Exam 3 Flashcards
(61 cards)
0
Q
Penetrating Injury
A
- object enters brain.
- focal or diffuse.
- less common than closed head injury.
- poorer prognosis than closed head injury.
- Phineas Gage.
1
Q
categories of TBI
A
- penetrating
- closed head injury
- blast-induced injury
2
Q
Closed Head Injury - Etiologies
A
a. falls (#1)
b. motor vehicle accidents.
c. sports related (1.8-3.6 million/year, probably more)
d. struck by/against injury.
3
Q
Effects of Closed Head Injury
A
- Primary effects- focal
- primary effects - diffuse
4
Q
Effects of CHI
- Primary effects- focal
due to:
A
- impact of the brain on the inner skull.
- acceleration, deceleration, rotation of the brain within the skull.
- coup, contra-coup effects (acceleration-deceleration injuries).
5
Q
CHI primary - focal
A
- contusions.
- lacerations.
- potential skull fracture.
- Hemorrhage (subdural, subarachnoid, intracerebral)
6
Q
CHI primary effects - diffuse
A
- edema (swelling)
2. diffuse axonal injury (MAJOR one).
7
Q
Secondary effects - CHI
- delayed from moment of impact -
A
- ischemia (deprived of blood).
- hypoperfusion (reduced blood flow)
- hyperperfusion (too much blood)
- necrosis.
- increased intracranial pressure
- excitotoxicity and oxidative stress.
8
Q
Long term pathology of moderate-severe TBI
A
- continued loss of brain volume, including hippocampus.
- continued loss of axonal connections.
- accumulation of beta amyloid.
9
Q
Diffuse axonal injury
A
- mainly from acceleration-deceleration injury.
- movement of part of brain relative to others causes axons to stretch and tear.
- mainly in deep white matter and brain stem.
10
Q
Severity of TBI measured by which scale?
most common for consciousness..
A
Glasgow Coma Scale
11
Q
Glasgow Coma Scale
A
- most commonly used scale to describe level of consciousness following TBI.
- evaluates eye opening, verbal response, motor response.
* * lowest score is a 3.
12
Q
overall classification systems
A
- Mayo clinic.
2. DoD/VA stratification.
13
Q
Concussion
aka Mild TBI (mTBI)
- differs from mod-severe TBI how?
A
- focal signs (often none).
- imaging results (usually negative or very minor).
- course - usually recover completely.
- cognitive testing - often inconclusive beyond the acute period.
- mechanism - axonal injury.
14
Q
controversies regarding single mTBI
A
- can it lead to subtle, persistent deficits?
- Does it lead to late life deficits?
15
Q
Blast-induced brain injury
A
- “signature” injury of the wars in Iraq and Afghanistan.
- due to explosion of IEDs
- helmets do not protect against this kind of injury.
- blast waves throw things around.. may cause brain injury.
16
Q
Effects of blast
-blast-induced injury-
A
- sudden increase in air pressure->immediate decrease in pressure
- > wind.
- rapid pressure shifts can injure the brain (contusion or concussion).
- air emboli can form in blood vessels, causing infarct.
- axons throughout the brain are affected.
17
Q
Treatment for Blast-Induced injury
A
- removal of foreign bodies, control bleeding, craniectomy.
- assess numerous other injuries (aka polytrauma).
18
Q
Chronic Traumatic Encephalopathy (CTE)
A
- progressive neurodegenerative disease.
- build up of abnormal form of a protein in the brain - Tau.
- first noted in 1928 in boxers.
- person may or may not have had symptomatic concussions.
19
Q
Risk factors of CTE (chronic traumatic encepholography)
A
- age at which mTBI began.
- number of years playing for an athlete.
- genetics (APOE e4)
20
Q
Symptoms of CTE (Chronic Traumatic Encepholohraphy)
A
- mood disorders (depression, violence, suicide).
- parkinsonian symptoms.
- ataxia
- dysarthria.
- executive dysfunction (ex. poor money management).
- paranoia and phobias
21
Q
underlying cognitive impairment affects:
A
- attention
- memory
- organization
- information processing
- problem solving
- executive functioning
22
Q
most common etiology of cognitive communication disorders..
A
TBI
23
Q
TBI effects
- deficits affected by:
A
extent of the brain damage
areas of brain effected
24
deficits post TBI
| cognitive deficits
- reduced alertness, arousal, and responsiveness
- impaired attention and perception
- memory deficits
- inflexability
- impulsivity
- disorganized thinking or acting
- difficulty processing abstract info
- difficulty learning new info, rules, and procedures
- inefficient retrieval of old info
- ineffective problem solving and judgment
- impaired executive functioning
- confusion
- confabulation
- slow processing speed- visual, auditory
- lack of awareness of deficits
25
problems with cognitive assessments
1. poor validity
2. poor at predicting functional abilities in real life
3. requires a team approach
4. lack of funding
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types of tests for cognition
- coma/TBI severity
| - formal tests
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COMBI
- Center for Outcome Measurement in Brain Injury
- collaborative project funded by NIDRR
- TBI outcome measures
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COMBI provides...
- a syllabus
- training information
- rating forms
- background info on reliability and validity
- list of published studies on the measure
- FAQ page
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what is excitotoxicity
excited to death - excess glutamate
30
what is oxidative stress?
imbalance between free radicals and antioxidants.
31
deficits that may occur after TBI
- cognitive-linguistic deficits
- aphasia (infrequent and resolves w/o treatment)
- motor speech disorder
- dysphagia
- physical disabilities
- tinnitus
- behavioral problems
- personality changes
32
deficits that may accompany blast injury
- chronic pain
| - Post-traumatic stress disorder
33
Post-traumatic brain disorder
- 3 categories:
1. re-experiencing symptoms
2. avoidance symptoms
3. hyperarousal symptoms
- may be difficult to separate TBI symptoms from PTSD symptoms.
