TBI Quiz 2 Flashcards
(115 cards)
1
Q
Observed signs of neurological or neuropsychological dysfunction
A
Headache Dizziness Irritability Fatigue Poor Concentration Vomiting Seizures following the head injury
2
Q
Neuropsychology
A
a branch of psychology that is concerned with how the brain and the rest of the nervous system influence a person’s cognition and behavior
3
Q
Why does mild TBI sometimes have more severe and lasting effects?
A
People don’t always seek medical attention
Medical providers may not recognize loss of consciousness
Some wait days/months to report symptoms
4
Q
Concussion
A
Causes damage to the blood vessels causing bruising and swelling and can cause nerve injury
Post traumatic amnesia can affect recovery
5
Q
Grade 1 Concussion
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Mild
Symptoms last less than 15 minutes
6
Q
Grade 2 Concussion
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Moderate
Symptoms last longer than 15 minutes
7
Q
Grade 3 Concussion
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Severe
Any loss of consciousness
8
Q
Post concussion syndrome
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2000 study - 15% of people had symptoms a year later
Caused by blow to head but persists because of abnormal nervous system functioning
9
Q
Top symptoms of post concussion syndrome
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Headaches
Memory impairments
Dizziness
Depression
Diagnosed and treated by neuropsychologists
10
Q
Assessment
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In the ER - CT scan over MRI
Cognitive screen - Ranchos Los Amigos scale of cognitive functioning, Glasglow coma scale
11
Q
Ranchos Los Amigos Scale of Cognitive Function
A
Can predict recovery from a ABI
Can be used during any stage of recovery
Looks at cog functioning via motor responses only
Has 10 levels
12
Q
RLA Scale Levels
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1- no response, total assist
2- reflex response to pain
3- localized response, directly to stim
4- confused, agitated, aggressive
5- confused inappropriate, non agitated, memory problems
6- confused appropriate, follows commands, safety unaware
7- automatic appropriate, consistently orientated, carryover
8- purposeful and appropriate, stand w. assist, frustrated
9- purposeful and appropriate, need assist for complex problems
10- appropriate, modified independent, appropriate social interaction
13
Q
Cognitive assessments
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Galveston Orientation and Amnesia Test (GOAT)
Scales of Cognitive Ability for Traumatoc Brain Injury (SCATBI)
Ross Information Processing Assessment (RIPA-2)
14
Q
Recovery is impacted by
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Age Alcohol Abuse Education Level Neuropsychiatric History Post-injury Stress Post- injury litigation Post-injury Compensation Claims Malingering
15
Q
Persistent effects of concussion
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Cognition Executive Functioning Disturbed Sleep Pattern Post Concussive Disorder Depression
16
Q
Medical treatments
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Ritalin Ambien Anti-depressants Antivert (Meclizine) Pain Medications Anti-seizure medications (Keppra, )
17
Q
Ritalin
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As a stimulant to increase processing
18
Q
Ambien
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As needed to re establish a consistent sleep cycle
19
Q
Anti-depressants
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As needed for psychological changes, not during daytime hours
20
Q
Antivert (meelizine)
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For dizziness/nausea
21
Q
Pain medicines
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Used sparingly because of addiction
22
Q
Anti seizure medicines
A
Anyone with a brain injury is more susceptible to seizures
23
Q
Visual changes
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Patients may complain of diplopia, visual blurring, nystagmus, difficulty reading, poor visual acuity
24
Q
Visual treatment
A
Can be treated with prism glasses
A prism lens is put over one eye
The lens bends the light to line up the image with the other eye
25
Physical therapy
Increased mobility, flexibility, and balance
| Vestibular functioning for dizziness)
26
Occupational therapy
For deficits completing ADLs
| Individualized for each client
27
Cognitive/speech therapy
In acute/acute rehab setting
Cognitive Assessment
Depending on LOS (length of stay) possible cognitive-linguistic treatment
In Outpatient Setting:
Working on executive functioning skills such as:
Sustained Attention; Alternating Attention
Focusing and Shifting Focus
Mental Flexibility; Working Memory
28
Mild TBI
An injury to the head as a result of blunt trauma or acceleration/deceleration
- Transient confusion, disorientation, impaired consciousness
- Dysfunction of memory around the time of the injury
- Loss of consciousness lasting less than 30 minutes
29
Head and neck injuries account for over __% of soldiers evacuated with injuries
25
30
Soldiers who report a TBI are
More likely to survive more than 1 explosion, are younger, have a lower rank, are more likely male
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PTSD and symptoms
An anxiety disorder that may develop after a traumatic event
Avoidance behaviors, Re-experiencing symptoms, hyperarousal, irritability, sleep disturbance
32
A study done in 2008 found __%of soldiers who reported PTSD in combination with TBI
43
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ImPACT - Immediate Post Concussion Assessment and Cognitive Testing
Validity is questioned
Does not take into account additional factors that might interfere with cognitive scoring
Other computer tests: CogSport, ANAM, HeadMinder CRI
34
Baseline Cognitive Testing- SAC, SCAT
```
Assesses-
reaction time
Memory capacity
Speed of mental processing
Executive functioning
```
35
Youth sports - return to play
Based on frequency of concussions and level of current concussion.
