Physiological Psychology Lecture #7

Question 1

Traumatic Brain Injury

Answer 1

“When a sudden, external, physical assault damages the brain”.

In the U.S.:
- 27,000 are hospitalized.
- 52,000 die from their injury.

Question 2

Causes of traumatic brain injury

Answer 2

In adolescence and young adults:
- Motor vehicle collisions.

In older adults:
- Falls

Question 3

TBI Sex and Age Breakdown

Answer 3

• Most common age: 15-24
• More common in men than women (at age 15-24), becomes more even as age progresses.

Question 4

Closed Brain Injury

Answer 4

Non-penetrating injury to the brain-no break to the skull. Injury can result from:
- Rapid forward and backward movement of brain in the skull–tearing and bruising of brain tissue and blood vessels.

Question 5

Coup

Answer 5

point of impact

Question 6

Countercoup

Answer 6

Injury of opposite side

Question 7

Diffuse Axonal Injury

Answer 7

Car crash, falls, sports, shaken baby syndrome.

Question 8

Penetrating Brain Injury

Answer 8

Penetrating or open head injuries where there is a break in the skull. Injury results from:
- Penetrating objects, and skull bone fragments damaging brain tissue and blood vessels = deprivation of normal blood supply and accumulation of blood.
- Cognitive impairment tend to be more focal.

Question 9

Ischemia

Answer 9

Deprivation of normal blood supply

Question 10

Hemorrhage

Answer 10

Accumulation of blood.

Question 11

Diffuse Axonal Injury (DAI)

Answer 11

“The shearing (tearing) of the brain’s long connected nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull”.
- Damage to white matter.
- Changes are microscopic.
- Can lead to disorders of consciousness (persistent vegetative state, coma).
- Difficult to see on CT scan or MRI
- Can occur without other visible damage.

Question 12

Grade 1 Axonal Injury

Answer 12

Mildest form of DAI
- Microscopic changes in the white matter of the cerebral cortex, corpus callosum, brain stem, and cerebellum.

Question 13

Grade 2 Axonal Injury

Answer 13

Moderate form of DAI (diffuse axonal injury)
- Grossly evident focal lesions isolated to the corpus callosum.

Question 14

Grade 3 Axonal Injury

Answer 14

Severe form of DAI
- Additional and severe focal lesions on the brainstem itself.

Question 15

Primary Injury

Answer 15

• Skull lacerations
• Skull fractures
• Contusions
• Cerebral lacerations
• Intercranial hemorrhage
• Diffise axonal injury

Question 16

Primary Injury

Answer 16

• Skull lacerations
• Skull fractures
• Contusions
• Cerebral lacerations
• Intracranial hemorrhage
• Diffuse axonal injury

Question 17

Secondary Injury

Answer 17

Due to:
- Increased intracranial pressure.
- Hypoxia
- Hypotension
- Hypothermia
- Electrolyte disturbance (Na, Ca, K)
- Toxic amino acids
- Oxygen radicals.

Question 18

Chronic Traumatic Encephalopathy (CTE)

Answer 18

• Produces neurodegeneration due to repeated head trauma.
• Prevalence in athletes who participate in contact sports.
• Mood and cognitive impairment can appear years after the injury occurred.
• Characteristic deficits include: dysexecutive functioning and mood liability.

Question 19

How can CTEs be confirmed postmotem?

Answer 19

Examination of brain tissue:
- Abnormal tau protein accumulation (similar to Alzheimer’s disease)

• Reduced brain volume (in corpus callosum and limbic system).
• Ventricular enlargement.

Question 20

True/False Individual will remember what happened/occurred after TBI

Answer 20

False

Question 21

Mild TBI

Answer 21

<30 minutes unconscious
- 13-15 Glasgow coma scale
- <24hrs post-traumatic amnesia

Question 22

Moderate TBI

Answer 22

30 min-24hours unconscious
9-12 Glasgow coma scale
1-7 days post-traumatic amnesia

Question 23

Severe TBI

Answer 23

> 24hrs unconscious
3-8 Glasgow coma scale
7days post traumatic amnesia

Question 24

Limitations to Glasgow Coma Scale

Answer 24

• Substance use.
• Administered drugs
• Intubation
• Injury to eye
• Hemiplegia
• Language

Question 25

Post-Traumatic Amnesia

Answer 25

state of confusion and disorientation that occurs immediately after TBI--part of healing process. - Brain is unable to form continuous day to day memories--memory is the slowest part of conscious mint to recover.

Question 26

Post-Traumatic Amnesia Behaviorally can present with:

Answer 26

- Confused and disoriented - Agitation and aggression - Inability to recognize loved ones - Childlike/clingy behaaviors -Confabulations - Can be difficult to remember family members - Goal is support re-orientation and sense of safety - Do not ask they to recall the injury--they cannot do this.

Question 27

Rancho Los Amigos Scale Revised (RLAS-R)

Answer 27

IV: Confused/Agitated: Maximal Assistance

Question 28

Dose Response Relationship

Answer 28

Most well-designed studies, using a representative, non-clinically referred study sample show: - Cognitive changes after TBI resolve within weeks to about 3 months at most spontaneously without treatment while changes tend to persist for less than or equal to 2 years following moderate to severe TBI

Question 29

Non-Injury Risk Facotrs that Can Influence TBI Outcomes

Answer 29

- pre-injury psychiatric status and conduct issues/incarceration - age at injury - level of education - stable employment 6 months pre-injury (best predictor of return to employment post injury. - marital status - other non-neurological injuries sustained--physical injuries can prevent return to meaningful activities.