TBI Quiz 2 Flashcards
Observed signs of neurological or neuropsychological dysfunction
Headache Dizziness Irritability Fatigue Poor Concentration Vomiting Seizures following the head injury
Neuropsychology
a branch of psychology that is concerned with how the brain and the rest of the nervous system influence a person’s cognition and behavior
Why does mild TBI sometimes have more severe and lasting effects?
People don’t always seek medical attention
Medical providers may not recognize loss of consciousness
Some wait days/months to report symptoms
Concussion
Causes damage to the blood vessels causing bruising and swelling and can cause nerve injury
Post traumatic amnesia can affect recovery
Grade 1 Concussion
Mild
Symptoms last less than 15 minutes
Grade 2 Concussion
Moderate
Symptoms last longer than 15 minutes
Grade 3 Concussion
Severe
Any loss of consciousness
Post concussion syndrome
2000 study - 15% of people had symptoms a year later
Caused by blow to head but persists because of abnormal nervous system functioning
Top symptoms of post concussion syndrome
Headaches
Memory impairments
Dizziness
Depression
Diagnosed and treated by neuropsychologists
Assessment
In the ER - CT scan over MRI
Cognitive screen - Ranchos Los Amigos scale of cognitive functioning, Glasglow coma scale
Ranchos Los Amigos Scale of Cognitive Function
Can predict recovery from a ABI
Can be used during any stage of recovery
Looks at cog functioning via motor responses only
Has 10 levels
RLA Scale Levels
1- no response, total assist
2- reflex response to pain
3- localized response, directly to stim
4- confused, agitated, aggressive
5- confused inappropriate, non agitated, memory problems
6- confused appropriate, follows commands, safety unaware
7- automatic appropriate, consistently orientated, carryover
8- purposeful and appropriate, stand w. assist, frustrated
9- purposeful and appropriate, need assist for complex problems
10- appropriate, modified independent, appropriate social interaction
Cognitive assessments
Galveston Orientation and Amnesia Test (GOAT)
Scales of Cognitive Ability for Traumatoc Brain Injury (SCATBI)
Ross Information Processing Assessment (RIPA-2)
Recovery is impacted by
Age Alcohol Abuse Education Level Neuropsychiatric History Post-injury Stress Post- injury litigation Post-injury Compensation Claims Malingering
Persistent effects of concussion
Cognition Executive Functioning Disturbed Sleep Pattern Post Concussive Disorder Depression
Medical treatments
Ritalin Ambien Anti-depressants Antivert (Meclizine) Pain Medications Anti-seizure medications (Keppra, )
Ritalin
As a stimulant to increase processing
Ambien
As needed to re establish a consistent sleep cycle
Anti-depressants
As needed for psychological changes, not during daytime hours
Antivert (meelizine)
For dizziness/nausea
Pain medicines
Used sparingly because of addiction
Anti seizure medicines
Anyone with a brain injury is more susceptible to seizures
Visual changes
Patients may complain of diplopia, visual blurring, nystagmus, difficulty reading, poor visual acuity
Visual treatment
Can be treated with prism glasses
A prism lens is put over one eye
The lens bends the light to line up the image with the other eye
Physical therapy
Increased mobility, flexibility, and balance
Vestibular functioning for dizziness)
Occupational therapy
For deficits completing ADLs
Individualized for each client
Cognitive/speech therapy
In acute/acute rehab setting
Cognitive Assessment
Depending on LOS (length of stay) possible cognitive-linguistic treatment
In Outpatient Setting:
Working on executive functioning skills such as:
Sustained Attention; Alternating Attention
Focusing and Shifting Focus
Mental Flexibility; Working Memory
Mild TBI
An injury to the head as a result of blunt trauma or acceleration/deceleration
- Transient confusion, disorientation, impaired consciousness
- Dysfunction of memory around the time of the injury
- Loss of consciousness lasting less than 30 minutes
Head and neck injuries account for over __% of soldiers evacuated with injuries
25
Soldiers who report a TBI are
More likely to survive more than 1 explosion, are younger, have a lower rank, are more likely male
PTSD and symptoms
An anxiety disorder that may develop after a traumatic event
Avoidance behaviors, Re-experiencing symptoms, hyperarousal, irritability, sleep disturbance
A study done in 2008 found __%of soldiers who reported PTSD in combination with TBI
43
ImPACT - Immediate Post Concussion Assessment and Cognitive Testing
Validity is questioned
Does not take into account additional factors that might interfere with cognitive scoring
Other computer tests: CogSport, ANAM, HeadMinder CRI
Baseline Cognitive Testing- SAC, SCAT
Assesses- reaction time Memory capacity Speed of mental processing Executive functioning
Youth sports - return to play
Based on frequency of concussions and level of current concussion.
