Lecture 9: Concussion Flashcards
Chronic Traumatic Encephalopathy (CTE)
a progressive degenerative disease caused by multiple concussions and other closed-head injuries
characterized by neurofibrillary tangles, plaques, and cerebral atrophy and expanded ventricles due to cell loss
Concussion
a common term for mild traumatic brain injury
Tau Protein
a protein abundant in the CNS that stabilizes microtubules within neurons
high levels in fluid bathing the brain are linked to poor recovery after head trauma
accumulation in brain tissue is a sign of dementia
Coup
a bruise (confusion) at the site of a blow to the head incurred where the brain has been compacted by the skull bone pushing inward
Contrecoup
a brain injury caused when a blow to the head impels the brain to strike the skull opposite the primary blow
Shearing
a process in which microscopic lesions on nerve fibers throughout the brain, especially in the frontal and temporal lobes, result from twisting movement caused by a traumatic blow to the head
twisting and shearing may also damage major fiber tracks, especially those crossing the midline
Hematoma
a local swelling or tumor filled with effused blood
Edema
an abnormal accumulation of fluid in intercellular spaces of the body
Coma
a state of deep unconsciousness due to brain injury or disease
What are the four purposes for a neuropsychological exam?
discriminating psychiatric and neurological symptoms
can give information regarding a patient’s cognitive status and personality characteristics
rehabilitation and treatment evaluation and planning
research related to the study of the organization of brain activity and its translation into behavior
What are common populations for neuropsychological exams?
neurological illnesses and injuries
neurodevelopmental disorders
medical illness
toxin exposure
learning disabilities
behavioral and psychiatric conditions
In what why do neuropsychological exams discriminate psychiatric and neurological symptoms?
PTSD vs MTBI
both may have similar symptoms but are treated differently
In what why do neuropsychological exams provide information about a patient’s cognitive status/personality characteristics?
day to day functioning: the self-perception vs reality difference
ability to meet task demands
OCPD and the workplace: assessment can help understand what types of jobs suit people best
In what why do neuropsychological exams aid in rehabilitation and treatment evaluation and planning?
the purpose of rehabilitation: what cognitive supports does patient need? what psychological supports?
barriers to rehabilitation: understanding behaviors/issues that impact a patient’s engagement
defined outcomes: expectations about improvement/timing
In what why do neuropsychological exams aid in research related to the study of the organization of brain activity?
recovery from brain injury/strike
example: restraint therapy after stroke
research in the neurosciences
example: assessment of cognitive functioning in driver’s evaluations in seniors
What is assessed in a neuropsychological evaluation?
general intellect
higher level executive skills (sequencing, reasoning, problem solving)
attention and concentration
learning and memory
language
visual-spatial perception and construction
motor and sensory skills
mood and personality
How does neuropsychological evaluation test for lateralization?
left handed people –> more creative; similar scores on motor tasks on right and left
right handed people –> long differences between right and left
if right handed person’s right hand is weak, there is damage
How does neuropsychological evaluation test for localization?
where is the lesion/injury
stroke in Broca’s area: deficit in speech production
hearing in temporal, vision in occipital, higher order in frontal
How does neuropsychological evaluation test for severity?
degree of neurological impairment
are they able to do basic activities?
What is the Glasgow Coma Scale?
measures best response in 3 domains
motor response ( /6)
verbal response ( /5)
eye opening ( /4)
classification
13-15: mild brain injury
9-12: moderate brain injury
3-8: severe brain injury
What is post traumatic amnesia (PTA)?
refers to the inability of head-injured patients to form new memories
What is the classification of post traumatic amnesia?
less than 5 minutes: very mild
5 to 60 minutes: mild
1 to 24 hours: moderate
1 to 7 days: severe
1 to 4 weeks: very severe
more than 4 weeks: extremely severe
How does neuropsychological evaluation test for acuteness?
acute injuries typically have a rapid onset, severe symptoms but improve quickly
examples: migraines, strokes
How does neuropsychological evaluation test for chronicity?
chronic neurological conditions typically last for a long time or recur
examples: severe traumatic brain injury, Parkinson’s disease, multiple sclerosis
How does neuropsychological evaluation test for progressivity?
progressive conditions show evidence of deterioration
examples: Multiple sclerosis, dementia, ALS (Lou Gehrig’s disease)
What are diagnostic tests for concussions?
concussions involve a disruption of brain function rather than structural damage
the majority of time CT scans or MRI tests show no obvious damage
What is the neuropathology of concussions?
trauma/concussion
diffuse axonal injury: stretching or movement of the brain changes chemistry of the brain
massive release of K+ ions
increase glycolysis for K+ pumps
What differences are seen in the fMRIs of concussed patients and unimpacted patients?
much more activation in concussed patients
brain had to work a lot harder to do the same task
What are the conclusions of concussion education?
educational interventions suggest that simply presenting available information may help increase knowledge about concussions, but does not produce long-term changes in behavior among athletes
the most successful education efforts have taken steps to ensure materials are user-friendly, interactive, and multi-modal embedded in mandated training programmes
psychosocial theory-driven methods used to understand and improve “buy-in” from intended audiences have shown promise in changing behavior
What is the prosocial mindset?
circuits designed to enhance positive social behavior
appetitive: designed to take us closer to an experience and want more
circuits are wired for prosocial versus threat/defensive behaviors
threat circuits (defensive postures; fear responses, backing up) are shut down by prosocial circuits
our default is a defensive circuit; is to be concerned about the future; so we need gratitude practices to feel good
gratitude practices can tilt the sea saw between defensive vs prosocial circuits to dominate
How is the anterior cingulate involved in gratitude?
link between limbic system and prefrontal cortex
processing of discomforting/bad feelings
the “shame” circuit?
How is serotonin involved in gratitude?
increases activity of neural circuits that makes you more likely to stay in a positive interaction
How is the medial prefrontal cortex involved in gratitude?
planning and deep thinking and evaluating your experiences
sets context; defines the meaning of your experience
controls the hypothalamus and other brain regions that positively impact your system; things like dopamine, anti-inflammatory markers, immune system
moderates an individual’s experience
What are gratitude practices?
heightened sympathetic tone (more alertness); intensity of emotions are enhanced
hearing narratives of other people experiencing positive things/gratitude (i.e. someone help them in the midst of a horrible situation)
story/narrative circuits in the brain are powerful; (decreased activation of the ACC)
What are the outcomes of gratitude practices?
improved rating of quality of social interactions
improved ratings of feeling more positive/happier
more likely to manage stress
improved emotional regulation
