Mindstorms Flashcards
When brain cells receive INADEQUATE oxygen.
Hypoxemia
When brain cells do not receive ANY oxygen.
Anoxia
What are the 4 major types of brain injury?
*Focal Contusional *Focal Hemorrhagic (or Ischemic Injury) *Diffuse Axonal Injury *Diffuse Hypoxemic or Anoxic Injury
Focal Contusional Injury
Bruising of specific areas of the brain
Focal Ischemic or hemorrhagic injury
caused by blockage or rupture of specific blood vessels that supply certain areas of the brain with oxygen - Stroke
injuries affecting the entire brain are termed ______
Diffuse
How long can brain cells survive without oxygenated blood?
Not more than 6 or 7 minutes
“Method is much, ____________________, ________________.” - Benjamin Cardozo
technique is much, but inspiration is even more.
Why shouldn’t you let someone with a possible head injury go to sleep?
You wouldn’t be able to tell if they fell into a coma.
Happiness is something no doctor can order up: It comes from _________________________________________________________.
doing things in your life that produce a sense of well-being.
What do you do if someone is having a seizure?
* Put them on their side (protects from aspirating) * Protect their head (put in lap or on pillow) * Call 911 for immediate medical attention * Never put anything in the mouth of someone who is in the midst of a seizure. * Many seizures end just minutes after they begin. * Risk of subsequent seizures.
Hypopituitarism
* Underactive pituitary glad. * Caused by injury to hypothalamus * Often overlooked in TBI diagnostic * Doesn’t appear until 3 months after TBI * Results in: weight gain, confusion, dry skin, stunted growth (in youths), amenorrhea (absent menstruation), infertility in women, and impotence in men. * Diagnosed with blood tests.
Hemiplegia:
Weakness or paralysis on one side of the body, most commonly seen following strokes.
Dysarthria:
A loss of oral muscle function that results in the inability to articulate words clearly, even though a patient’s knowledge of language is intact.
Dysphagia:
An inability to swallow caused by damage to the neurons that control the coordinated movement of the muscles in the back of the throat.
Ataxia:
An inability to coordinate muscle movements leading to awkward gait and imbalance.
What are the 2 subdivisions of long term memory?
Explicit (or declarative) and implicit.
What are the 2 subdivisions of explicit memory?
Episodic and semantic
Episodic memory
account of what occurs in our lives (what you had for breakfast, or who visited)
Semantic memory
* Facts * Learned from others * “textbook learning” * sometimes called “crystallized memory”
Implicit memory
* muscle memory or procedural memory
* doesn’t require conscious thought
* uses different parts of brain than other memory
retrograde amnesia:
loss of pre injury memories
postraumatic amnesia
unable to lay down new memories
Aphasia:
loss of speech and language
fluent aphasia
problems understanding spoken and written language (also known as sensory aphasia or Wernicke’s aphasia)
nonfluent aphasia
difficulty communicating both orally and in writing (also called motor aphasia or Broca’s aphasia)
global aphasia
can’t speak or comprehend language usually resolves into fluent or nonfluent aphasia
Episodic dyscontrol syndrome (EDS)
primitive emotion unchecked by higher executive functioning of frontal lobes (often leading to inappropriate expressions) If damage is restricted to outer areas of frontal lobes (dorsal lateral areas), the person may just not care about anything. This is often confused with depression as symptoms are similar. Both expressions called frontal lobe syndromes
Percentage of prisoners in our jails with TBI?
82% 65% had lost consciousness more than once due to head injury
Anosognosia
Brain-based disorder resulting with compromised frontal function, in which subject stubbornly refuses, and truly lacks the ability to understand, that they have problems.
Loss of sexual restraint caused by damage to which lobes?
Frontal and temporal
Abnormally high or low sex drive caused by damage to the __________
hypothalamus
Time is _____. - Anonymous
Brain
Hobbies can provide ___________________________
Real life therapy
The medical director
*team leader (symphony conductor) * drives treatment planing and therapeutic strategies * oversees and supervises entire staff * specialty may be in neurology, neuropsychiatry, or physical medicine and rehabilitation.
Complete TBI team usually has staff members from 3 disciplines
Neurology Neuropsychiatry Physical medicine and rehabilitation
Neuropsychologists perform:
*psychological, behavioral, and neuropsychological testing * cognitive therapies (to strengthen and compensate)
Clinical Psychologists
Provide counseling for patients and families (usually through teaching, cognitive behavioral manner, not “talk therapy”).