Can be the same game or can last up to a month
Public awareness of TBI
Policy Efforts State Laws Educate Coaches, Parents, Athletes As SLPs- use BI Month to educate www.cdc.gov/headsup
What would we be treating an adolescent for after an TBI?
Attention/study skills
Complex comprehension
Chronic traumatic encephalopathy
Repetitive mild TBI which causes degenerative brain infection and progressive injury
the tau protein within in calls becomes abundant and doesn’t work properly
Damage in higher rate in brain stem, Diencephalon and basal ganglia
Stage 1 CTE
Headache; Loss of concentration
Restricted to specific areas- mainly the lateral frontal cortices
Stage 2 CTE symptoms
Depression; Explosivity; Short Term Memory Loss
More than one area has increased tau; still frontal areas
Stage 3 CTE symptoms
Executive Functioning and Cognitive Impairments
Impairment spreads to temporal and parietal cortices. Common to see tau fiber tangles in the amygdala and hippocampus
Stage 4 CTE Symptoms
Dementia; Word-retrieval difficulties; Aggression
Widespread tau bundles; especially in the medial temporal lobe; and gray matter areas
Cognitive-linguistic skills
Skills required for proper communication
Impaired when person lacks efficient access to language rules or has a cog impairment in a function that impairs language
Examples of cognitive linguistic skills
Attention, memory, organization, reasoning and social skills
Especially with ____ injuries patient’s may present with both language and cognitive-linguistic deficits
diffuse
Macrolinguistics
Topic maintenance tangential speech verbosity coherence and cohesion story grammar and gist comprehension
topic maintenance
the ability to appropriately tell a story or make conversational exchanges on a given topic for a specific amount of time
Tangential speech
the speech seemed cluttered and disorganized and one thought does not follow another appropriately
Verbosity
the verbose speech is noted to lack conversational discourse exchange and the person will sustain the conversation with his/her thoughts with little awareness
coherence and cohesion
the ability to tie narratives together
Especially troubling with a TBI (macrolinguistics)
deficits with verbally sequencing steps
will also have trouble with pronouns and comparatives from previous thoughts
Story grammar
making sure your story has a beginning, middle and end or a problem a solution to a problem and consequences
Gist comprehension
the ability to recognize if your audience understands the point of your story and could retell it
microlinguistics
involve the formulation of sentences
deficits are with the quantity and quality of the sentences/speech
logorrhea
incoherent repetitive speech, does not make sense
What are characteristics of word finding deficits
anomia
delayed responses
frustration
compensatory strategies for word retrieval
circumlocution
rephrasing
synonym generation
use of an alphabet board/writing down the word
Nonverbal communication
just as important
deficits can also affect pragmatic skills and effective communication
eye gaze
affect
research = limited on gesture use post TBI
eye gaze
looking directly at your communication partner
we assess - eye contact throughout initial assessment, can be too much or too little
affect
the experience of feeling emotion
if a person has flat affect they keep the same facial expressions for all emotions
linked to difficulty in reading others emotions as well
Pragmatics - assessment
informal
compiled by the clinician based on client interview
unstructured discourse
family interview when applicable
pragmatics - treatment
group therapy and metacognitive
the goal is to improve self-perception of social skills
to put clients in social situations often
Assessment in acute care setting
establishing communication - verbal or nonverbal
orientation x4 (person, place, time, situation)
assessing comprehension - auditory and reading
current level of functioning
functional independence measure (FIM)
ranchos los amigos scale of cognitive functioning
FIM levels
contains 18 items composed of 13 motor tasks, 5 cognitive tasks
tasks rate on a 7 point ordinal scale
5 areas rated are - comprehension, expression, social interaction, problem solving and memory
FIM levels
level 7 - independent
level 6 - modified independence - extra time or adaptive equipment
level 5 - requires set-up and supervision
level 4 - requires minimal assistance (completes 75% or more)
level 3 - requires moderate assistance (completes 50%)
level 2 - requires maximum assistance (completes less than 25%)
level 1 - requires total assistance
Initial aphasia assessment
determines if an aphasia is present
if your patient has damage to the left side - look for signs
A screening will usually reveal word retrieval deficits
Top aphasia assessments
boston diagnostic aphasia examination (BDAE)
western aphasia battery (WAB)
Orientation
knowing who you are and tracking the passage of time
we assess if someone is orientated x4 (person, place, time, situation)
Attention - sustained
maintaining attention to complete a single task (reading a book)
attention - selective
