Ch. 3

Question 1

Age: Infants vs. Children

Answer 1

• Neurons undergo massive changes in form and connections during normal development and aging.

Question 2

Age: Infants vs. Children Sequence of Development 1 month

Answer 2

Nerve cells migrate to appropriate targets in central nervous system. Once neurons reach their destinations, they develop axons and dendrites, forming synapses.

Question 3

Age: Infants vs. Children Sequence of Development 8 months

Answer 3

The most intense dendritic growth happens.

Question 4

Age: Infants vs. Children Sequence of Development 1 year

Answer 4

The synaptic density activity reaches the maximum.

Question 5

Age: Young Adults vs. Old Adults

Answer 5

• Better recovery levels than older individuals. More strength, motivation, energy
• Age has an effect on long-term adaptation to brain injuries.

Question 6

Age: Brain Reserve Capacity definition

Answer 6

hypothesis that says that there is a pool of available brain capacity that provides protection from clinical symptoms but is still vulnerable to depletion via intrinsic and extrinsic events.

Question 7

Premorbid Intelligence and Education Level: Lower vs. Higher Education

Answer 7

o Varied cognitive requirements associated with educational activities may contribute to greater connectivity of neural networks. A person with a desk job will have a different brain than a researcher.
o University education vs. high school education. University education more cortical neurons and dendrites.
o Role of innate ability and exposure that the person gets. Contributes to brain physiology and functional capacities.
o Educated individuals are more likely to have better or more practiced pre morbid learning abilities and potentially more motivation for participation in rehab, higher family support, and more access to rehab services.

Question 8

Gender

Answer 8

Limited research on possible gender effects on recovery of function.
o Evidence for brain differences are present between males and females in terms of the shape and size leading to both interhemispheric and intrahemispheric.
o Potential recovery mechanisms including dendritic branching and synaptic contacts appear to be influenced by fluctuations in gonadal hormones.
o According to Kimura (1983), aphasia is more frequently in males.
o Sex hormones and hormonal cycling important role in an individual’s response to injury.

Question 9

Cultural Background

Answer 9

o	Include 
•	Language differences
•	Differences in group identify
•	Beliefs and values
o	The literature indicates that multicultural clients are likely to end treatment prematurely due to 
•	Misunderstanding
•	Frustration
•	Role ambiguities
•	Differences in priorities of treatment
o	There is a need to develop culturally relevant and appropriate treatment materials and activities.

Question 10

Premorbid Functioning

Answer 10

o Individuals with TBI tend to have a higher rate of drug and alcohol abuse prior to injury. In many cases, the substance use may contribute to brain injury.
o Factors predictive of poor vocational outcomes in TBI
• Unstable work history
• Alcohol use following injury

Question 11

Spontaneous Recovery

Answer 11

natural recovery of the brain within the first 6 months after the injury. Person is recommended for all therapy during those months to maximize the results of recovery.

Question 12

Spontaneous Recovery Time Range

Answer 12

o Most rapid recovery occurs in the first 6 months (spontaneous recover) with slower, but significant recovery occurring over the next 2 years.

Question 13

Diaschisis

Answer 13

reduced activity in remote and undamaged area that is functionally connected to a lesion area.

Question 14

Injury Extent and Severity: Focal vs. Diffuse

Answer 14

Recovery tends to occur rapidly for focal pathologies compared to diffuse injuries, although recovery may also relate to overall size of injury. Focal lesions may still have a significant and long-term impact based on areas of damage.
o With focal lesions, it is possible to restitution of functions. However, with severe injuries the recovery involves greater amount of compensation and behavioral adaptation.

Question 15

Recovery Rate: Simple Overlearned Tasks vs. Complex Activities

Answer 15

o Simple highly familiar tasks vs. complex tasks, highly familiar tasks typically occur faster than recovery of novel, complex tasks.
o Complex activities tend to require multiple underlying and interconnected skills
• Require more conscious and flexible control
• Usually using frontal lobe during complex tasks
• Based on this, it can be concluded that frontal lobe functions including effortful attention, flexible planning, organization, and problem solving are often among the most persistent impairments following diffuse brain injury.

Question 16

Psychological Factors

Answer 16

• Depression and anxiety are very common.
• Lack of awareness of deficit may be possible following TBI.
• Impaired self-awareness is associated with poor self-monitoring and poor self-regulation.
• Lack of awareness may lead to difficulties in many aspects of rehabilitation including
o Successful engagement and completion of treatment regiments
o Maintenance of deficit reducing compensatory aids
o Appropriate vocational choices

Question 17

Psychological Factors: other challenges to progress

Answer 17

o Anger
o Resistance
o Refusal to participate

Question 18

Neuroplasticity

Answer 18

brain’s capacity to change and alter its structure and function and its very critical to recovery following an injury.

Question 19

Synaptic Plasticity

Answer 19

o Learning and experience cause physical changes in the adult brain.
o All adults have an ongoing neural connectivity.
o A neuron that has lost input from a damaged neuron can develop new dendrites or dendritic spines to receive information from another neuron in the same circuit, or even from another, more distant circuits. This synaptic plasticity is important for both normal learning as well as recovery processes.
o “Cells that fire together wire together” synaptic connections become stronger when pre and post synaptic neurons are activated at the same time

Question 20

• Recommendations during early stages of recovery:

Answer 20

o Make sure the patient is rested.
o Make informed use of pharmacological interventions.
o Make use of natural windows of increased arousal and responsiveness.
o Monitor and control the attentional load of your clients. Watch out for overstimulation.
o Many behaviors may be elicited by an effective cue.
o Distributed practice over short periods is more effective than massed practice conducted in a single session.

Question 21

• Recommendations during later stages of recovery:

Answer 21

o Use shaping and behavioral chaining strategies.
o Emphasis on modification of antecedents and consequences in behaviorally oriented training.
o Teaching personalized attention and memory strategies.
o Work towards speed and efficiency of processing and responding while minimizing error rates.