TBI Assessment Flashcards
Initial Thoughts
There is no such thing as a typical brain injury
Brain injury can occur at any age
There is no uniform set of symptoms characteristic of all TBIs
There are some commonly seen consequences of brain injury
cognitive deficits
perceptual deficits
physical deficits
behavioral/emotional deficits
Cognitive Deficits
- attention deficits
- memory disorders
- language impairments
- impaired abstraction and judgment capabilities (inflexibility)
- decreased speed, accuracy, and consistency
- defective reasoning processes
- susceptibility to internal/external stressors
Perceptual Deficits
- decreased acuity or increased sensitivity in vision, hearing, or touch
- vestibular deficits
- spatial disorientation
- disorders of smell and taste
Physical Deficits
disorders of ataxia, spasticity, and tremors
musculoskeletal disorders (pain/discomfort in the bones, joints, muscles, or surrounding structures; can be acute, chronic, focal or diffuse)
Emotional and Behavioral Deficits
- irritability
- impatience
- poor frustration tolerance
- dependence
- denial of disability
Prior to Direct Assessment
- obtain as much information as possible (i.e., chart review)
- review type and severity of the brain injury
- date of onset
- identify the cerebral areas affected
- investigate the client’s medical history
- pre-trauma personality and pre-morbid status
- recent CT scans and MRIs
- additional neuromedical variables (extended coma, cerebral hemorrhage, etc)
TBI vs. Aphasia vs. ?
- speech/language characteristics resulting from TBI often resemble aspects of aphasia
- prominent aphasia-like symptoms include anomia, circumlocution, paraphasia, and perseveration
- dysarthria (especially spastic dysarthria)
- dysphagia
the primary objection to making a diagnosis of aphasia (saying the Pt has aphasia) is that the pragmatic and language behaviors associated with a true aphasia differs from those associated with a TBI
CVA = aphasia: results in mild to severe language deficits while retaining most social and pragmatic functions
TBI = essentially normal receptive/expressive language; communication difficulties are related to cognitive deficit components
Assessment Areas
- general cognitive/intellectual abilities
- language functions
- visuospatial, visuomotor, and visuoconstructional abilities
- attention and concentration
- learning ability (both verbal and nonverbal modalities)
- memory ability (both verbal and nonverbal modalities)
- motor functioning
- higher cognitive functioning
- emotional functioning
- remember the roles of the neuropsychologist
S/L Batteries Useful for TBI
Assessment of Intelligibility of Dysarthric Speech BDAE and MTDDA Boston Naming Test BTHI EOWPVT and ROWPVT PPVT Scales of Cognitive Ability for TBI or SCATBI Token Test WAB RIPA (pediatric, adult, and geriatric)
Hard/Soft Neurological Signs
- hard signs give clear evidence of neurologic dysfunction
- soft signs are correlated with but do not confirm neurologic dysfunction
- soft signs are not unusual for any child under 8y because they reflect an immature central nervous system
- soft signs are more often present in children w/developmental disabilities and those w/TBI than typically developing children
- hard/soft signs are difficult to interpret without additional information from your comprehensive evaluation
- diagnoses should not be based solely on the presence or absence of one or more neurologic signs
Hard Neurological Signs
Include but are not limited to:
- abnormal infantile reflexes in non-infants (Babinski reflex, rooting, etc)
- disrupted motor function in one or more areas (unilateral paralysis or paresis)
- disrupted sensory function in one or more areas (loss of vision)
- dysarthria (slurred speech) that is not due to medications or physical injury
- apraxia of speech or limbs
- aphasia
Soft Neurological Signs
Include but are not limited to:
- hyperkinetic motor overflow (constant movement of extremities)
- impulsivity (responding prior to thinking or being given all info)
- distractibility both internally (daydreaming) and externally (environmental sights and sounds)
- inattention or difficulty focusing on one’s work
- heaving use of concrete thinking based on stimulus features (bus is yellow w/wheels as opposed to a vehicle or means of transportation)
- slowed processing speed
- simultaneous movements of opposite limbs or digits that are unintended based on the task
- uncoordinated movements; slow motor movements
- immature grasp of writing instrument and difficulty drawing
- late milestone development
Flow of Assessment I
Orientation Automatics Following directions Organization 1. sequencing 2. categorization -rapid naming -convergent/divergent naming -similarities/differences -which one doesn’t belong and why
Flow of Assessment II
Math -word problems Auditory processing Memory Functional problem solving Multifactor problem solving Deductive/inductive reasoning Divergent thinking/abstract reasoning (verbal absurdities, humor)+ Convergent thinking; drawing conclusions Reading passages
Levels of Consciousness
Alert: fully awake and appropriately responsive to internal/external stimuli; still may have cognitive deficits
Lethargic: not fully awake; may drift in/out of awareness when not being stimulated; may appear sleepy or confused w/poor arousal or energy
Apathetic: lacks motivation or initiation for goal-directed behaviors or volitional activities; shows diminished concern for things that were previous interests; loss of enthusiasm
Aggressive: irritability and tendency for dis-inhibited verbal/nonverbal impulsivity; often temporary as pt recovers
Fluctuating: variations in levels of awareness, energy, behavior
Alert
fully awake and appropriately responsive to internal/external stimuli; still may have cognitive deficits
Lethargic
not fully awake; may drift in/out of awareness when not being stimulated; may appear sleepy or confused w/poor arousal or energy
Apathetic
lacks motivation or initiation for goal-directed behaviors or volitional activities; shows diminished concern for things that were previous interests; loss of enthusiasm
Aggressive
irritability and tendency for dis-inhibited verbal/nonverbal impulsivity; often temporary as pt recovers
Fluctuating
variations in levels of awareness, energy, behavior
Recovery Issue
your role will change based on your setting
you will have to adapt your evaluations and treatments to fit the needs of your pt’s
recovery can be categorized into three stages:
- early
- middle
- late
Early Stage Goals
Acute phase (will require maximum therapeutic support)
Determine:
-can your pt comprehend commands and questions?
-can your pt make needs known?
-is your pt’s cognitive skills adequate for communication?
-is there a need for coma management techniques?
-presence of dysphagia?
-family education needs?
-role(s) of family in therapy
-staff education regarding pt’s needs
Middle Stage Goals
Client may appear more “normal”
Is the client ready to return to the community; support or independently
Determine:
1.type and level of cognitive-communication breakdown
2.any compensatory strategies
3.best methods family can use to assist client
4.what about:
-caring for children, independent functioning, management of finances, societal expectations
Questions may arise about client’s competency
Take note of delayed response times (latency periods), perseveration, failure to note errors, difficulty following instructions