maintaining attention to complete a single task in a distracting environment (reading a book on the subway)
attention - alternating
completing two tasks efficiently, but switching attention between them (reading a page at a time then writing notes on what you read)
attention - divided
completing two or more tasks simultaneously, multi-tasking (reading a book and walking at the same time)
Memory- immediate
Recalling information right after hearing it
Memory- short term
Recalling newly learned information after approximately a 30 second delay; working memory
Memory- long term
Recalling newly learned information after a 10 minute delay
General knowledge or content based
Recent memory
recalling what has happened to the person within the day
Episodic memory
Recalling specific dates or events
Procedural memory
recalling previously learned topics or steps/sequences to a task
Prospective memory
Recalling information for a future event
Problem solving
Identifying problems
Generating solutions
Organizing - what you need for the solution
Sequencing
Correctly putting items in order
Time management
Tracking the current time and the passage of time correctly
Safety awareness
Identifying potential dangers to oneself or others
Self monitoring
The ability to recognize errors and fix them
Executive functioning
Awareness/insight Goal setting Planning Self Initiation Self evaluation Carryover
Critical thinking
Inferencing
Deductive reasoning
Abstract reasoning
Mental flexibility
Cognitive assessment
Completed 1:1
If person is easily distracted do in a room with lots of talking or music to get accurate representation
Standardized testing may not capture everything
Many places also do neurocognitive testing
Clinicians make informal assessments
California verbal learning test (CVLT)
For Memory skills
Standardized for Adults from Ages 16-89
Patients are given a list of 9 words to recall after an immediate delay, a short delay, a long delay, and then with cued responses
Galveston orientation amnesia test (GOAT)
Given after TBI
Can be given daily to assess change
Looks at current orientation and post traumatic amnesia
15 questions
Scales of cognitive ability for TBI ( SCATBI)
Consists of 5 sections- perception, discrimination, organization, recall, reasoning
Easily organized to give subtests separately
When making your own assessment
Look at Clock drawing Visual attention/target cancellation Various attention types Functional computation Time management
Neuroplasticity
The ability for new cells to form, and for existing cells to take over for injured or damaged cells
Spontaneous recovery
new axons sprout and begin to take over for the injured nerve cells
no definite time window
for most lasts 6-8 weeks
Biofeedback
gaining greater awareness of your physiological functions - usually with equipment
Neurofeedback
example of biofeedback
sensory electrodes placed on scalp
strengthens brains ability to self regulate
individual can change thinking to slow down or speed up waves
Our role in brain injury treatment
facilitating the neuroplasticity
training compensatory strategies
orientation - compensatory strategies
using external aids (calendars, clocks etc)
fade cues over time for carryover
review daily info/events
severely affected sustained attention treatment
establishing a period of focus or eye contact to attempt to complete communicative intent
Selective attention treatment
asking a patient questions verbally while playing music
Divided attention treatment
having a patient sort cards while spelling words you are giving them
visual attention treatment
having a patient complete a visual cancellation task
interactive metronome
computer based program
provides constant feedback
can help with processing, comprehension, attention, reading and sports
recall treatment
can use logbook/planner
many won’t use this outside therapy so smartphones and apps help carryover
Memory compensatory strategies
Internal - repetition, visualization, grouping
External - writing things down
Problem solving treatment
placing client in real-life scenarios to generate solutions
deductive reasoning treatment
draw conclusions based on cancellations
higher level
tasks - sudoku, logic puzzles
abstract reasoning treatment
analyzing info presented
finding patterns, making comparisons
tasks - explaining proverbs, completing analogies
Executive functioning treatment
self monitoring
planning and organizing
pragmatics treatment
best in a group setting
want client to recognize their inappropriate behavior
focus on - eye contact, topic maintenance, appropriate verbal/nonverbal exchanges
errorless learning
eliminates frustration
more severe deficits
forward and backward chaining
having a person learn new information 1 building block at a time
behavior plans
ABC approach may be used
antecedent, behavior, consequence
interdisciplinary
positive reinforcement
when a behavior produces a new stimulus or motivating force
consequence strengthens behavior by adding a stimulus
negative reinforcement
occurs when a behavior removes or eliminates a stimulus
control of environment
if they’re distracted go to quieter room
selective attention - go to noisy environment
