Chapter 1-3 Flashcards
What is an ABI?
Underlying disorder in brain function; not heridetary, congenital, degenerative or induced by birth trauma
What is a traumatic brain injury?
Alteration in brain function, or other evidence of brain pathology, caused by external force
Why are brain injured patients at risk of developing significant disability?
Often, frequently unidentified, understanding of brain injury is limited, and treatment is not readily available
What is a traumatic impact injury/?
Traumatic impact injuries result from contact; either the head is struck by/against another object
What are the 2 sub-categories of traumatic brain injuries?
Open - Penetrating
Closed - Non-penetrating
What can happen with closed injuries?
Brain lacerations and contusions ; intracerebral hemorrhage within the brain, causing focal injuries (at a specific location within the brain)
What is a coup-counter coup injury?
linear acceleration, with rapid linear deceleration of the brain resulting in frontal lobe focal lesions.
What is the difference between an open and a closed injury?
Closed injuries can result in more diffuse axonal injuries resulting from tearing or shearing of axons
Open injuries are a result of a breach of the skull, or the meninges, often resulting in focal injuries such as subdural hematoma or cerebral hemorrhage
What is a potentially major complication of a penetrating injury?
Secondary infection, often due to the breach of skull/meninges
What is traumatic inertial injury?
Considered a non-impact injury; resulting from inertial (internal) forces .
Most commonly involve acceleration/deceleration forces
Injury when the brain contacts the skull (coup) and injury when the brain hits the other side of the skull (counter-coupe)
What are some examples of non-traumatic brain injury?
Damage cause by internal factors such as; lack of oxygen or nutrients, exposure to toxins, pressure from a blockage or tumor, or other neurological disease
What determines a brain injury classification of Traumatic or Non-Traumatic?
Relates to the cause of the primary injury
What is secondary injury?
Pathophysiological processes; impaired blood flow, tissue damage, edema formation, inflammation
Delayed non-mechanical processes; metabolic imbalance, membrane permeability, blood brain barrier breakdown
What are some aspects of secondary injury?
Hypoxia Anemia Metabolic abnormalities Hydrocephalus Intracranial hypertension Delayed release of amino acids Excitatory oxidative free-radical production release of free-radical production and metabolites
What does incidence refer to?
Prevalence?
The rate or range of occurrence
The # of people with a given condition at a specific time; the # of ppl living with brain injury
CNS cells refers to what?
Central Nervous System cells, different than the rest of the cells in your body
What is the annual cost to society, without identification, support and treatment of Brain Injury?
76.5 billion
What age group has the greatest risk factor for TBI, within these categories:
Adolescents
Young Adults
Adults
15-19
20-24
65+
75+ have highest rate of TBI-hosp/death
What is the estimated annual occurrence of TBI amongst these same groups?
Adolescent
Young adult
Adult
0-14 years - 511, 257
adults 65+ - 237, 844
Non-accidental trauma (abuse) is the cause of death in 80% of children under 2 who experience head trauma
What percentage of domestic violence victims also experience symptoms of brain injury?
67%
What is a factor in 37-51% of brain injuries?
Alcohol/intoxication
What kind of challenges are there for populations in prisons, with brain injury?
- high proportion of people incarcerated have undiagnosed brain injury
- without diagnoses and treatment, complicates the rehabilitation procedure
- when released to community, no diagnosis and no treatment puts individuals at higher risk of recidivism and non-productivity
25-87% of inmates have experienced a TBI, compared to 8.5% of general population
Female inmates convicted of violent crime are more likely to have sustained a pre-crime TBI or some other form of physical abuse. True or False
True
What are a couple of screening tools used to screen for concussion called?
ACE - acute concussion evaluation
HELPS tool
WARCAT - in the military
What does “lost productivity” refer to?
Loss of earning potential, payment of taxes and the re-investment of earnings into the economy
What percentage of Brain Injury patients are adequately funded for their rehabilitation?
5%. The other 95% require advocacy
What is the Rehabilitation Act of 1973?
Set foundation for state vocational rehab system (VR)
Federally supported system of services assisting people with disabilities in pursuing meaningful careers
- assists in gaining meaningful employment
- designed to assist disabled to attain competitive community based jobs
What must providers of brain injury support services provide?
Person Centered Planning (PCP) that supports max. independence :
- Age appropriate services/supports
- Freedom to move about in the community
- Integrated and accessible services
- PCP involving vocational + integrated employment goals, volunteer work or other day time activities
- In an ‘at-home-like’ setting within the community
Define Brain Injury as a chronic disease
- Not an event, or a fixed outcome
- Beginning of a chronic progression
- Impacts multiple organ systems
- Can cause/accelerate disease
What are the brain injury mortality stats?
2x more likely to die than non brain injured
7 yr life reduction
37x more likely to die from seizures
12x more likely to die from septicemia
4x more likely to die from pneumonia
3x more likely to die of other respiratory problems
What are the co-morbidity rates of Brain injury?
