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Cognitive Communication > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

What are two types of injury that could occur with a TBI?

A

An open head injury (penetrating) and a closed head injury (non-penetrating)

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2
Q

What is an open head injury?

A

Something from the outside that makes it in-skull broken. There is a danger of infection and may be more focal.

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3
Q

What is a closed head injury?

A

There is a non-acceleration vs an acceleration injury. There is no open wound and more diffuse damage.

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4
Q

What are the primary effects from a TBI?

A

Diffuse Axonal Injury, Focal Contusions, and Coup or contrecoup.

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5
Q

What is a diffuse axonal injury?

A

There is a stretching and shearing of axons within the cerebrum and brainstem. (acceleration injury)

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6
Q

What are focal contusions?

A

Bruising, typically in frontal and temporal lobes, as the brain is pushed into the bony protuberance of the inside of the skull.

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7
Q

What is a coup?

A

An injury to the brain on the side of first impact.

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8
Q

What is a contrecoup?

A

The injury on the opposite side of impact as the brain rattles back from the coup.

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9
Q

What kind of communication areas could be affected from a TBI?

A

A variety of speech and language impairments are possible. They are mutism, aphasia, dysarthria, discourse deficits, and auditory or vestibular symptoms associated with TBI.

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10
Q

What is needed to be considered with mutism?

A

Can happen in the early stages of recovery due to impaired consciousness and locked-in syndrome.

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11
Q

Aphasia with a TBI?

A

Most commonly anomia, particularly early stages of recovery and 1/3 of severe TBI cases.

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12
Q

How often does dysarthria occur in TBI cases?

A

1/3 of severe TBI cases

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13
Q

What needs to be considered about discourse deficits?

A

Can still directly affect communication. May have poor topic maintenance, cohesion, and coherence.

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14
Q

What are severe communication deficits?

A

Recovery over an extended period of time to continue to reassess, 55-59% recover functional natural speech in middle stages of recovery.

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15
Q

What can be used as a scale for communication deficits?

A

Ranchos Los Amigos Scale Levels of Cognitive Functioning-Revised. Level five is used if the individual is unable to rely on speech, often due to severe motor speech and language deficits.

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16
Q

What are auditory or vestibular symptoms associated with TBI?

A

Tinnitus, dizziness, vertigo, hyperacusis, hearing loss, and loud sensitivity. Blast injuries may include tympanic membrane rupture, dislocation of ossicles, and cochlea damage. These signs may indicate blast exposure despite lack of other signs and symptoms.

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17
Q

What else is most common post TBI?

A

Dysphagia is also common.

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18
Q

What must be measured when considering a person’s cognition after a TBI?

A

orientation, awareness, theory of mind, attention, memory, and executive functions.

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19
Q

What is the typical order in which skills return post injury?

A

person, place, then time. Disorientation to purpose may return last or continue

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20
Q

What does orientation X3 mean?

A

to person, place, and time

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21
Q

What does oriented X4 mean?

A

fully oriented

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22
Q

What is considered a barrier to successful rehab outcomes?

A

A person’s awareness and their lack of ability to recognize their own deficits

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23
Q

What is emergent awareness?

A

A person being able to recognize their deficits in real time and needing to use compensatory strategies. (if you aren’t aware of balance issues, you will try to walk)

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24
Q

What is anticipatory awareness?

A

Recognize when a present deficit will cause and problem and take steps to lessen the consequences or avoid the situation. (you know not to step on the hurt food; you know to write down when you took a pill to keep track)

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25
Q

What happens if you have impaired TOM?

A

You will have difficulty taking other people’s perspectives into account

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26
Q

What is common post TBI regardless of severity?

A

Deficits in attention. These deficits interfere with successful rehab outcomes.

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27
Q

Deficits can be in all areas of attention. They include:

A

Focused, sustained, selective, alternating, and divided

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28
Q

What else can individuals with TBI be?

A

hypervigilant, become overstimulated, unable to be redirected. They may have difficulty selecting stimuli to attend to.

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29
Q

There are different levels of impaired consciousness

A

After consciousness is regained, minimal awareness state and having difficulty orienting to simple stimuli is common. When lower level skills are resolved, higher level attention skills (divided attention), may remain impaired-especially during complex tasks.

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30
Q

How many people with TBIs report persistent memory problems?

A

75%

31
Q

What are different types of memory that can be impacted?

A

Short and long term memory.

32
Q

What are different types of information that can be impcted?

A

Declarative, nondeclarative, visual, and verbal.

33
Q

More individuals with TBI have difficulty with what?

A

Storing/retrieving declarative than procedural

34
Q

Even mild TBI injuries will have what?

A

Deficits with episodic memory

35
Q

What is important to remember about EF’s?

A

EF’s are a group of cognitive processes that facilitate goal-directed behavior. EDF post TBI varies in severity and type.

36
Q

People with TBI may struggle to do what?

A

Set reasonable goals, plan and organize their behavior to reach goals, initiate behaviors that help achieve goals, inhibit behaviors that are incompatible with reaching goals, and monitor performance and revise plans as needed.

37
Q

People with EDF may also effect

A

poor judgement and struggle to anticipate the difficulty of daily tasks.

38
Q

What is important to assess after a TBI?

A

Injury severity. Look at the implications for prognosis and participation in rehab.

39
Q

What are two common measures of injury severity?

A

Length of impaired consciousness/coma (how long you were out) and the length of posttraumatic amnesia (PTA)-this is both anterograde and retrograde

40
Q

What kind of injuries do blasts lead to?

A

primary, secondary, tertiary, and quaternary injuries

41
Q

What is a primary injury?

