Lecture 11, 12 Flashcards
How is mild traumatic brain injury (mTBI) diagnosis based on?
Based on the initial neurological signs and symptoms at the time of the event.
What are the neurological signs and symptoms used to diagnose mTBI?
- Loss of consciousness, altered mental status, amnesia or confusion
- Loss of consciousness <30 minutes
- Glasgow Coma Scale score of 13-15
- Post-traumatic amnesia ≤ 24 hours
What are the categories of mTBI?
Sports-related concussion
Mixed-mechanism mTBI
Military-related concussion
What is a Mixed-mechanism mTBI?
falls, motor vehicle accident, assaults, etc
What is a military-related concussion?
blast-related, blunt force trauma, combination
What occurs during a concussion?
- ionic balance of the neurons is disrupted
- excess amounts of glutamate (neurotransmitter) are released
- toxic synapses & slowed communication between neurons (caused by the combination of dysfunction in sodium-potassium pump and too much glutamate)
What happens when there is a disruption in ionic balance of the neurons?
Potassium rushes OUT of cells
Sodium and calcium flood INTO cells
Brain temporarily goes into a _____ state consuming lots of energy and resources quickly. Followed by a __-__ day decrease in cerebral blood flow and hypometabolism.
Hyperactive; 7-10
What microstructural changes occur during mTBI?
diffuse axonal injury
edema
inflammation
Describe diffuse axonal injury.
- dysfunction that can occur in the frontal lobe, cerebellum, and corpus callosum
- unmyelinated cells are susceptible to damage
What is the acute stage of mTBI?
7 days post injury
T/F: CT and MRI scans are insensitive to neuro-pathology of mTBI (e.g., diffuse axonal injury)
True
What are the tree promising scans sensitive to the neuro-pathology of mTBI?
fMRI: functional magnetic resonance imaging
PET: positron emission tomography
SPECT: single-photon emission computed tomography
T/F: There are no current, definitive biomarkers, neuroimaging procedures, or neuropsychological tests that can diagnose remote mTBI events
True
What is SPECT?
single-photon emission computed tomography
What is PET?
positron emission tomography
What is fMRI?
functional magnetic resonance imaging
T/F: Lack of positive imaging findings invalidates diagnosis of mTBI.
False. does NOT
Clinical diagnosis of mTBI is based on what?
history of a traumatic injury resulting in alteration of consciousness
Acute and persistent symptoms fall within 3 categories:
physical
emotional
cognitive
List 5 physical symptoms.
headaches sleep disturbance dizziness balance problems fatigue vision changes, light sensitivity tinnitus
List 3 emotional symptoms.
irritability anxiety depression post-traumatic stress mood swings
List 3 cognitive-communication symptoms.
- concentration and attention problems (processing speed)
- memory and learning
- executive function
- social cognition and social communication
- word finding difficulties
_____ difficulties include: Maintaining attention, maintaining train of thought, and focusing with both verbal and visual attention
Functional
_____ is a precursor to memory and learning.
Attention
Slow information processing includes:
- evident on timed tasks, verbal fluency measures
- processing conversations
- following directions
- note-taking
- following complex, multistep instructions
____ working memory impacts language comprehension. 79% prevalence in persons with mTBI.
Verbal
Impairments in verbal memory encoding and learning efficiency contributes to ______ learning difficulties.
academic
______ memory can negatively impact quality of life.
episodic
List 3 things involved in social communication.
- Requires rapid evaluation of context and listener •Prior to initiating an appropriate topic
- Providing sufficient and relevant, but not excessive details
- Controlling utterance length•Allowing others to comment
- Using both verbal and nonverbal methods to convey stated and implied meaning
What is the primary language symptom?
word finding problems
Audiologist assess for _____ _____ ______ _______
central auditory processing disorder (CAPD)
Run-on sentences Fragments Grammatical errors Semantic errors Agreement errors for verbs and pronouns
are all _____ and _________ errors.
Micro; macrolinguistic
T/F: Dysarthria is not seen in mTBI.
True
T/F: Stuttering reported in mTBI is likely to be neurogenic.
False; unlikely
What are the cognitive-communication domains?
attention processing speed working memory memory and learning executive function social cognition/communication receptive language expressive language speech
Chronic Traumatic Encephalopathy (CTE) is presumed to be a condition where _________________ tau protein accumulates in the brain. Causing progressive deterioration of neurologic function resulting in _____.
hyperphosphorylated;
dementia
In CTE tau accumulates throughout the brain including the: ____, ____, _____ _____.
hippocampus
amygdala
cortical areas
Diagnosis of CTE are based on what:
post-mortem brain pathology and personal reports by family and friends.
List the symptoms attributed to CTE.
- decreased memory and executive function
- aggression, depression, erratic behaviors
- changes in motor function and balance problems
What are long-term consequences of repeated mTBI?
depression and cognitive deficits later in life
Repeated concussions may result in _____ cognitive deficits and psychosocial emotional issues.
chronic
Military-related mTBI is ____ likely to have chronic, persisting symptoms than sports-related concussions
more
T/F: Blast injuries causes an instantaneous rise in atmosphere pressure, that is much higher than normal for humans to withstand .
True
What are the 4 mechanisms of blast injuries?