Can be the same game or can last up to a month
36
Public awareness of TBI
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Policy Efforts
State Laws
Educate Coaches, Parents, Athletes
As SLPs- use BI Month to educate
www.cdc.gov/headsup
```
37
What would we be treating an adolescent for after an TBI?
Attention/study skills
| Complex comprehension
38
Chronic traumatic encephalopathy
Repetitive mild TBI which causes degenerative brain infection and progressive injury
the tau protein within in calls becomes abundant and doesn't work properly
Damage in higher rate in brain stem, Diencephalon and basal ganglia
39
Stage 1 CTE
Headache; Loss of concentration
| Restricted to specific areas- mainly the lateral frontal cortices
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Stage 2 CTE symptoms
Depression; Explosivity; Short Term Memory Loss
| More than one area has increased tau; still frontal areas
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Stage 3 CTE symptoms
Executive Functioning and Cognitive Impairments
| Impairment spreads to temporal and parietal cortices. Common to see tau fiber tangles in the amygdala and hippocampus
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Stage 4 CTE Symptoms
Dementia; Word-retrieval difficulties; Aggression
| Widespread tau bundles; especially in the medial temporal lobe; and gray matter areas
43
Cognitive-linguistic skills
Skills required for proper communication
Impaired when person lacks efficient access to language rules or has a cog impairment in a function that impairs language
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Examples of cognitive linguistic skills
Attention, memory, organization, reasoning and social skills
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Especially with ____ injuries patient's may present with both language and cognitive-linguistic deficits
diffuse
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Macrolinguistics
```
Topic maintenance
tangential speech
verbosity
coherence and cohesion
story grammar and gist comprehension
```
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topic maintenance
the ability to appropriately tell a story or make conversational exchanges on a given topic for a specific amount of time
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Tangential speech
the speech seemed cluttered and disorganized and one thought does not follow another appropriately
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Verbosity
the verbose speech is noted to lack conversational discourse exchange and the person will sustain the conversation with his/her thoughts with little awareness
50
coherence and cohesion
the ability to tie narratives together
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Especially troubling with a TBI (macrolinguistics)
deficits with verbally sequencing steps
| will also have trouble with pronouns and comparatives from previous thoughts
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Story grammar
making sure your story has a beginning, middle and end or a problem a solution to a problem and consequences
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Gist comprehension
the ability to recognize if your audience understands the point of your story and could retell it
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microlinguistics
involve the formulation of sentences
| deficits are with the quantity and quality of the sentences/speech
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logorrhea
incoherent repetitive speech, does not make sense
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What are characteristics of word finding deficits
anomia
delayed responses
frustration
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compensatory strategies for word retrieval
circumlocution
rephrasing
synonym generation
use of an alphabet board/writing down the word
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Nonverbal communication
just as important
deficits can also affect pragmatic skills and effective communication
eye gaze
affect
research = limited on gesture use post TBI
59
eye gaze
looking directly at your communication partner
| we assess - eye contact throughout initial assessment, can be too much or too little
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affect
the experience of feeling emotion
if a person has flat affect they keep the same facial expressions for all emotions
linked to difficulty in reading others emotions as well
61
Pragmatics - assessment
informal
compiled by the clinician based on client interview
unstructured discourse
family interview when applicable
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pragmatics - treatment
group therapy and metacognitive
the goal is to improve self-perception of social skills
to put clients in social situations often
63
Assessment in acute care setting
establishing communication - verbal or nonverbal
orientation x4 (person, place, time, situation)
assessing comprehension - auditory and reading
current level of functioning
functional independence measure (FIM)
ranchos los amigos scale of cognitive functioning
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FIM levels
contains 18 items composed of 13 motor tasks, 5 cognitive tasks
tasks rate on a 7 point ordinal scale
5 areas rated are - comprehension, expression, social interaction, problem solving and memory
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FIM levels
level 7 - independent
level 6 - modified independence - extra time or adaptive equipment
level 5 - requires set-up and supervision
level 4 - requires minimal assistance (completes 75% or more)
level 3 - requires moderate assistance (completes 50%)
level 2 - requires maximum assistance (completes less than 25%)
level 1 - requires total assistance
66
Initial aphasia assessment
determines if an aphasia is present
if your patient has damage to the left side - look for signs
A screening will usually reveal word retrieval deficits
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Top aphasia assessments
boston diagnostic aphasia examination (BDAE)
| western aphasia battery (WAB)
