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Flashcards in Chapter 5, 6, 7, 9 Deck (96)
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1

Autonomic Storming

AKA dystonia
failure of sympathetic or parasympathetic components of the autonomic nervous system to regulate body functions
-characterized by disruptions in heart and respiratory rates, BP, temperature, perspiration, muscle overactivity, posturing, dystonia, rigidity, and spasticity

2

Deep vein thrombosis

blood clot in and deep venous part of the circulatory system
common in TBI

3

Pulmonary Embolism

blockage of a main artery in the lung frequently caused by a blood clot that has traveled from elsewhere in the body (often a DVT)

4

Urinary Tract Infection

-occur early and late post-BI
-may be detected through cognitive or behavior changes

5

is bladder or bowel incontinence behavioral or intentional

no, typically not. There is great shame and embarrassment in not being able to control these functions

6

Treatments for incontinence

foley catheter
suprapubic catheter
timed-voiding schedule
anti-cholinergic drugs
bowel routine

7

aspiration

material/bolus passing level of vocal folds into airway

8

The Congress of Neurological Surgeons states that in the acute phase following a head injury, a person will require at least ___% more calories than he or she needed prior to the injury

40%

9

BI present in ___% of SCI cases

60%

10

Effect on BI co-occurring with SCI on LOS and motor outcomes

People with paraplegia and co-occurring severe TBI had worse motor outcomes and longer acute rehab LOS than individuals with only paraplegia and no TBI

11

Complete SCI

no motor or sensory function below level of injury

12

incomplete SCI

functioning of sensory and possibly motor below the level of injury

13

decubitus ulcers

pressure injury/sores from prolonged pressure on any area due to positioning and increased spasticity or tone

14

important principles to prevent decubitus ulcers

Use bracing (immobilization, external fixation, orthotics)and proper wheelchair/bed positioning

15

Stage I Pressure Injury

red and warm to the touch
may itch or burn
timely identification may help reverse and minimalize further damage

16

Stage IV Pressure Injury

-most severe
-may lead to potentially serious infection, which may be life threatening
-result in large open areas of tissue destruction down to and including muscles, bones, tendons, and joints

17

How to prevent pressure sores

-keep skin clean and dry
-change position every 2 hours
-pressure-relieving devices: specialty mattress, specialty cushions, tilt in space w/c

18

MRSA (stands for, cause, treatment)

Methicillin-Resistant Staphylocuccus Aureus
-typically a product of poor hygiene, including poor hand washing by care providers and repeated use of soiled clothing
-requires antibiotics to treat

19

3 Categories of seizures after a TBI

(classified by time of appearance after initial impact)
1. Immediate post-traumatic convulsions (IPTC)
-within seconds of impact
2.Early post-traumatic seizure (EPTS)
- within first week
3. Late post-traumatic seizures (LPTS)
- >1 week after BI

20

Immediate post-traumatic convulsions (IPTC)

involve loss of consciousness and involuntary movement within seconds of impact

21

Early post-traumatic seizures (EPTS)

-occur up to 7 days after initial impact
-result of primary direct effects of the trauma
-approx 50% occur within 24 hrs of impact
-strong risk factor of late post traumatic seizures

22

Late Post-Traumatic seizures (LPTS)

-greater than 1 week after initial head trauma
-generally within first 18-24 months after BI
- also known as post-traumatic epilepsy
-presence of seizure disorder associated with increased mortality
-individuals with post-traumatic epilepsy die at a younger age than those that do not. Worse with advanced age at time of injury and presence of SDH

23

tonic posturing

back arching, eyes roll back in head

24

clonic/myoclonic jerks

muscle spasms causing a jerking in limbs less than 2-3 min in duration

25

Postictal period

short period of time following a seizure where there is an altered state of consciousness

26

decerebration

loss of cerebral brain function

27

hippocampal atrophy

shrinkage of the hippocampus

28

status epilepticus

more than 30 min of continuous seizure activity or two or more sequential seizures without full recovery of consciousness

29

Causes of pain after BI

orthopedic pain
muscular pain
headache
spasticity/contracture
HO
myofascial pain
neuropathic pain

30

nociceptive pain

pain related to peripheral nerve fibers

31

neuropathic pain

associated wtih primary lesion dysfunction of nervous system

32

pain management strategies

NSAIDs
OTC pain meds (acetaminophen)
topical agents
antispasticity meds
opoids
nerve blocks
steroids
ice
heat
ROM
stretching
ultrasound therapy
TENS

33

post-traumatic headache (PTH)

-headache that commences within 14 days of LOC
-may spontaneously resolve within 6 months or symptoms may persist and become chronic