Primary
Secondary
Tertiary
Quaternary
Define the 4 mechanisms of blast injuries (primary, secondary, tertiary, and quaternary)
Primary- Result directly from the explosion
Secondary- Result from the blast fragments or other objects flying through the air
Tertiary- Result when an individual is thrown by the force of the blast
Quaternary- All other injuries or complications; including burns, toxic inhalation, inhalation of coal or asbestos dust, exposure to radiation, asphyxiation
Blast-plus-impact TBI is exposure to ______ blasts and ______-related blows.
multiple; impact
Blast-plus-impact TBI results in a complex combination of impairments in: _______, _______, and _____-____ functioning.
physical, cognitive, psycho-social
An explosive pressure wave causes ______ and _____ damage to the human auditory system causing hearing loss and tinnitus
peripheral; central
What hearing loss is the most prevalent type of auditory impairment?
permanent sensorineural hearing loss
What causes a conductive hearing loss?
Ruptured tympanic membrane
Military veterans with PTSD and depression have a high risk for self-reported ______ ______, even in the absence of mTBI.
cognitive dysfunction
In acute mTBI, a comprehensive assessment is deferred for a minimum of __ weeks and up to __ months based on symptom resolution studies.
2; 3
Purpose of comprehensive assessment in acute mTBI is to identify and describe underlying strengths and weaknesses of:
cognitive skills
language skills
social skills
effects of cognitive communication impairments on individual’s performance in daily activities and participation
What are the underlying strengths and weaknesses related to cognitive domains in mTBI?
attention, _______ processing, memory, executive function, _____ ______ skills.
information; social communication
T/F: Many formal standardized assessments are not sensitive enough to postconcussive impairments. Defer to neuropsychological evaluation when available
True
T/F: Goal of cognitive therapy is to treat functional concerns observed by the clinician.
F. functional concerns described by the patient
Name 2 symptom checklists that can be used with a patient.
- Neurobehavioral Symptom Inventory (NSI)
- Acute Concussion Evaluation (ACE)
- Post-Concussion Scale (PCS)
- Symptom Evaluation portion of Sports Concussion Assessment Tool 5 (SCAT5)
- Self-Awareness of Deficits Interview
What two approaches are there for cognitive communication rehabilitation counseling?
Patient-centered approach
Goal attainment scaling (GAS)
Name the approach:
- Engages individual’s participation in goal setting
- Integrates goal-directed counseling for eliciting behavior change
Patient centered approach
Name the approach:
•Engages patient in setting direction for his/her therapy
•Establishing personal functional goals that serve as measures of clinical outcomes
Goal attainment scaling (GAS)
Cognitive communication treatment is: systematic, ______ oriented, ______ activities, and based on assessment and understanding patient’s brain-behavioral deficits.
functionally; therapeutic
List the three treatment approaches for attention.
direct attention training
use of compensatory strategies
education
What attention treatments are effective for people with mTBI?
treatments that focus on strategies to allocate attention resources (e.g., rehearsal, self-pacing) and reduce anxiety and frustration.
The following are interventions for _____ _____
•Increasing awareness and management of temporal demands of tasks
•Compensatory strategies to allocate attention resources and manage flow rate of information •Verbal mediation
•Self pacing
•Self monitoring of mental effort
•Management of secondary emotional reactions during task
Processing speed
What are facilitation strategies for memory?
semantic associations
visual imagery
mnemonic training
T/F: Use of external memory strategies and technology has proven effective globally.
True
What is metacognitive strategy training?
Direct instruction to facilitate behavior self-control and self-monitoring task performance
What steps are applied in Metacognitive Strategy Training?
- Identify an appropriate goal
- Anticipate what needs to be done to reach the goal
- Identify possible solutions to challenges
- Self-monitor and evaluate progress
- Modify behavior or strategy use if adequate progress is not being made
- Self-monitor and evaluate progress through to outcome
- Review what was successful and unsuccessful
Define TBI.
An acquired injury to the brain due to an applied force that results in widespread damage to cortical and subcortical structures
______ Mechanism of Injury is related to the instantaneous effects of acceleration/deceleration (translational) and rotational forces acting on the skull and brain
Primary
Secondary mechanism of Injury results from primary mechanism but can occur _____ or ____ later.
minutes; days
Shearing strain during rotation causes damage to the _____ (rotational forces TBI)
cortex
List the variety of scales and ways to describe what happens during a TBI
Glascow Coma Scale
Post traumatic amnesia
Altered level of consciousness
Altered state of consciousness: coma vegetative state \_\_\_\_\_\_ vegetative state \_\_\_\_\_\_ vegetative state \_\_\_\_\_\_ conscious state
persistent
permanent
minimally
List 5 common deficits following TBI.
- Orientation
- Attention
- Memory
- Executive functioning
- Processing speed
- Self-awareness
- Language
- Pragmatics
- Dysphagia
- Motor speech (dysarthria)
- Hearing
- Vision
Name the globally recognized model for assessing deficits at the impairment, activity, and functioning levels within the recovery continuum.
World Health Organization’s Classification of Functioning, Disability, and Health (WHO-ICF)
List the the types of assessment for TBI.
- Early assessment
- Scales and Observational checklists
- Self-report and Quality of Life measures
- Standardized Assessment measures
- Functional Assessment measures
Name 3 scales and observational checklists for TBI.
- Ranchos Los Amigos Levels of Cognitive Functioning
- Functional Independence Measures (FIM Scores)
- Disability Rating Scale
Lecture 12 slide 18
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