Assessments of TBI Flashcards
1
Q
Initial thoughts- TBI Assessments
A
- there is no such thing as a typical brain injury
- brain injury can occur at any age
- there is no uniform set of symptoms characteristic of all TBIs
- there are some commonly seen consequences of brain injury
1. cognitive deficits
2. perceptual deficits- sensory
3. physical deficits
4. behavioral/emotional deficits
2
Q
Cognitive deficits (8)
A
- attention deficits (basis for all)
- memory disorders
- language impairments
- impaired abstraction and judgment
- capabilities (inflexibility)
- decreased speed, accuracy, and consistency
- defective reasoning processes
- susceptibility to internal/external stressors (greater)
internal stressor- drive to suceed, fatigue
external stressor- deadlines- sometimes tbi patients don’t perceive the stressors
3
Q
Perceptual Deficits
A
- decreased acuity or increased sensitivity in vision, hearing, or touch
- vestibular deficits (balance=equilibrium)
responsible for vestibular (toe, cerebellum, vision, EPS, semicircular canals) - spatial disorientation- proprioception
- disorders of smell and taste-anosmia
(taste receptors on the epiglottis)
4
Q
Physical Deficits
A
- disorders of ataxia, spasticity, and tremors
- musculoskeletal disorders (pain/discomfort in the bones, joints, muscles, or surrounding structures; can be acute, chronic, focal or diffuse) (pt involved)
5
Q
Emotional and behavioral deficits
A
- irritability
- impatience
- poor frustration tolerance
- dependence- worse with aphasia
- denial of disability
- emotionally liable (cry, laugh)
6
Q
Prior to direct assessment…
A
- obtain as much information as possible (i.e., chart review)
- GCS- not over time- it is a point in time
- review type and severity of the brain injury
- date of onset
- identify the cerebral areas affected (subcortical, cerebellar?)
- investigate the client’s medical history
- pre-trauma personality and pre-morbid status
- recent CT scans and MRIs (radiology report)
- additional neuromedical variables (extended coma, cerebral hemorrhage, etc)
7
Q
TBI vs Aphasia vs ? 1
A
- speech/language characteristics resulting from TBI often resemble aspects of aphasia
- prominent aphasia-like symptoms include anomia, circumlocution, paraphasia, and perseveration
- dysarthria (especially spastic dysarthria) (cortical)
- look at language and pragmatics
- dysphagia
- You can have aphasia and TBI
8
Q
TBI vs Aphasia vs ? 2
A
- the primary objection to making a diagnosis of aphasia (saying the Pt has aphasia) is that the pragmatic and language behaviors associated with a true aphasia differs from those associated with a TBI
- CVA = aphasia: results in mild to severe language deficits while retaining most social and pragmatic functions
- TBI = essentially normal receptive/expressive language; communication difficulties are related to cognitive deficit components
9
Q
Assessment Areas (9)
A
- general cognitive/intellectual abilities
- language functions
- visuospatial, visuomotor, and visuoconstructional abilities
- attention and concentration
- learning ability (both verbal and nonverbal modalities)
- memory ability (both verbal and nonverbal modalities)
- motor functioning
- higher cognitive functioning
- emotional functioning
- remember the roles of the neuropsychologist
*** Don’t forget to assess language when doing cognition
10
Q
s/l batteries (useful for TBI)
A
- Assessment of Intelligibility of Dysarthric Speech
- BDAE and MTDDA- Boston diagnostic aphasia assessment, minnesota
- Boston Naming Test
- BTHI- Brief test of head injury
- EOWPVT and ROWPVT
- PPVT
- Scales of Cognitive Ability for TBI or SCATBI
- Token Test- following directions
- WAB- Western aphasia battery
- RIPA (pediatric, adult, and geriatric)- Ross information processing assessment
11
Q
“hard/soft” neurological signs 1
A
- hard signs give clear evidence of neurologic dysfunction
- soft signs are correlated with but do not confirm neurologic dysfunction
- correlation is not equal to causation**
- soft signs are not unusual for any child under 8y because they reflect an immature central nervous system
- soft signs are more often present in children w/developmental disabilities and those w/TBI than typically developing children
12
Q
“hard/soft” neurological signs 2
A
- hard/soft signs are difficult to interpret without additional information from your comprehensive evaluation
- diagnoses should not be based solely on the presence or absence of one or more neurologic signs
13
Q
“hard” neurological signs
A
- include but are not limited to:
1. abnormal infantile reflexes in non-infants (Babinski reflex, rooting, etc) (UMN) - confirm neurological dysfunction
- rooting reflex
2. disrupted motor function in one or more areas (unilateral paralysis or paresis)
3. disrupted sensory function in one or more areas (loss of vision)
4. dysarthria (slurred speech) that is not due to medications or physical injury
5. apraxia of speech or limbs
6. aphasia
14
Q
Soft neurological signs 1 (5)
A
- include but are not limited to: (if the child is less than 8, not a definite neuro issue)
- hyperkinetic motor overflow (constant movement of extremities)
- impulsivity (responding prior to thinking or being given all info)
- distractibility both internally (daydreaming) and externally (environmental sights and sounds)
- inattention or difficulty focusing on one’s work
- heavy use of concrete thinking based on stimulus features (bus is yellow w/wheels as opposed to a vehicle or means of transportation)
15
Q
Soft neurological signs 2 (5)
A
- slowed processing speed
- simultaneous movements of opposite limbs or digits that are unintended based on the task
- uncoordinated movements; slow motor movements
- immature grasp of writing instrument and difficulty drawing
- late milestone development