34

Percentage of people who get PTH after mTBI vs moderate-severe TBI

95% after mTBI
22% after moderate-severe

35

primary headache

headache with no specific cause

36

secondary headache

headache that may have identifiable cause that can be determined

37

chronic headache

occurs at least 15 days per month for at least 3 months

38

primary nocioceptive afferent nerves involved with post-traumatic headache

CN V (Trigeminal)
CN IX (Glossopharyngeal)
CN X (Vagus)
Greater Occipital Nerve (from C2 root)
Lesser Occipital Nerve (from C3 root)

39

Spasticity

motor disorder characterized by a velocity-dependent increase in tonic strength with exaggerated tendon reflexes resulting from excitability of the stretch reflex caused by upper motor neuron damage

40

What medication is standard of care for spasticity management

baclofen

41

hyperreflexia

involuntary increase in muscle tone and exaggerated deep tendon reflexes

42

contractures

abnormal, usually permanent condition of joints charaterized by decreased ROM, often in a flexed position, and fixation due to wasting awat and shortening of muscle fibers and loss of skin elasticity

43

signs of heterotropic ossification

-decrease in joint ROM
-increased spasticity & pain
-joint may become red and swollen
-swelling in lower leg that mimics DVT
-usually occurs on same side of body where spasticity is worst
-hip is most common, followed by shoulder and elbow.
-knee is least common place
-surgery warranted in some cases after individual reaches maximum motor recovery (usually 1.5 years)

44

Stage II pressure ulcer

-partial thickness
-loss of dermis
-shallow open ulcer

45

Stage III pressure ulcer

-full thickness tissues loss
-fat may be visible but not bone, tendon, or muscle exposed

46

Stage IV pressure ulcer

full thickness tissue loss with exposed bone, tendon, or muscle

47

Unstagable pressure ulcer

full thickness tissue loss in which actual depth of ulcer is complete obscured by slough and/or eschar in the wound bed

48

Deep tissue injury

purple or maroon localized area of discolored intact skin or blood filled blister due to damage of underlying soft tissue from pressure and/or shear

49

predominant disabling factors 5-10 years after BI

cognitive
behavioral
personality changes

50

Alzheimer's disease

most common form of dementia
-progressively worsens
-most common early symptom is short term memory loss

51

Older adults with hx of TBI vs age-matched controls without TBI on attention, verbal memory, relative cognitive decline over 2-5 year period

-no difference in relative cognitive decline
-TBI group had lower scores on attention and verbal memory

52

10 elements of successful aging after BI

1. Exercise
2. Brain Health
3. Heart Health
4. Advovate
5. Nutrition
6. Mental Health
7. Protect the Brain
8. Socialize
9. Avoid Drugs & alcohol
10. the brain is capable of making billions of connections; make more (neuroplasticity)

53

fatigue

awareness of decreased capacity for physical and/or mental activity due to an imbalance in the availability, utilization, and/or restoration of resources (physiological or psychological) needed to perform the activity

54

physiological fatigue

casued by depletion of energy, hormones, neurotransmitters, or reduced number of neural connections due to brain injury
-direct result of injury or dysfunction in the brain; may be associated with muscle weakness or other changes or injuries in the PNS

55

Psychological fatigue

a state of weariness related to reduced motivation, prolonged mental activity, or boredom that occurs in situations such as chronic stress, anxiety, or depression

56

Secondary fatigue

can be caused by a number of factors such as pain, sleep disturbance, or stress

57

Measures used to assess fatigue in BI

-Visual analog scale for fatigue (VAS-F)
-Fatigue Severity Scale (FSS)
-Barrow Neurological Institute Fatigue Scale (BNI Fatigue Scale)
-Global Fatigue Index (GFI)
-Multidimensional Assessment of Fatigue (MAF)
-Causes of Fatigue Questionnaire (COF)

58

Treatment of fatigue

-assess for anxiety, depression, and pain
-lifestyle modifications
-sleep hygiene techniques
-Modafinil (wake-promoting drug)
-non-pharmacological interventions (light therapy- enhancing vigilance and mood)

59

Sleep disruptions following BI

-insomnia
-hypersomnia
-escessive daytime sleepiness (EDS)
-changes in sleep-wake cycle
-changes in REM sleep

60

Causes of sleep disturbance after BI

-injury to brain regions or pathways
-presence of depression
-disrupted circadian regulation of melatonin production

61

Prevalence of Minimally conscious State

280,000

62

Prevalence of Vegetative state

35,000

63

Prevalence of individuals with DOC total

315,000

64

Minimally Conscious State

severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated

65

emergence from DOC evidenced by

functional communication as evidenced by verbal or gestural yes/no
OR
functional use of 2 or more objects

