quiz 5

Question 1

what are the different categories of TBI

Answer 1

open

closed
- acceleration-decceleration
- diffuse axonal injury (DAI)
- combat related blast injury

Question 2

open tbi

Answer 2

when the scalp, skull, and meninges are penetrated (ie gunshot wound)

Question 3

closed tbi

Answer 3

typically from mechanical forces
- acceleration-deceleration

Question 4

acceleration-deceleration

Answer 4

the moving head suddenly stops but the brain continues to move in the original direction
- coup: point of initial impact
- contrecoup: wwhen the brain rebounds in the opposite direction and impacts another surface of the skull

(closed head tbi)

can cause DAI

Question 5

diffuse axonal injury (DAI)

Answer 5

jerking/twisting motion of brain during acceleration and deceleration resulting in axonal stretching, shearing, and tearing
- results in disrupted neuronal communication among various brain regions

Question 6

combat-related blast injury

Answer 6

may result in injury from one or more of 4 mechanisms:
- primary mechanism results from rapid pressure changes from the blast wave in organs with air-fluid interfaces
- secondary injury occurs when debris, set in motion by the blast, strikes th body, resulting in focal damage
- third mode is when the body is thrown against a surface which causes injury
- fourth includes other processes, like inhalation of toxic agents or radiation

Question 7

what is the difference between primary and secondary damage in a TBI?

Answer 7

primary= focal and diffuse lesions

secondary= things like infection, oxygen deprivation, brain swelling, and elevation of intracranial pressure

Question 8

what populations are at highest risk (highest incidence) for TBI?

Answer 8

• ages 15-24 (typically associated with motor vehicle crashes)
• then over age 65 and under age 5 (mostly from falls)
• males twice as likely as females
• those with previous tbi are 3x as likely to have another tbi

Question 9

basic structure of the glasgow coma scale (GCS) and 3 major areas of function assessed

Answer 9

• assesses severity of injury by rating (1) the degree of eye opening, (2) best verbal response, and (3) best motor response

severe: 3-8; coma over 6 hrs; PTA over 24 hrs
moderate: 9-12; coma less than 6 hrs; PTA 1-24 hrs
mild: 13-15; coma 20 min or less; PTA 60 min or less

numbers are the glasgow coma score

Question 10

define coma

Answer 10

condition where a patient displays minimal, if any, purposeful respose to the external environment
- believed to result from damage to the central portions of the brainstem

Question 11

persistent vegetative state (PVS)

Answer 11

people who survive but never regain any degree of consciousness in the sense of higher cortical function
- don’t speak or follow commands, but do regain the alerting mechanism
- called PVS after they have been in this condition for a month

Question 12

define minimally conscious state (MCS)

Answer 12

minimal but definitive evidence of self- or environmental awareness
- reflects transitional stage showing an improvement in consciousness or (as with a neurodegenerative disease) progressive decline
- consistent evidence of one or more of the following behaviors:
- following simple commands
- intelligible verbalization
- recognizable yes/no responses to relevant environmental stimuli not attributable to reflexive activity

Question 13

4 spheres of personal orientation that may be disturbed by a TBI

Answer 13

1. person: autobiographic memory (usually returns first)
2. place: knowledge of familiar places
3.** time**: requires ability to take in, store, and recall new info presented after injury
4. circumstance: recalling this usually returns before place & time

Question 14

describe the pragmatic difficulties commonly encountered by individuals with a prefrontal cortex TBI

Answer 14

• difficulties with the formulation of discourse (not attributable to aphasia)
• inappropriate social interactions (interpreting social cues, abstract language/irony-sarcasm)

Question 15

definition of ‘rehabilitation’

Answer 15

the development of an individual to the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with their physiologic or anatomical impairment and envirnonmental limitations

Question 16

discuss distinction between restorative and compensatory approaches to treatment and how the two can complement on another

Answer 16

resotrative: based on notion that neuronal growth (which results from improvement in function) is associated with repetitive exercise of neuronal circuitls
- ‘muslce building approach’—repetitive exercises and drilling

compensatory: concedes that certain functions can’t be recovered, so the goal is to develop strategies to circumvent the impaired functions

this view of cognitive rehabilitation implies that restoration and compensatory strategies are distinct phases of the rehabilitation continuum. First we do restorative treatment and then we implement compensatory strategies where needed.

• Note- compensatory can be considered restorative in that strategizing with compensatory mechanisms is a form of restoring that cognition they once had. There are overlap between the two approaches and they complement one another.

Question 17

Rancho Los Amigos (RLA) levels of cognitive functioning

namely the level number and heading, and assitance required

Answer 17

total assistance: levels 1-3
- I = no response
- II = generalized response
- III = localized response
maximal assistance: levels 4 & 5
- IV = confused–agitated
- V = confused–inappropriate–non-agitatead
moderate assistance: level 6
- VI = confused–appropriate
minimal assistance: level 7
- VII = automatic appropriate
stand-by assistance: level 8
- VIII = purposeful and appropriate

- total assitance= patient expends ≤ 25% of effort & needs ≥ 75% assistance

- maximal assitance= patient at expends least 25% but ≤ 50% and requires ≥ 50%

- moderate assistance= patient expends at least 50% but ≤ 75% and needs < 50% assistance

- minimal assitance= for routine activities of daily living patient expends at least 75% and requires ≤ 25% assistance

- stand-by assistance= patient requires no more than verbal cues without physical contact, or requires help with set-up of items or assistive devices