A

caused by an extremely high pressure wave. All of the organs of the body are pushed. The most impacted are air-filled organs and organs surrounded by fluid-filled cavities (brain, spinal cord). The injury is greater when closer to the explosion

42
Q

What is a secondary injury?

A

An injury similar to OHI/CHI. Blast fragments flying through the air and can cause penetrating BI, contusions. Proximity is still a factor

43
Q

What are tertiary injuries?

A

From the body being thrown with force. The individuals are thrown against other objects by force of blast and cause multiple fractures. There are additional injuries to the brain consistent with CHI acceleration injuries

44
Q

What are quaternary injuries?

A

burns and chemical exposure. Other injuries and medical complications from the blast. Includes burns, toxic inhalation, radiation, asphyxiation, etc

45
Q

What are multitrauma injuries?

A

That one or all of these four types of injuries can occur.

46
Q

What is it called when multitrauma injuries happen?

A

polytrauma. TBI is a frequent result of polytrauma and occurs in combination with other disabling conditions (amputation, aud/visual impairements, PTSD, etc)

47
Q

What are some comorbidities of mTBI?

A

pain, dizziness and balance issues, sensory impairments, disordered sleep, fatigue, depression, irritability, ptsd, and other mental health concerns

48
Q

What is agoraphobia?

A

Fear of being in public.

49
Q

How many people seen in VA settings present with what?

A

A triad of symptoms that characterize the mTBI polytrauma in over 40% of people seen. Many have perissitng postconcussive symptoms, PTSD, and chronic pain

50
Q

What is the most frequent complaint reported by SMs with Hx of mTBI?

A

A headache (in 90%)

51
Q

What is the second most prevalent?

A

dizziness and balance issues. 59.3%. Dizziness may be due to peripheral injury. (vestibular part of auditory system) Patients with these 2 complaints tend to recover slower and have poorer prognoses with respect to returning to work.

52
Q

How many mTBIs have vision impairments?

A

about 50% have sensitivity to light, diplopia, blurred vision, reduced acuity, etc.

53
Q

how well does vision usually improve?

A

usually improves within about a month unless there is neuro/structural damage to the eye

54
Q

How often does hearing loss and tinnitus occur?

A

occurs in 60% of blast mTBI. The auditory system appears particularly at risk from blasts.

55
Q

what kind of hearing loss is most prevalent?

A

permanent sensorineural hearing loss. Those with a ruptured tympanic membrane after have conductive hearing loss

56
Q

There is a significant association between what that can be a diagnostic factor after the fact?

A

A ruptured TM and a Loss of consciousness. A ruptured TM is observable after the fact.

57
Q

What does research suggest in mTBI regarding the recovery process?

A

Early intervention and education. Keeping them up to date on where they are helps them with recovery.

58
Q

What is the domain affected most with dementia?

A

Memory is the principal neuropsychological domain affected most.

59
Q

Dementia involved related impairments in:

A

attention, EFs, language and communication, visuospatial ability

60
Q

What reduced regarding independence in dementia?

A
  1. reduced ability to complete tasks of daily living and 2. reduced awareness and safety.
61
Q

What is reversible dementia?

A

From vitamin B12 deficiency, metabolic disorders, toxic reaction to meds, drug abuse, and acute CNS infections. It can be treated-its underlying cause can possibly be cured.

62
Q

What is irreversible dementia?

A

progressive deterioration in cognitive function and capacity for independent living. Most common from Alzheimer disease, vascular disease, lewy body disease, and frontotemporal lobar degeneration. Can also be mixed.

63
Q

What is to be known about AD?

A

Most common dementia type. Accounts for 50-70% of diagnoses. Affects nearly 5.2 million americans. 200,000 of these are early-onset. Affects more women, greater in African American and Hispanic populations. Expected to affect 16 million americans by 2050.

64
Q

What are the hallmark of AD symptoms?

A

episodic memory and working memory dysfunction. Neuropathology begins with brain areas crucial to these (medial temporal lobe within the hippocampus).

65
Q

AD results in what?

A

significant EF impairments from early stages. Memory and EF impairments then affect communication.

66
Q

What is vascular dementia?

A

2nd most common cause of dementia. Impaired cognitive function and ADLs resulting from cerebrovascular disease, cardiovascular disease or circulatory distubrances that injure brain areas that are vital for memory and cognitive functions.

67
Q

In vascular dementia, what are the deficit patterns?

A

They are “patchy”. Some are affected early (visuospatial) and some are relatively spared (semantic memory).

68
Q

What is frontotemporal lovar degeneration?

A

accounts fro 10-20% of all dementia diagnoses. Affects 50-60,000 americans. Is typically diagnosed in one’s 30/40’s and progresses quicker than AD. It is the most common dementia affecting younger populations.

69
Q

Tell more about frontotemporal lobar degeneration:

A

results in a group of syndromes from degeneration of frontal and temporal brain regions. Best understood as family of neurodegenerative diseases rather than a single one. Results in deterioration in behavior and thinking. Isolated speech/language imapirments are often the earliest symptoms.

70
Q

What are three syndromes?

A

behavioral , language and motor.

71
Q

What is included in the language variant?

A

primary progressive aphasia. When the primary complain is language impairment for more than 2 years. Fluent-semantic aphasia, progressive nonfluent aphasia, and logopenic aphasia.

72
Q

What is logopenic aphasia?

A

Word retrieval difficulties, impaired phonological loop (WM)

73
Q

What is the motor variant component of the syndromes?

A

motor neuron disease, corticobasal degeneration, progressive supranuclear palsy

74
Q

What is lewy body dementia?

A

associated with abnormal deposits of proteins in the brain. dementia due to Parkinson’s disease (affects about 1/3 of individuals with PD)

Cognitive Communication (2 decks)

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