PSYC 492 UNIT 3 - TBI and Rehab Flashcards
injury to the brain occurring after birth, which is not hereditary, congenital, degenerative, or induced by birth trauma
acquired brain injury (ABI)
A brain injury that comes from “within” is ————-.
non-traumatic
A brain injury that is caused by force (“hit” or “blow”)
Traumatic Brain Injury
An infection that damages the brain would be considered a ———— brain injury.
Non-Traumatic
other: tumor, stroke, anoxic/hypoxic (strangulation, overdose)
T/F:
A traumatic brain injury is visible.
False, a TBI can be penetrating or non-penetration (closed head)
Primary Brain Injuries:
list 5
- occur at time of injury
- hemorrhage
- hematoma
- contusions
- axonal injuries
Secondary brain injuries….
list 3
- hypoxia
- edema
- infection
A hallmark of TBI is ——————
Diffuse Axonal Injury
or Traumatic Axonal Injury
Explain diffuxe axonal injury.
Diffuse degeneration of axons
Depending on how you hit your head, you might have global damage, but a lot of damage can happen globally
—————- is immediate axonal severage. What does this mean?
- primary axotomy
This is when the injury is so severe, it tears right away
What 3 things can the strain of diffuse axonal injury cause?
- biochemical alterations
- Cytoskeletal damate
- secondary axotomy
——— damage is when the axons that support the brain break down.
cytoskeletal
What is secondary axotomy?
progressive deterioration affecting both proximal and distal axonal fragments
A chronic issue associated with Traumatic Brain Injury is ———.
- white matter change
White matter differences over time can lead to atrophy of the brain.
T/F.
No two TBIs are the same.
True
DTI shows that for both brain scans, white matter organization and fibers are much less dense a year later. But outcome looks different between both patients.
- Patient A looks fuller at a year than it did 2-days post TBI
- Patient B looks fuller at 2 days, then gets worse
Per year, there are approximately ————- ER vistis, hospitalizations, and deaths each year. Why is this likely an underestimate of the real number of TBIs?
2.5 million
because many people are unaware that they have a TBI; also some people don’t have as good of access to care and are unable to go to the hospital/get treated for TBI (e.g., at-risk populations like people experiencing domestic violence)
In Nebraska…
—- person dies from TBI/day
— are hospitalized a day
—– visit the ER for TBI/day
——— Nebraskans are living with disability due to TBI
Costs ——————–
- 1
- 3
- 24
- 36000
- $413 million
Causes and Risk Factors for TBI
52% of TBI hospitalizations were due to ——–. This was the leading cause for ages 0-17 and 55+ (kids and older adults)
falls
Causes and Risk Factors for TBI
20% of hospitalizations for TBI were due to —————-. For people ages 15-44 (teens to middle age), this was the leading cause of TBI hospitalization
motor vehicle accidents
T/F
Women are more likely than men to get a TBI.
False; men are 2.22x more likely to get a TBI
Which groups of people are more likely to get a TBI?
- veteran populations
- justice-involved individuals
- survivors of intimate partner violence
- people of racial/ethnic minorities
Disparities in TBI
——-% of justice-involved youth screened positive for TBI
72%
Why are veteran populations more likely to get a TBI?
not only blast injuries, but TBI also occurs in non-deployed settings
Individuals experience homelessness are —- to —-x more likely to have a TBI. Moreover, they are —-x more likely to have a moderate or severe TBI.
2-4x more likely to have any TBI
10x more likely to have moderate or severe TBI
Locally, —-% of survivors of intimate partner violence have experienced some sort of hit to head or strangulation. —–% of survivors of intimate partner violence screened positive for TBI.
91% IPV survivors have had hit to head or strangulation
58% of IPV survivors screened positive for TBI
Youth and adults of which race/ethnicity have higher rates of TBI hospitalizations and deaths than any other group?
indigenous
Which 2 race/ethnicities are less likely to receive follow-up care and rehab for TBI?
black; Hispanic
What might a mild, moderate, and severe TBI look like?
mild: concussion
moderate: involves loss of consciousness/mental alteration
severe: major damage to the brain, 24+ hours unconscious
TB severity is difficult to determine.
What scale is often used to assess the severity of a TBI?
Glasgow Coma Scale
The more responsive you are, the more likely your injury is mild.
The 3 primary domains assessed in the Glasgow Coma Scale are?
- eye opening
- verbal response
- motor response
How is the eye opening response measured in the Glasgow Coma Scale?
From 1 (severe) to 4 (mild)
eyes open…
- no eye opening response
- only in response to pressure/pain
- only in response to sound
- spontaneously
How is the verbal response measured in the Glasgow Coma Scale?
1 (severe) to 5 (mild)
verbal response is…
1. no verbal response
2. make sounds
3. can say words
4. can speak but is confused
5. orientated
How is the motor response measured in the Glasgow Coma Scale?
