4] Treating The Patient With Brain Injury

Question 1

4 main types of brain injury

Answer 1

1] external forces
2] accelerate/decelerate
3] blast injuries
4] [penetrating objects

Question 2

Gender more likely to have TBI related deaths and injuries

Answer 2

Men (3x more for death)

Question 3

0-4 years get TBI by

Answer 3

Assault

Question 4

5-24 years get TBI by

Answer 4

MVA

Question 5

65 and older get TBI by

Answer 5

Falls

Question 6

What are the deficits seen with damage to the frontal lobe

Answer 6

Deficits in: reasoning, planning, parts of speech, movement, emotions, problem solving

Question 7

Deficits seen with damage to the parietal lobe

Answer 7

Movement
Orientation
Recognition
Perception of stimuli

Question 8

Deficits associated with damage to the temporal lobe

Answer 8

Perception and recognition of auditory stimuli, memory and speech

Question 9

Wandering hand syndrome seen with damage to whcih lobe

Answer 9

Temporal lobe

Question 10

Deficits seen with damage to the occipital love

Answer 10

Visual processing deficit

Question 11

Deficits seen with damage to the cerebellum

Answer 11

Incoordination of voluntary movements resulting in problems with: 
Posture
Balance
Coordination
Speech

Question 12

Damage to what results in difficulty learning motor behaviors?

Answer 12

Cerebellum

Question 13

Delicate and rapid sequence of sensory and motor events requiring the coordination activity of several parts of the body

Answer 13

Communication

Question 14

Listeners do not tell on

Answer 14

Info delivered from speech waves

Question 15

Listeners depend on ?

Answer 15

Cues- CONTEXT

Question 16

Which population has the most amount of language disorders?

Answer 16

Children - 43.7%

Question 17

Vocal tract includes

Answer 17

Lungs, trachea, larynx, pharynx, nose and mouth

Question 18

3 primary functions of speech production

Answer 18

Breathing
Swallowing
Speech

Question 19

When we speak, what do we control?

Answer 19

Rate of breathing

Question 20

Impaired auditory comprehension, speech is often a normal rate and melody

Answer 20

Fluent aphasia

Question 21

Fluent aphasia is lesion where

Answer 21

Posterior temporal gyrus of L hemisphere

Question 22

Non-fluent aphasia is characterized by

Answer 22

Limited vocab
Hesitant speech
Awkward articulation
Restricted use of grammar

Question 23

Where is non-fluent aphasia located

Answer 23

Anterior lesion- frontal convolution in L hemisphere

Question 24

Global aphasia is not a type but

Answer 24

A designation of severity

Question 25

Wernickes aphasia is AKA

Answer 25

Fluent, sensory, receptive aphasia

Question 26

Wernickes aphasia is located?

Answer 26

Lesion in posterior portion- temporal gyrus L hemisphere

Question 27

Characterized by impaired auditory comprehension

Answer 27

Wernickes aphasia

Question 28

Wernickes aphasia is?

Answer 28

Fluent speech with word subs and nonsense words

Question 29

Reading and writing for wernickes

Answer 29

Severely impaired

Question 30

Define anomic aphasia

Answer 30

Can’t find the right words in context of fluent, grammatically well-formed speech

Question 31

Wernickes aphasia may evolve into ?

Answer 31

Anomic aphasia

Question 32

Brocas aphasia is aka

Answer 32

Nonfluent Expressive Motor Verbal aphasia

Question 33

Brocas aphasia is a lesion in ?

Answer 33

Frontal convolution of L hemisphere in subcortical white matter and extends posteriorly to precentral gyrus

Question 34

Broca’s aphasia is characterized by (4)

Answer 34

Awkward articulation Restricted vocab Writing skills mirror speech pattern Reading is less impaired than speech and writing

Question 35

Conduction aphasia is a lesion in?

Answer 35

Parietal lobe or posterior superior temporal lobe

Question 36

Can be fluent or non-fluent

Answer 36

Conduction aphasia

Question 37

What’s good and poor in conduction aphasia

Answer 37

Good comprehension | Poor repetition, naming, writing

Question 38

Transcortical motor aphasia is a lesion in

Answer 38

Anterior superior frontal lobe

Question 39

What type of aphasia is transcortical motor aphasia?