5% of entire epileptic population
TBI patients; 1.5-17x more likely to develop SUDEP (sudden death in epileptic patients)
What is the prevalence of disorder incidence after TBI?
Post-traumatic epilepsy:
Mod Injury - 4.2%
Severe - 16.7%
Sleep disorder - 36.7%
What are the symptoms of Chronic Traumatic Encephalopathy?
Begins slowly with:
deterioration of concentration, attention, memory and judgement, insight
headaches, dizziness occasionally
Severe cases eventually show symptoms of Parkinsonism;
Disturbed coordination
Slurred speech, masked faces, difficulty swallowing, tremors
Severely correlates with # of injuries
What is the prevalence of neuroendocrine disorders in B.I patients?
Dysfunctional pituitary gland greater than 30%
Growth hormone deficiency or insufficiency - 20%
Hyperthyroidism - 5%
Gonadotropin deficiency - 12-15%
What is the most debilitating consequence of TBI?
Psychiatric/psychological mood disorders.
- OCD, anxiety, psychotic mood disorders, and major depression
What musculoskeletal dysfunction is prevalent following B.I?
Spasticity: characterized by muscle tone resulting in abnormal patterns.
Requires life-long treatment, left untreated it can result in muscle contractures, tissue breakdown and skin laceration
What is made up of the brain and spinal cord?
Central Nervous System (CNS) which enables movement and action
How much does the brain weigh?
less than 1lb at birth, grows to 3lb, bathed in cerebrospinal fluid
What is the blood-brain barrier?
It is a barrier that ensures harmful substances canno pass through to the membrane and harm the brain
What 3 meninges cover the brain?
Outer layer; Dura matter - like a heavy plastic covering
Arachnoid layer - Like a spider web that bridges the brains wrinkles/folds
Pia matter - (tender) Molds around every tiny crook/crevice on brains surface
What is the function of the Spinal Cord?
Neurological superhighway
- Controls all nerve communication between brain/body
- Complex interconnection of nerves execute all body functions
What are the common neuroimaging techniques, and when were they developed?
Began in the 1970’s with:
Computed Tomography ( CT ) - Using an x-ray beam tech, creatures digital image of the brain, one section or slice at a time to harmlessly detect foreign objects
Magnetic Resonance Imaging (MRI)
- Greater anatomical detail/clarity in the image; displays pathologies more sensitively
What is a neuron made up of, and what is its function?
3 parts: Cell body, Axon (long slim wires that transmit signals from one cell body to another), Dendrites (networks of short wires that receive info at the synapse, from other neurons.)
Neurons receive/transmit information in a relay where electrical impulses alternate with chemical messengers (neurotransmitters)
What is an action potential?
Miniature information center, which does or does not fire electrical impulse. Depends on numerous signals it receives every moment.
After brain injury, how can neural pathways be affected?
Many pathways may be torn apart, stretched, metabolically slowed or chemically disrupted, causing information transmission to be delayed or no longer possible in the affected neurons/regions of the brain
What is the function of the brain stem?
Relays info in/out of the brain
Central point for all incoming/outgoing information and basic life functions
Made up of the Medulla, Pons and the Midbrain
Contains many of the centers for the sense of hearing, touch, taste and balance
What is the Reticular Activating System (RAS) and what is its function?
A collection of nerve fibers and nuclei.
Modulates or changes arousal, alertness, concentrations and basic biological rhythm
Brain injury can result in turned down RAS
What is the Medulla?
First part in the lower brain stem
- involved in many basic living functions
- if injured, life is immediately threatened
What are the Pons?
Just above the medulla
Essential for facial movement, sensations, hearing and coordinating eye movement
What is the Diancephelam?
Made up of the thalamus, hypothalamus, and other structures. Cm’s above the midbrain.
Master relay center for forwarding information, sensation and movement
What is the cerebrum?
hemispheres and lobes; can sustain serious injury; unresponsive thinking but life is sustained
What is the thalamus?
Sits at the very top of the brainstem, beneath the cortex
Major relay for incoming and outgoing sensory information.
Injury can cause severe attention and concentration difficulty, difficult memory storage, weak mental stamina, decreased sensory info
What is the cerebellum?
Lower, back of the brain. Coordinates, modulates and stores all body movement. 1/8th of brain mass, own arrangement of brain cells
What does the ‘tree of life’ refer to?
Governs every movement, monitors impulse from motor and sensory centers (brainstem, basal ganglia, sensorimotor cortex) to help control the direction, rate, force and steadiness of a persons movements. Enables development and storage of motor skills
What is the cerebral cortex?
left/right hemisphere. each has 4 lobes; frontal, parietal, temporal and occipital
dedicated to highest levels of thinking, moving and acting
What is the corpus collosum?
A complex band of nerve fibers that exchanges info between the two hemispheres of the brain. Surgeries to eliminate seizures resulted in cutting this out.