1 (severe) to 6 (mild)
motor response is…
1. no motor response
2. abnormal extension
3. abnormal flexion
4. will flex to withdraw from pain
5. moves in response to localized pain
6. obey commands
T/F
You must lose consciousness in order to have a TBI.
False, you do not need to lose consciousness to have a mild TBI.
Posttraumatic amnesia in TBI says what about the injury severity?
the less you are able to remember, the more severe the injury
T/F
TBIs are visible on imaging scans.
False
Some are, but mild TBIs might not show up on an imaging scan. If it shows up it is probably more severe
List 7 physical symptoms of TBI.
- neck pain, headache, numbness
- imbalance, clumsiness, dizziness
- sensitivity to noise/light
- nausea
- fatigue
- difficulty with sleep
- visual impairments (including eye tracking)
Explain how TBI might affect your cognitive functions.
TBI might have effect on:
- attention, including sustained attention
- memory: especially short-term and learning new info
- executive function: ability to complete goal-oriented behaviors
- processing speed: might know info, but takes longer to pick it from brain
What aspects of executive function might be affected by TBI?
- initiation/organization of activity
- reasoning and problem solving
- mental flexibility (shifting, multi-tasking)
EF deficits often mistaken for laziness; invisible
People who experience a TBI might have communication difficulties including difficulty with:
- rules/cues (both verbal and nonverbal) of social interactions
- understanding what is being said
- expressing themselves
What symptoms might impact a person with TBI’s ability to understand speech and express themselves?
difficult understanding what is being said because of:
- slowed processing speed
- inattention
- difficulty “tracking” conversation
difficulties expressing selves because:
- word-finding difficulties
- poor organization of speech/thought
- struggle to stay on topic
Name examples of communications difficulties related to a person with TBI’s issues with:
- rules/cues
- difficulty understanding
- difficulty expressing selves
Difficulty with rules/cues:
- might get too close to you (nonverbal)
- inability re “read between the lines” (verbal)
Difficulty w understanding:
- might be inattentive or distractable
Difficulty w expression:
- awkward pauses when preparing to respond
- feeling like they are being “put on the spot”
List some emotional/behavioral symptoms a person with TBI might experience.
- personality change
- difficulty w emotional and behavioral self-regulation (motivation and control)
- may appear emotionally “flat”
- may be impulsive/disinhibited (speak without thinking)
- lack of insight/self-awareness (lack of knowledge about their own emotional state; can’t identify which emotion they are feeling; person who was previously successful might not have cognitive capacity to keep doing job but they don’t realize it)
Mental health is a ———– and ———– issue in TBI.
- prevalent
- persistent
People with TBI are 2.8x more likely to develop psychiatric disorder
The consequences of poor mental health are severe for survivors of TBI. Explain.
People with TBI are…
- at high risk for suicidal ideation and tendencies after TBI
- make more frequent attempts than those without TBI
- at higher risk of dying by suicide
What are the rates of psychiatric disorder so much higher in TBI?
- effects of injury on brain chemistry, structure, functioning
- psychological impact of accident/event
- psychosocial effects of resulting diabilities
- psychiatric disorders also might be pre-disposing risk factor for TBI
How many people with TBI have a history of psychiatric disorder before their injury?
51%
Why is it so important to recognize a TBI in an individual in order to improve mental health.
- having a TBI may complicate treatment efforts for psychiatric disorders
- “traditional” pscyh interventions may need additional considerations
How do the effects of TBI impact brain chemistry, structure, and functioning?
limbic system affected = effect on emotional regulation
frontal lobes particularly susceptible to TBI and can affect social function
skull structures that are pointy/hold brain in place can shear the brain as it shakes within skull
What traditional psych interventions may need additional consideration when a TBI is involved? Why?
- psycho-pharmacological (medication considerations
- psychotherapy (might engage with client differently, client may take longer to do things)
- psychosocial interventions (group therapy or peer support might be more difficult for someone with TBI)
TBI Recovery
Domains may resolve at different rates after TBI. ———– may take longer than other symptoms.
Cognition
TBI Recovery
How long does it take most mild TBIs to recover?
within first 3-4 weeks
moderate, severe, and 10% of mild injuries require more time to recover and may become chronic issues
Multiple TBIs have a ——— effect.
cumulative
want to avoid multiple injuries, especially in short time span
People with mild TBIs bounce back much more quickly than moderate/severe injuries. Best chance of returning to normal.
(just a fact)
What should you do acutely after mild brain injury?
- plenty of rest and sleep
- avoid physically or cognitively demanding tasks
- don’t do too much too fast (gradual return)
- do not “tough it out”
- avoid alcohol and other substances
- repeat concussions before brain has healed can be dangerous (be safe!)
T/F
People with TBI might have difficulty navigating social relationships and/or settings.
True
T/F
Mental health issues clear up quickly after TBI and are only relevant immediately following the injury.
False
T/F
Psychologies may have to think about adapting therapeutic approaches when working with clients with TBI.
True
It is okay to resume all normal activities immediately after sustaining a TBI.
False