6 supporting members of a good TBI team
* Physical therapists * Occupational therapists * Speech and language pathologists * Rehabilitation nurses * Recreational therapists * Vocational therapists
Case managers
Supportive liaisons between patients and their funding sources. Ideally remains involved after patient discharge.
Factors in depression
* genetic predisposition * environmental stressors * hormonal imbalances * abnormal brain chemisty
SSRI’s
selective serotonin reuptake inhibitors
A person with severe TBI will rarely say that she is depressed - she will more likely demonstrate it by exhibiting the following symptoms:
* fatigue * inability to pay attention * obsessive thinking
SSNRI’s
Selective serotonin and norepinephrine reuptake inhibitors
Alternative to SSRI’s and SSNRI’s
inhibit reuptake of norepinephrine and dopamine (doesn’t produce weight gain or sexual dysfunction common in SSRI’s) bupropion (Wellbutrin)
Tricyclics
* Older class of antidepressants * impact whole array of neurotransmitters * may provide releif from pain * side effects: dry mouth, blurry vision, and constipation
emotional incontinence
* loss of control of emotions * can go from laughing to crying in minutes
What are Benzodiazepines (BDZ) used for?
* short term management of debilitating anxiety or insomnia
Alprazolam (Xanax)
Benzodiazepine
Xanax
Exelon
* Rivastigmine * Works by increasing acetylcholine
What natural salt can help balance mood?
Lithium carbonate * Can stabilize lives of TBI survivors * Can be toxic to cardiac and central nervous system if levels get too high
Why are stimulants used for TBI’s?
* reduce distraction and impulsivity * wake sleepy and lethargic patients * increase processing and ability to pay attention
Many stimulants increase what neurotransmitter?
dopamine
Common stimulants for TBI’s
* methlphenidate (Ritalin) * amphetamine (Dexedrine) * pemoline (Cylert)
Common SSNRI’s
* venlafaxine (Effexor) * mirtazapine (Remeron)
Common tricyclics
* impipramine (Tofranil) * amitriptyline (Elavil) * nortriptyline (Pamelar)
What non stimulant induces wakefulness, and what are it’s advantages over stimulants?
modifinil (Provigil) * non habit-forming * doesn’t increase heart rate and blood pressure
Key points to managing frustrated patients
* back off for a few minutes * after they cool down ask if they want help * ask if anger helped them accomplish their goal * see if they can “express rationale for the breakdown” * never assume you understand the patients rationale or problem
Why is routine easier on a brain injured individual?
Short-term memory can be so impaired by deficits in attention and concentration that new learning cannot take place. Routine impresses unconscious (procedural) learning stored in implicit memory. It doesn’t require the conscious thought involved in explicit memory and uses completely different neuronal pathways.
Repetition is key
break down tasks into simple steps and practice the important ones with added repetition Ex: practice putting shoes on more than once a morning
People cannot learn without
awareness
Ultimately, therapies directed at improving cognition are also designed to impact a persons _________, ___________________________________.
behavior, the observable manifestations of thought.
Reorganize bedroom to minimize _________ and establish _________ that will not require him to _______.
distractions routines think
Behavioral therapy works on the basis of what two simple strategies?
Reward the good and ignore the bad
Why try and ignore bad behavior?
humans are wired to crave attention, even if it’s negative attention. We’d rather argue and fight than be ignored.
“Many patients complain that they are “just too tired” to do these exercises, but if the family caregivers permit these activities to be set aside, _________________________________________.
the fatigue will only get worse.
When adults with moderately severe brain injuries are trying to return to work or school, the author thinks it is time for what?
Neuropsychological testing and structured vocational evaluation
How did Sigmund Freud define the good life?
As having the ability to both love and work.
Today, there is practically an epidemic of traumatic brain injury - a staggaring ___________ Americans disabled by TBI.
6.3 million
“If the human brain were so simple that we could understand it, we would be so simple that we couldn’t”
Emerson M. Pugh (research scientist for IBM)`
Peripheral nervous system (PNS)
all the nerves outside of the spinal cord and brain (usually run parallel with our blood vessels)
Central nervous system (CNS)
brain and spinal cord
Four major structures of brain stem:
* midbrain * reticular activating system * pons * medulla oblongata
Function of brain stem:
most basic functions * regulation of heart * breathing rates * blood pressure * general arousal
Function of limbic system
memories and emotional responses
2 other names for the cerebral cortex are:
* neocortex (“new brain”) * also called gray matter
Why is grey matter grey?
