TBI Flashcards
Penetrating (open) head injuries
- In such injuries a sharp object may penetrate the skull and enter the brain
- Severity of head injuries may depend on type of object, velocity of missile, and secondary damage occurring from infection, bleeding and subsequent hydrocephalus
Low velocity vs high velocity injuries
- low velocity injuries have concentrated force that fracture the skull and drive bone debris into the brain (examples: injury due to knife glass, some types of air rifles, axe, tree branches)
- High velocity injuries may enter the brain more clearly but may cause relatively more destruction of the tissue around and along the projectile’s paths (examples: car accidents, projectiles)
- Blast injuries (the textbook classifies these as penetrating or open head injuries) includes injuries due to rocket-propelled grenades, landmines, and improvised explosive devices
Non-penetrating (closed) head injuries
Examples: Motor vehicle accidents, skiing accidents, sports-related events (boxingn, football, soccer)
types of non-penetrating (closed) head injuries
non-acceleration and acceleration injuries
Non-acceleration injuries
these injuries are caused when an individual’s fixed or restrained head is struck by a oving object. E.g. A man standing on the street and getting hit by a car, a man sitting on a chair and being hit by a bullet
Acceleration injuries
these injuries are caused when an individual in motion is struck by a stationary or moving object. E.g. car accident in motion, skiing accident, person falling from hieght
Assessments of memory
- Recognition memory test
- Wechsler memory scale
Recognition memory test
here an individual is shown words, faces, or designs and then asked to indicate the images that were presented before. Useful in assessment of individuals who have difficulties in drawing, copying, or responding verbally
Wechsler memory scale
provides information about immediate and delayed recall, recognition of short paragraphs, a word list, unfamiliar faces, and abstract design. It also includes measures of immediate and working memory (digit span, spatial span, letter-number sequencing)
Assessments for executive functioning
- Wisconsin card sorting test
- stroop color and word test
- tower test
- controlled oral word association test
wisconsin card sorting test
assesses set shifting
Stroop color and word test
assesses set shifting, inhibition of prepotent responses
tower test
assesses planning
controlled oral word association test
assesses word generation according to initial letter while following a set of rules
General measures of disability and outcomes
- functional independence measures
- The disability rating score for severe head trauma
functional independence measures
- one of the most widely used tests
- assesses level of assistance required to perform different ADLs
The disability rating score for severe head trauma
More sensitive that GOS and has fewer ceiling effects than the FIM (functional independence measures) and FAM (functional assessment measures)
Katz adjustment scale
assesses personality changes following brain injury and their psychosocial effects
- consists of 127 items with both patient and relative report form. Detects changes following rehab and correlates well with other measure of social outcomes
Neurobehavioral rating scale
assesses wide range of cognitive behavioral and psychiatric symptoms. Shown to be sensitive to personality changes following brain injury, changes over time, and different patterns of frontal lobe-associated psychopathology
Mayo-portland adaptability inventory
assesses temperament and emotionality (anxiety, depression, agitation) activities and social behavior (social contacts, leisure activities) and physical capabilities (use of hand, dysarthria)
Treatment to restore/improve memory function
- memory practice drills: repeated testing w/out strategy
- maintenance rehearsal training: simple repetition to facilitate working memory
Types of rehearsal training for memory
- Scene rehearsal practicing a scene with eyes closed
- Fact rehearsal remember an event by referencing to facts
- Self-referencing relating new information into old information
- Semantic, rehearsal; organized information into semantic categories
Working memory training
- Card games
- Mental math/word games
memory encoding strategies
- Improve acquisition (attention)
- Check perceptual abilities
- Teach memory cues
- Persistence
Treatment recommendations for memory deficits
- restore/improve memory function
- teach retrieval strategies
- mnemonic devices
Retrieval strategies
- Good encoding cues help retreival also (good encoding–good retrieval– good memory)
- search; use of phonemic cues for nearly learned information
- Free association
- Reinstate mood; have client reinstate the mood they are in at the same time
- First letter cue
- time-related reconstruction of events
- Primacy and recency effects
Mnemonic devices
- Visual imagery, trying to remember pictures
- Verbal organization. Paired association of new information with prior stimulation
- Semantic elaboration. Make a story
- First letter mnemonic ; use first letter of each word
- Sentence generations: use of sentences or words to remember things
- Prospective memory training: it is the memory to do somethingin the future. Use of memory books for future appointments and schedule
Assessment of TBI-related pragmatic deficits
- Systematic observation: include use of checklists or indicates listing different communication parameters
——Pragmatic protocol: considered the gold standard for observational checklists. Includes 32 pragmatic behaviors into 4 categories. Items are judged as appropriate, inappropriate, or not observed
——Communication profiling system: incudes a cyclical collection and analysis of naturalistic communication data
