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CBIS EXAM STUDY GUIDE
1. Nuerocognitive Issues Assoicated 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, casused 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% hsopitalized, 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!
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14. Most common cause of TBI and death by age - 20-24: MVAs and Firearms
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 Decison: 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 proccessing 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. Peristent 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 nuerons which continually release tau protein cashing dementia over time
4 / 28 hearing, touch, taste, and balance Even if the cerebral cortex is gravelly damaged, the brain stem can keep someone alive - or in a vegetative state
35. Functions of the Cerebellum: Balance, coordination, skilled motor activity
36. Reticular Activating System (RAS): Part of the brain stem - collection of nerve fibers that modulate changed
in arousal, alertness, concentration, and biological rhythms Can be turned down or up much like a light dimmer switch - i.e during a coma, it is turned down - if turned down too much, can result in death
37. Medulla: Part of the brain stem- responsible for basic living functions such as breathing, HR, BP, swallowing, and
vomiting
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
5 / 28 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
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 Hemipshere: 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
7 / 28 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!
61. Synaptogenesis: A part of nueroplasticity - the formation of synapses between nuerons
The more synapses there are the more eflciently nuerons can communicate!
62. Nueroprotection: Preventing secondary damage post injury
63. Apoptosis: Process in which a brain cell self destructs if it is not working as it should be
64. Experience Dependent Learning: Neural connections that are established which depend entirely on and are
due to an environmental experience
65. Autonomic Storming: 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, constipa- tion, and erectile disfunction 15-33% of TBIs sustainees experience AS
66. Deep Vein Thrombosis (DVT): Bloodclots
8 / 28 Symptoms include shortness of breath, pain/discomfort that worsens with coughing or breathing, light headedness, dizziness, feeling faint, coughing up blood, rapid pulse
67. Pulmonary Embolism (PE): Occurs when a blood clot travels to the lungs- same symptoms for DVT
68. Disinhibited Nuerogenic 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 nuerotransmitters 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
10 / 28 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
Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, opioids, anti-depressants, nerve blocks, trigger point injections, anti- convulsants, and epidural steroids
77. Primary vs. Secondary Headaches: Headache that as no idenfitiable cause vs one with an identi- fiable
cause
78. Acute vs. Chronic Headaches: Short vs lasting atleast 15 days out of a month 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
79. Tension Headache: Described as bilateral head pain, "clamping", caused by head or neck muscle strain. Not
associated with any other symptoms and does not worsen with PA.
80. Craniomandibular Headache: Associated with temporal-madibular joint, often causes difficulty with eating
and talking
81. Cervicogenic Headache: Generated from the cervical spine, clinical diagnosis in made with the use of nerve block
82. Migraines: Located on one side of head or the other; lasts 4-72 hours; worsens with heat, light and exercises 4 phases:
Prodrome (pre-headache symptoms), Aura, Headache, Postdrome (symptoms following headache) Can be treated with catteine, NSAIDS, bata blockers, environmental changes, and narcotics (last resort)
83. COLDER: Acronym used to help diagnose and assist in treating headaches
Character Onset Location Duration and frequency Exacerbation
11 / 28 Relief
84. Percentage of physical complications existing >2 years post TBI: 30%!
85. Spasticity: Increase in muscle tone, tendon reflexes, and involuntary velocity of movements
Treated multimodally with with meds (i.e. baclofen, diazepam, etc.) OT and PT services
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
13 / 28 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 injury
101. Coma: Disorder of consciousness
No arousal, no awareness, lasts weeks to months, impaired brain stem reflexes
102. Vegetative State: Disorder of consciousness
Arousal, no awareness, lasts months to years
103. Minimally Conscious State: Disorder of consciousness
Arousal, fluctuating awareness, lasts months to years
104. Statistic of People Living with a DOC in the U.S.: 315,000 People
105. Management of DOC: Focuses of full participation in daily routine, provide sensory stimulation, look for generalized
and localized responses to stimulation, perform ROM, apply orthotics, upright positioning, bed mobility to combat atrophy/contractures/skin breakdown
106. Fatigue: Decreased capacity for physical of mental activity due to an imbalance of resources needed to complete
activity at hand
107. Sleep Disruption: Disorders of initiating and maintaining sleep
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108. Primary Fatigue vs. Secondary Fatigue: Results directly from injury vs exacerbation of primary fatigue
109. Physiological Fatigue vs. Psychological Fatigue: Caused by decreased production of hypocretin
which increases arousal vs that caused by anxiety, depression and weariness
110. The Coping Hypothesis: Explanation for cause of fatigue in TBI sustainess - says that it may be caused by increased
ettort required to meet demands of life caused by TBI
111. Measures of Fatigue: Visual Analogue Scale
-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
16 / 28 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
129. Short Term Memory: Enables memory recall lasting a few minutes to hours
130. Working Memory: Temporary storage and active processing of information i.e. calculating change
131. Long Term Memory: Permanent consolidation and storage of information
132. Explicit Memory vs. Implicit Memory: Memory requiring conscious recall vs muscle memory
133. Semantic Memory: Memories of words, ideas, and concepts
134. Episodic Memory: Memories of personal experiences
135. Procedural Memory: Memory of skills and tasks
136. Compensatory Approach to Treatment vs. Restorative Approach to Treat- ment:
Assumes certain functions cannot be recovered and focuses on strategies to "compensate" for losses vs. belief that repetition, exposure and experiential learning can change brain circuitry
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137. Coma-Emergent Agitation: Emerging from coma can case confusion, anger, hyperactive movements,
heightened responses to external stimuli, poor cooperation and violence Can last up to 10 days
138. Management of Coma-Emergent Agitation: Use consistent and familiar statt, environmental alteration to
decrease triggers, provide familiar objects, reduce stimuli, establish predictable routines
139. Stability Triangle: Model that suggests you must establish medical stability, develop stable activity plan and
promote stable behavior in order to achieve stability
140. ABA: 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
141. Behavior Change Process: Assess behavior -> define target behavior -> collect data -> change
behavior
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
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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
20 / 28 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
157. Screening Tools for SUD: ASSIST, CAGE, AUDIT, CRAFFT
158. 4 Quadrant Treatment for SUD and TBI Co-Committance: Quadrant 1 - low severity TBI and
SUD - receive treatment in acute medical setting - brief intervention Quadrant 2 - high severity TBI and low severity SUD - receive treatment in TBI rehab - education, screening, and brief intervention Quadrant 3 - low severity TBI, high severity SUD - receive treatment in SUD treatment setting - screening, accommoda- tions and linkage Quadrant 4- high severity TBI and SUD - receive treatment in TBI and SUD treatment setting - integrated program to treat both
159. Biomedical Model of Disability: Concerned with changing the individual and treating the problem (TBI)
160. Functional Model of Disability: Aimed at adapting the functions of individuals for meaningful participation
in life, focused on person centered care
161. Environmental Model of Disability: Addressing physical and social environments to meet the needs of an
