TBI

Question 1

Open Injury

Answer 1

pierces the scalp and skull
Penetrates the meninges of the brain
Examples: gun shot or knife
Also called penetrating injuries

typically results in Focal Damage – limited to the area of injury

Damage is largely isolated to one area of the brain

Question 2

Closed Injury

Answer 2

does not pierce the scalp and skull

Result of mechanical forces: acceleration-deceleration
Linear
Rotational

typically results in diffuse injury
Damage is widespread over areas of the brain

Question 3

Primary injuries

Answer 3

are a direct result of trauma
In other words: Injuries that occur at the time of trauma
Result from combination of 2 forces:
impact (skull deformation/fracture/focal injury)
acceleration/deceleration (linear & rotational)

Question 4

Open TBI primary injuries:

Answer 4

Skull fracture

Brain damage along path of foreign object

Question 5

Closed TBI primary injuries:

Answer 5

Skull fracture
Contusion
Diffuse axonal injury

Question 6

Contusion

Answer 6

– bruising

Question 7

Axonal Injury

Answer 7

– widespread damage to axons

Question 8

Coup

Answer 8

• initial point of impact

Question 9

Contra coup

Answer 9

damage on opposite side of the initial impact

Question 10

Coup/Contra-Coup

Answer 10

Primary Injury

Results in brain contusions

Base of skull boney with ridges- further damages brain

Areas vulnerable to damage:
Lateral and ventral (underside) portions of frontal and temporal lobes
Prefrontal region
Limbic system
Connections among brain areas

Question 11

Rotational forces:

Answer 11

Primary Injury

Twist cortex around the brainstem
Can twist, stretch, and shear blood vessels and axons

Question 12

Diffuse axonal injury (DAI)

Answer 12

Primary Injury

Twisting, stretching, and/or shearing of axons
Associated with coma
Reticular formation

Question 13

Secondary injuries

Answer 13

Aftermath of primary injury

Neurochemical & metabolic changes
Bleeding of the brain (hemorrhage/hematomas)
Loss of oxygen to the brain (Hypoxia-ischemia/hypotension)
Infarction – damage due to loss of blood
Brain swelling (edema)
Increased cranial pressure (ICP)
Seizure

Question 14

Glasgow Coma Scale (GCS)

Answer 14

TBIs are classified as mild, moderate, or severe

instrument used to classify injury severity

Assesses an individual’s level of consciousness

Scores on the GCS range from 3-15 (higher more conscious)

The lower the score; the more severe the injury

Majority of TBIs are mild
GCS of 13-15

Question 15

Consequences of TBI

Answer 15

Consequences are VARIABLE
No two brains are the same
Injured brain regions may be similar but deficits can be different

Disability after TBI occurs on a continuum
Can impact ability to live independently
Can impact family
Individual with severe TBI may not be able to work or attend school and may be dependent on the care and support of family

Question 16

Hallmark of TBI

Answer 16

Deficits in:
Orientation – person, place, time & circumstance
Attention (divided – multitasking; alternating – one task, then another)
Memory (Working memory – directly affects language)
Reasoning
Executive function – problem solving

Question 17

Language deficits after TBI:

Answer 17

Aphasia (Aphasia tests may not capture language deficits after TBI)

Impaired auditory comprehension

Word finding

Naming errors

Confabulation

Confused language – empty, irrelevant speech that may contain circumlocutions, confabulations, and be tangential

Result of cognitive impairment NOT language abilities

Pragmatics

Question 18

Pragmatics after TBI

Answer 18

difficulty effectively using language
“Talk better than they communicate”

Considered cognitive-communication deficit
Discourse characterized as:
Disorganized
Inappropriate for social situation
Difficulty with abstract language

Take away- language deficits mostly associated with use rather than form.

Question 19

Dysarthria

Answer 19

motor speech disorder resulting from damage to the pyramidal or extrapyramidal tracts

Question 20

Mutism

Answer 20

Speech d/o caused by Lesion to left basal ganglia nuclei or severe diffuse axonal injury

Better prognosis for those with basal ganglia nuclei lesions

Question 21

Dysphagia

Answer 21

difficulty swallowing

Can resolve over time with treatment

Question 22

Role of SLP in TBI

Answer 22

Collaborate with other professionals, patient, and family
Assess and mange all areas of communication
Receptive/expressive language
Written language (including reading)
Speech production
AAC
Hearing screening
Cognitive-communication deficits
Pragmatics
Assist with developing cognitive supports
Treatment varies based on stage of recovery

Question 23

Early stages of recovery:

Answer 23

Patient is nonresponsive or response to stimuli is inconsistent
Unable to participate in standardized assessments
Monitor for ability follow commands

Treatment: Goals are to increase responses to verbal stimuli and establish communication
AAC may be introduced
AAC likely to be low-tech with yes/no responses

Question 24

Intermediate stages of recovery:

Answer 24

Patient may be confused and agitated
Confused language
Informal assessments

Treatment Goals: May be in the form of group or individual therapy

Goal is to improve functioning in day-today environments

Restorative and compensatory approaches are used

Question 25

Later stages of recovery:

Answer 25

Transition to purposeful and appropriate behaviors

May continue to have cognitive and communication deficits

Patient’s abilities vary based on injury severity and communication needs

Tests are selected based on the individual’s needs

Testing potential areas of deficit including: memory, attention, problem solving, executive function, language

Observation needed to determine functional abilities

Treatment Goal: carry over progress to everyday environments

Question 26

Assessment

Answer 26

May perform well on standardized test but not do well in real life

Have to complete formal and informal testing

Discourse analysis:
Starts with an elicitation task- “tell me the story of…”
Audio or video recorded and transcribed
Utterances divided into T-units (dependent & independent clauses)

Analyzed for:
Story grammar components/summarization skills
Microlinguistic (grammar), microstructural (cohesiveness, use of pronouns match), and macrostructural (story grammar, sentenece structure) components