34
Psychological and vocational consequences
| post TBI
- many people fail to adapt successfully to residual deficits.
- high risk for loss of relationship and social support.
- social isolation and loneliness
- anxiety
- depression
- family members negatively affected.
- vocational issues: increased unemployment or necessary job changes that result in lower pay and status.
35
Recovery post TBI
- individuals seem to follow similar pattern of recovery.
- scales have been developed to describe this pattern
- Rancho Los Amigos levels of cognitive functioning.
- Shordone Scale
36
Rancho Scale
- describes 8 stages of recovery
- revised by one member of the team to 10 stages
- not all individuals will pass through all stages
- reaching level 8 does not mean full recovery
- to be used with persons 1 year post or less.
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Shordone Scale
- 6 stages of recovery
| - used less frequently than Rancho
38
formal tests of cognition
| - categorization -
- can be categorized by area evaluated (memory, executive function..)
- can be categorized by ICF areas (function-impairment, activity-limitation..)
- Many are not specifically for TBI (Detroit tests of learning aptitude - 5)
39
COMBI - assessment plan
| - overall planning -
- determine from examination of case history
- formal tests not always possible in early stages of recovery.
- consider preliminary screenings
- include qualitative measures
- use ASHA language/cognition Evaluation Template as guide.
- consult ICF TBI Core Set
- confirm results with significant others
40
Assessment of attention
- should be model driven
| - consider Sohlberg and Mateer's clinical model of attention
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Assessment of Social Cognition
- emotion perception
| - cognitive empathy
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what is social cognition?
aka "theory of mind"
- the capacity to attend to, recognize, and interpret interpersonal cues that enable us to: 1. understand behavior of others, 2. predict behavior of others, 3. share experiences and communicate effectively.
43
Assessment of memory and executive functioning
- consider the range of possible impairments
- assess areas most related to return to functional independence.
- be aware of overlap in cognitive constructs
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Interpreting results
| - what to focus on -
- specification of strengths and weaknesses
- stage of recovery
- potential persisting cognitive-communication deficits
- effects of cognitive impairments on communication.
- effects of nature and severity of communication deficits on impairment, activity and participation.
- consider pre-morbid levels of cognitive-communication demand, limits of the assessment, cultural and/or linguistic issues
45
Treatment principles for TBI
- Cognitive-communication
- Education
- Psychosocial adjustments/adaptation
* * maximize ability to return to independent activity and participation in work, school, and social interactions.
46
Cognitive Communication principles
| - treatment of TBI -
- promote restoration of function when possible.
- maximize residual functions
- provide compensatory strategies for long term/permanent deficits.
- modify the environment in ways that help compensate for deficits.
- Readjust expectations for the individual's performance.
47
Education principles
| - treatment of TBI -
- Educate the individual (re: effects of head injury, promote adjustments to deficits and participation in goal setting)
- Educate the significant others (to help them understand the deficits and to minimize reactions to the individual that may be maladaptive.)
- Educate other stakeholders (teachers, employers..)
48
Client-Centered Treatment
* * Intervention MUST be individualized!
- goals should tap into the person's strengths while addressing the weakness.
- individual and significant other(s) should actively participate in goal selection and evaluation of progress.
49
Treating Attention Deficits
- direct attention training
- metacognitive training (self-instructional strategies)
- external aids
- environmental accomodations
- Collaboration
- attention process training program
50
Direct Attention Training
- research findings are inconclusive.
- The evidence we do have suggests
1. combining direct treatment with strategy training and feedback.
2. address complex attention and working memory, not simple.
3. target specific impairments of the client.
4. ask what client expects to change, change and measure that.
51
What are the types/aspects of attention
- sustained
- shifting attention
- speed of processing
- selective attention or ignoring distractions
52
Metacognitive training
| - attention training -
- time pressure management
- other self-instruction strategies
- evidence suggests:
1. select self-instruction techniques based on client's needs.
2. ID tasks where attention problem interferes & address those.
3. this approach works best for clients aware of their deficits.
53
Environmental accomodations
| - attention training -
- modify instructions
- minimize competing stimuli
- clear clutter from work space
- use ear plugs
54
Collaboration
| - attention training -
- the clinician supports "everyday people" to be coaches for the client
55
Attention Process Training Program
| APT, Sohlberg and Mateer
- hierarchically arranged series of training modules
| - modules organized by attentional domain
56
Treatment of Memory Disorders
- memory drill (does not work)
- prospective memory training
- mnemonics
- domain-specific learning
- external approaches
- metamemory
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Domain-specific learning
- procedural memory often intact when episodic is not
| - use intact procedural to train functional skills
58
External approaches
| - treatment of memory disorders -
- may include data storage devices, cueing devices, and environmental manipulations.
- may require intensive training
- may be low or high tech.
- proximal vs distal environmental changes
- initiate vs. respond (must be worked out)
59
Metamemory
| - treatment of memory disorders -
- monitoring of memory and learning while it is taking place.
- can the individual predict what will be difficult?
- can the individual learn when, how, what and how long to use a strategy?
- if a metamemory is impaired, will need to use implicit training.
60
Errorless or Error Free Learning
- a person with TBI may have problems knowing incorrect from correct responses.
- incorrect responses may become "primed" and what are remembered the next trail.
- goal is to prevent errors with cues, prompts, or correct answers.
- spaced retrieval - ask client to remember for increasingly longer periods.
- use errorless learning to:
1. teach new skills
2. teach new knowledge