Nerves in this area lack the insulating myelin
Bulges on brain are called?
Gyri
Fissures on brain are called?
Sulci
largest opening at the bottom of the skull
foramen magnum
3 membranes covering the brain
dura, pia, arachnoid
dura
*first membrane under the skull *toughest layer covering the brain
pia
thin lining that hugs the brain
arachnoid
web-like lining between dura and pia
brain incased in what fluid
cerebrospinal fluid (CSF)
medulla oblongata
* lowest part of the brain stem * takes care of automatic responses like: - breathing - swallowing - blood pressure - body temperature - pupils
reticular activating system
* within the brain stem, adjacent to and above the medulla * reponsible for: - producing arousal - controlling sleep-wake cycles
pons
* “bridge” from lower brain stem to midbrain and cerebellum
* coordinates motor movements
* helps maintain balance
midbrain
*reflexive control of visual and auditory information and orientation * dorsal part connects RAS and cerebellum
cerebellum
* “little brain” attached to back of brain stem * 3 lobes * coordinates all our movements * including regulating fluid speech * remembers learned motor responses like riding a bike
thalamus
* the brain’s relay center to the cerebral cortex * “every bit of information, every message… goes through the thalamus … look like testicles in the middle of your brain
The thalamus and hypothalamus are the two all-important gateways to ___________, _________, and _________.
higher thought, emotion, mental health
Hypothalamus
* right below thalamus * one of the brains control towers * “Although no bigger than a pea, it’s a dynamo of function”. * controls eating patterns * sleeping and waking cycles * body temperature * blood sugar levels * emotional tone * sex drive * hormonal balances via pituitary gland
pituitary gland
regulates hormonal production and secretion
cortisol
* a steroid that promotes healing * produced by adrenal gland * controlled by hypothalamus * can create chronic stress response if constantly produced
Limbic system
* network of nerve cells that providing the “biological basis of our emotional lives” * right below higher functioning cerebral parts of the brain * “ensures that emotions reach our conscious thoughts - and our thoughts affect our emotions.” * limbic system and cerebral cortex actively influence each other (why emotional events are well remembered) * damage to limbic system can leave patient distant and disconnected from others
Hippocampus and amygdala are responsible for ____________________________________.
much of what we remember and the tone of our emotions. (Triggers limbic system)
Hippocampus is directly connected to what functions.
the senses.
- touch
- sight
- hearing
- smell
Neocortex
Uniquely human additions to the cerebral cortex that all mammals share. “new brain”
prefrontal cortices are responsible for:
executive functions (reasoning and judgment)
The frontal lobes are where your….
personality anatomically exists. Where it is created, honed, and refined. Where the ego is housed.
“If someone suffers damage to his frontal lobes, …”
“… he will not be himself - literally.”
What is the general function of the parietal lobes?
Sensation and perception
The frontal and parietal lobes meet where there are strong connections for what?
Muscle movement and sensation.
The main function of temporal lobes
* make sense of what we hear (via the auditory cortex) * perceptions and memories (via limbic system and it’s connections)
What is the primary function of the occipital lobes?
analyze what we are seeing
In general the left hemisphere controls:
* details * logical thinking * language skills * numerical calculations * and movement on the right side of the body
In general the right hemisphere controls:
* big picture concepts * visual memories * artistic talents * and movements of the left side of the body
Brain hemispheres. The right side sees “_________”, the left side sees “__________’.
the forest the trees
What chemicals carry messages between neurons?
Neurotransmitters
Prozac
flouxetine SSRI
Paxil
paroxetine SSRI
Zoloft
sertraline SSRI
Lexapro
excitalopram SSRI
Celexa
citalopram SSRI
What might help TBI Patients with memory loss
Exelon (Rivastigmine) * Already used in treating Alzheimer’s * Because TBI’s increase the likelihood of Alzheimer’s, it might be reason to use these medications earlier in management.
Chlordiazepoxide
Benzodiazepine
(Librium)
Clonazepam
Benzodiazepine
(Klonopin)
Diazepam
Benzodiazepine
(Valium)
Lorazepam
Benzodiazepine
(Ativan)