66

No Response

no discernable reflexive or volitional response noted to stimuli

67

Generalized Response

Response to stimuli is automatic, reflexive, or non-purposeful, and is non-specific

68

Localized Response

Response to stimuli reflects person's ability to regulate incoming sensory information and voluntarily control the response to the stimulation
-localized responses are NOT reflexes and can occur in relationship to the area stimulated

69

Goals of medical management of DOC

1. Maintain physical stability to allow participation as fully as possible in daily routines and therapy
2. Prevent medical complications
3. Provide opportunities for stimulation to the brain through environmental manipulation and pharmacological intervention

70

Common medical challenges associated with DOC

skin breakdown
respiratory
bowel/bladder dysfunction
autonomic dysfunction syndrome

71

Autonomic dysfunction syndrome (ADS)

a problem with the autonomic nervous system (located in medulla and lower brainstem) that controls processes such as digestion, heart rate, the immune system, respiratory rate, etc

72

Symptoms of Autonomic Dysfunction syndrome (ADS)

-dystonia
-agitation
-tachycardia
-diaphoresis
-hyperthermia
-hypertension
-tachypnea

73

How to treat Autonomic Dysfunction Syndrome (ADS)

-environmental control (determining provoking factors such as bright lights, noise, specific movement patterns) and minimizing or eliminating
-medications- propranolol, gabapentin, clonidine, bromocriptine, dantrolene, morphine

74

Neuralgia

pain caused by damage to a nerve of structural change to a nerve

75

Neuroma

when a nerve becomes entrapped in scar tissue

76

Syndrome of the Trephined

-specific to patients who have had had a craniectomy following TBI
-related to surgical site
-characterized as headache, dizziness, cognitive changes,
-involves shrinking of the skin flap after craniectomy due to positional changes
-typically have good improvement after cranioplasty

77

Stability Triangle components (for stability to be established and maintained)

1. medical stability
2. behavior stability
3. stable activity plan

78

medical stability

control of medical complications such as pain, sleep disturbance, incontinence, seizures, etc)

79

behavior stability

requires team to assess problematic behavior such as resistance or refusal, mood instability, threatening or demanding behaviors, verbal and physical aggression, property destruction, elopement, self-harm, and substance abuse or misuse

80

stable activity plan

team must explore individual's abilities, interests, and need for support associated with specific activities and settings, and work to minimize all related risks

81

functionally equivalent alternatives

behavior that serves the same function as the target behavior, but is safer, more appropriate, and thus is more useful for the individual

82

operational definition

outlines what exactly will be counted as an occurrence or episode of the behavior; must be observable or measurable, definition must be specific enough such that multiple observers can agree upon what would count as an occurrence

83

focus of neuropsych evaluation

determines how different areas and systems of the brain are working

84

neuropsych assessment process

record review
clinical interview
standardized testing
report and feedback

85

neuropsych evaluation provides

detailed description of individual's abilities, strengths, adn weaknesses in various areas of functioning

86

neuropsych evaluation achieved through

administration of tests that measure behavioral constructs of specific human abilities such as attention and memory, in a standardized fashion

87

neuropsych findings can be used to

determine nature and extent of cog deficits, presence of a neurologically based disorder, understand how cog deficits may contribute to problems in daily life, determine nature and degree of change in cog performance on re-assessment, assist in treatment planning, determine appropriateness of a surgical intervention, and make recommendations for modifications or accommodations in the community

88

ACRM definition of cognitive rehabilitation

systematic, functionally oriented service of therapeutic cognitive activities, based on an assessment and understanding of the person's brain-behavior deficits. Services are directed to achieve functional changes by:
1. reinforcing, strengthening, or reestablishing previously learned patterns of behavior
2. establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems

89

2 fundamental principles of cognitive rehab

neuroplasticity
adaptability

90

neuroplasticity

ability of nervous system to regenerate and reorganize its structure, functions, and connections

91

restorative cognitive tx goals

aims to reestablish lost functions or develop new functions

92

restorative treatment consists of

repetitive, targeted, consistently challenging exercise thought to facilitate recovery of impaired neural circuits

93

adaptability

individual's capacity to change behaviors in order to adapt to changes in their natural or external environment

94

compensatory cog tx goal

designed to minimize the effect of deficits and to recover a degree of function

95

compensatory tx consists of

development of internal and external environmental strategies that make use of residual, intact abilities and relative strengths`

96

Factors affecting duration of psychiatric symptoms

unique to the individual
-genetic bias concerning mental illness
-effects on the brain
-stressors related to living with a disability
-individual's psychological resiliency
-quality of the person's support network