 504 Accommodation Plans: Designed to help children learn alongside peers, provides written documentation for needs required by child
with a presumed disability i.e. preferential seating, increased time, verbal testing, note takers, etc. Can be carried into higher education but may not have a formal 504 plan.. A result of section 504 of Rehabilitation Act of 1973 that prohibits discrimination based on disability
184. Individualized Education Plan (IEP): Written for specialized academic instruction, can be used by students in public school until age 21 - all
public schools MUST provide services outlined in IEP by law
185. Individualized Transition Plan (ITP): Section of an IEP that outlines transition goals and services and how to achieve goals from transition to
high school into real world. All students with IEP must have an ITP by age 16
186. Abusive Head Trauma (AHT) and Shaken Baby Syndromes Statistics: AHT is most common cause of TBI in 0-5 year olds,
boys most commonly abused