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Orientation
knowing who you are and tracking the passage of time
| we assess if someone is orientated x4 (person, place, time, situation)
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Attention - sustained
maintaining attention to complete a single task (reading a book)
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attention - selective
maintaining attention to complete a single task in a distracting environment (reading a book on the subway)
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attention - alternating
completing two tasks efficiently, but switching attention between them (reading a page at a time then writing notes on what you read)
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attention - divided
completing two or more tasks simultaneously, multi-tasking (reading a book and walking at the same time)
73
Memory- immediate
Recalling information right after hearing it
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Memory- short term
Recalling newly learned information after approximately a 30 second delay; working memory
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Memory- long term
Recalling newly learned information after a 10 minute delay
| General knowledge or content based
76
Recent memory
recalling what has happened to the person within the day
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Episodic memory
Recalling specific dates or events
78
Procedural memory
recalling previously learned topics or steps/sequences to a task
79
Prospective memory
Recalling information for a future event
80
Problem solving
Identifying problems
Generating solutions
Organizing - what you need for the solution
81
Sequencing
Correctly putting items in order
82
Time management
Tracking the current time and the passage of time correctly
83
Safety awareness
Identifying potential dangers to oneself or others
84
Self monitoring
The ability to recognize errors and fix them
85
Executive functioning
```
Awareness/insight
Goal setting
Planning
Self Initiation
Self evaluation
Carryover
```
86
Critical thinking
Inferencing
Deductive reasoning
Abstract reasoning
Mental flexibility
87
Cognitive assessment
Completed 1:1
If person is easily distracted do in a room with lots of talking or music to get accurate representation
Standardized testing may not capture everything
Many places also do neurocognitive testing
Clinicians make informal assessments
88
California verbal learning test (CVLT)
For Memory skills
Standardized for Adults from Ages 16-89
Patients are given a list of 9 words to recall after an immediate delay, a short delay, a long delay, and then with cued responses
89
Galveston orientation amnesia test (GOAT)
Given after TBI
Can be given daily to assess change
Looks at current orientation and post traumatic amnesia
15 questions
90
Scales of cognitive ability for TBI ( SCATBI)
Consists of 5 sections- perception, discrimination, organization, recall, reasoning
Easily organized to give subtests separately
91
When making your own assessment
```
Look at
Clock drawing
Visual attention/target cancellation
Various attention types
Functional computation
Time management
```
92
Neuroplasticity
The ability for new cells to form, and for existing cells to take over for injured or damaged cells
93
Spontaneous recovery
new axons sprout and begin to take over for the injured nerve cells
no definite time window
for most lasts 6-8 weeks
94
Biofeedback
gaining greater awareness of your physiological functions - usually with equipment
95
Neurofeedback
example of biofeedback
sensory electrodes placed on scalp
strengthens brains ability to self regulate
individual can change thinking to slow down or speed up waves
96
Our role in brain injury treatment
facilitating the neuroplasticity
| training compensatory strategies
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orientation - compensatory strategies
using external aids (calendars, clocks etc)
fade cues over time for carryover
review daily info/events
98
severely affected sustained attention treatment
establishing a period of focus or eye contact to attempt to complete communicative intent
99
Selective attention treatment
asking a patient questions verbally while playing music
100
Divided attention treatment
having a patient sort cards while spelling words you are giving them
101
visual attention treatment
having a patient complete a visual cancellation task
102
interactive metronome
computer based program
provides constant feedback
can help with processing, comprehension, attention, reading and sports
103
recall treatment
can use logbook/planner
| many won't use this outside therapy so smartphones and apps help carryover
104
Memory compensatory strategies
Internal - repetition, visualization, grouping
| External - writing things down
105
Problem solving treatment
placing client in real-life scenarios to generate solutions
106
deductive reasoning treatment
draw conclusions based on cancellations
higher level
tasks - sudoku, logic puzzles
107
abstract reasoning treatment
analyzing info presented
finding patterns, making comparisons
tasks - explaining proverbs, completing analogies
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Executive functioning treatment
self monitoring
| planning and organizing
109
pragmatics treatment
best in a group setting
want client to recognize their inappropriate behavior
focus on - eye contact, topic maintenance, appropriate verbal/nonverbal exchanges
110
errorless learning
eliminates frustration
| more severe deficits
111
forward and backward chaining
having a person learn new information 1 building block at a time
112
behavior plans
ABC approach may be used
antecedent, behavior, consequence
interdisciplinary
113
positive reinforcement
when a behavior produces a new stimulus or motivating force
| consequence strengthens behavior by adding a stimulus
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negative reinforcement
occurs when a behavior removes or eliminates a stimulus
115
control of environment
if they're distracted go to quieter room
| selective attention - go to noisy environment
