TBI

Question 1

Definition of TBI

Answer 1

An acquired brain injury that disrupts the normal function of the brain that can be caused by a bump, blow, or jolt (or blast) to the head or a penetrating head injury

Question 2

Incidence of TBI

Answer 2

number of new TBIs over a particular time period

Question 3

Prevalence of TBI

Answer 3

number of people living with impact of TBI currently

Question 4

Estimated prevalence of TBI-related disability in US

Answer 4

3.2 mill - 5.3 mill

Question 5

Most likely to have TBI-related ED visit

Answer 5

0-4
15-19
> or equal to 75 yrs

Question 6

TBI etiologies

Answer 6

bicylining, football, playground activites, basketball, soccer, falls struck by object, MVA, assualt, self-inflicted

Question 7

TBI pathophysiology - primary injury

Answer 7

caused by initial blow or insult to the brain

Question 8

TBI pathophysiology - secondary injury

Answer 8

disruption of the blood brain barrier
production of reactive oxygen species and resultant oxidative stress
metabolic dysfunction
inflammation and excitotoxicity

Question 9

what is included in direct mechanical injury caused by trauma

Answer 9

fractures, intracranial hemorrhage, contusion and traumatic axonal injury

Question 10

coup-coutracoup - primary injury

Answer 10

Injury at the site of impact and on the opposite side from the movement of the brain against the skull
(either front to back or side to side)- causes a contusion

Question 11

diffuse axonal injuries - primary injury

Answer 11

Delicate nerve tissues rip, tear, and stretch

Question 12

Secondary injury

Answer 12

deterioration that follows initial trauma, during first 24 to 72 hours, brain and body responding to insult
infection, hypotension, brain swelling, raised intracranial pressure

Question 13

factors influencing outcomes after TBI

Answer 13

age - younger than 7 or older adults have worse outcomes
social-enviornmental factors - SES, caregiver and family function, social support, return to social functioning
access to care - insurance as a factor
comorbidities

Question 14

factors associated with poor prognosis for tbi

Answer 14

defined as mortality at 14 days
death/severe disability at 6 months after injury

Question 15

how to measure global outcomes after tbi

Answer 15

GOS-E (glasgow outcome scale) (most common for tracking overall recovery)

DRS - disability rating scale, measures impairment, disability, and handicap

SRS - supervision rating scale, 13 pt scale to rank levels of supervision

Question 16

considerations for tbi assessment

Answer 16

level or consiousness/arousal
neurobehavioral deficits that may impact participation
motor deficits
sensory deficits
consider how task translate to real world
formal vs informal assessment

Question 17

an assessment for tbi should

Answer 17

eval strength and weaknesses
guide development and implementation
guide devleopment of remedial and compensatory strategies
steer discussion w pateints and family regarding recovery
serve as an anchor for future challenges resulting from recovery and treatment

Question 18

what kind of info do you need in case history - tbi

Answer 18

nature and onset of tbi
hospitalizations
medical status current and prior to injury
current medications
review of auditory, visual, motor, and cognitive status
review of emotional and mental status
education and occupational
areas of concern
languages used
impact of condition on individual and their family/caregivers
goals and priorities of individual and their family/caregivers

Question 19

Pros and cons to standardized assessment

Answer 19

pros to standardized test - tbi
compares you to peers and gives a baseline

cons to standardized test - tbi
less patient feedback, stressful, other preexisting factors can complicate interpretation

Question 20

things to be aware of in tbi formal and informal assessment

Answer 20

fatigue, emotional response, motivation, strategies used

Question 21

Early assessments - tbi

Answer 21

GOAT - Galveston orientation and amnesia test
GCS
PTA - post-tramatic amnesia

often in acute care

Question 22

TBI assements used in rehab

Answer 22

Rancho
DRS - disability rating scale
FIM - functional independent measurement

Question 23

tbi assessment used further out of onset of injury

Answer 23

BREIF - A
QOLIBRI - quality of life after brain injury scale

Question 24

hypothesis testing in tbi

Answer 24

figuring out why they cant do something

Question 25

dynamic assessment in tbi

Answer 25

purpose is to make sure you are getting their best you might test-teach-retest accommodating seeing what they respond to best

Question 26

what is the goal of cognitive rehabilitation

Answer 26

minimize the functional impact of injury-related cognitive and behavioral impairment in order to maximize safety, independence, and quality of life can use remediation, compensation, or environmental management

Question 27

4 steps in cognitive rehabilitation

Answer 27

1 - problem orientation, awareness, goal setting 2 - compensation 3 - internalization 4 - generalization

Question 28

long term goals for tbi

Answer 28

evaluated on longer time frames (often dictated by setting or mechanism) Ex - patient will improve ability to compensate independently for memory deficits using external aids

Question 29

short term goals for tbi

Answer 29

type of task, complexity, level of cueing or assistance, strategy employed, measure of success (speed, number, %) ex- patient will initiate 10/10 simple household tasks in the morning for 5 consecutive days, with minimal assistance to use memory notebook

Question 30

general approach for treatment for mild to moderate tbi

Answer 30

•Treatment of executive function is based in metacognitive strategy training •Goal of re-establishing internal task-approach structures and improve ability to monitor and regulate behavior •Focus on self-monitoring and self-regulating behavior •May include problem solving and goal management training, especially as they relate to functional activities •If self-awareness exists, need explicit performance feedback

Question 31

general approach for treatment for severe tbi

Answer 31

•Skill-specific training (with focus on tasks), with errorless learning •No expectation of generalization/transfer

Question 32

tbi treatment framework

Answer 32

awareness - understanding and incorporating patient awareness and impairment levels into discussion plan - help patient in anticipation and planning of step-by-step procedures to meet task demands, including patient's proposed strategy use execute and self-monitor - Observing the patient's execution and self-monitoring of selected responses and helping the patient to internalize self-guided and self-monitoring techniques, as nee evaluate - •Helping pt to evaluate task outcome, compare actual outcome to predicted outcome, change task and strategy approach if necessary, and the resets for next practice

Question 33

what are the fundamental elements of supporting problem solving? tbi

Answer 33

•Identifying a problem and goals •Picking a solution from alternatives and making a plan •Executing the plan with self-monitoring

Question 34

goal plan do review - tbi

Answer 34

build awareness of the goal anticipate and plan how to accomplish goal execute and self-monitor (do goal) self-evaluate and review the goal and how the outcome was and what can be done next time and what worked and did not

Question 35

why might people with tbi have issues identifying a problem

Answer 35

difficulty with initiation, impulsivity, task persistence, disorganization

Question 36

goal management training - tbi

Answer 36

standardized approach (7 sessions, 2 hours each), group based, big focus on mindfulness-based attention regulation, often partnered with PST

Question 37

content free cueing - tbi treatment

Answer 37

STOP stop think organize plan pause current activity and review specific goals

Question 38

treatment of attention impairments general approach

Answer 38

direct attention training metacognitive strategy instruction

Question 39

principles of treatment of attention impairments

Answer 39

task training should be hierarchical lots of repetition do not do direct attention training without MSI

Question 40

What are general strategies for metacognition

Answer 40

•Self-pacing •Verbal mediation •Rehearsal •Anticipate task demands •Self-monitoring (following goal setting) •Emotional regulation •Modify the environment •"What are your absolutes that you have to have to even start working on things?"