Answer 39

Non-fluent aphasia

Question 40

What’s good and poor in transcortical motor aphasia?

Answer 40

Good comprehension, excellent repetition. | Poor naming and writing.

Question 41

Pure word deafness is a lesion in

Answer 41

Heschl’s gyrus or b/w that and temporal gyrus

Question 42

Is pure word deafness fluent or nonfluent aphasia?

Answer 42

Fluent aphasia

Question 43

What’s good and poor with pure word deafness?

Answer 43

Good writing, naming, reading comprehension. | Poor comprehension and repetition.

Question 44

Rancho- | Purposeful, appropriate, stand-by assistance on request

Answer 44

Level 9

Question 45

Rancho- | Confused, appropriate, mod A

Answer 45

Level 6

Question 46

Rancho- | Purposeful, appropriate; modified independent

Answer 46

Level 10

Question 47

Rancho- | Confused, inappropriate non-agitated, max A

Answer 47

Level 5 rancho

Question 48

Rancho- | Purposeful, appropriate; stand by assistance

Answer 48

Rancho level 8

Question 49

Rancho- automatic, appropriate; min A for daily living skills

Answer 49

Rancho- level 7

Question 50

Rancho- | No response, total assistance

Answer 50

Rancho level 1

Question 51

Rancho- | Generalized response, total assistance

Answer 51

Level 2 rancho

Question 52

Rancho- | No response, total assistance

Answer 52

Level 1 rancho

Question 53

Rancho- | Localized response; total assistance

Answer 53

Rancho level 3

Question 54

Rancho- | Confused/agitated: max A

Answer 54

Level 4 rancho

Question 55

Rancho- | Confused, inappropriate, non-agitated: max A

Answer 55

Level 5 rancho

Question 56

Rancho- | Confused, appropriate: mod A

Answer 56

Level 6 rancho

Question 57

3 parts if treatment of individuals with TBI

Answer 57

Physical Cognitive Behavioral

Question 58

What other factors affect cognition? (3)

Answer 58

Depression Meds Not enough sleep

Question 59

One way to maximize performance and learning

Answer 59

Memory book

Question 60

5 things you can put in a memory book

Answer 60

``` Photos Calendar Therapy schedule Activity log HEP ```

Question 61

What’s the first thing you do with a patient?

Answer 61

CHECK alertness!!

Question 62

Criteria for cessation of physical rehab session (12)

Answer 62

``` 1- Sx drop in MAP (dizzy, lighthead, syncope) 2- HR less than 40 or more than 130 3- RR less than 5 or more than 40 4- SBP more than 180 5- new arrhythmia 6- possible MI 7- pulse ox more than 88% 8- marked vent dysynchrony 9- patient distress 10- concern for airway device integrity 11- fall to knees 12- endotracheal tube removal ```

Question 63

4 stages of treating a patient with increased agitation

Answer 63

1- anxiety 2- defensive 3- increased tension 4- acting out

Question 64

Patients behavior for anxiety

Answer 64

Can see undirected energy

Question 65

 Offer empathy  Ask pt what may make them feel better & comply if able  Make sure person knows thatyou have heard/understand the concerns

Answer 65

Staff response to anxiety

Question 66

```  Rational thought is lost  Self-protection primary goal of pt  See verbal belligerence & hostility  See power struggles/ “button pushing” ```

Answer 66

Patients behavior- defensive

Question 67

Most critical step in treating a patient with increased agitation

Answer 67

DEFENSIVE STEP

Question 68

- identify what situations are primarily responsible - remain professional and in control - set structural limits that are clear to person,s imple and enforceable - deliver in non-threatening manner - make individual aware of appropriate response - practice response

Answer 68

Staff response to defensive

Question 69

See loss of physical and emotional control

Answer 69

Patient behavior- acting out

Question 70

- Use LEAST restrictive form of crisis intervention | - verbal management of situation is exhausted

Answer 70

Staff response to acting out

Question 71

Most important stage of treating pt with increased agitation

Answer 71

Tension reduction

Question 72

Happens after person acts out, pt starts gaining physical and emotional control, may not remember anything of event

Answer 72

Tension reduction

Question 73

``` • Re-establish channel of communication • Have pt take deep breaths (proves he is able to follow commands & will help personrelax) • Provide pt with information about what is going to occur next ```

Answer 73

Staff response to tension reduction