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Speech Pathology > TBI Quiz 2 > Flashcards

TBI Quiz 2 Flashcards

1
Q

Observed signs of neurological or neuropsychological dysfunction

A 
Headache
Dizziness
Irritability
Fatigue
Poor Concentration
Vomiting
Seizures following the head injury
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2
Q

Neuropsychology

A

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

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3
Q

Why does mild TBI sometimes have more severe and lasting effects?

A

People don’t always seek medical attention
Medical providers may not recognize loss of consciousness
Some wait days/months to report symptoms

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4
Q

Concussion

A

Causes damage to the blood vessels causing bruising and swelling and can cause nerve injury
Post traumatic amnesia can affect recovery

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5
Q

Grade 1 Concussion

A

Mild

Symptoms last less than 15 minutes

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6
Q

Grade 2 Concussion

A

Moderate

Symptoms last longer than 15 minutes

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7
Q

Grade 3 Concussion

A

Severe

Any loss of consciousness

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8
Q

Post concussion syndrome

A

2000 study - 15% of people had symptoms a year later

Caused by blow to head but persists because of abnormal nervous system functioning

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9
Q

Top symptoms of post concussion syndrome

A

Headaches
Memory impairments
Dizziness
Depression

Diagnosed and treated by neuropsychologists

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10
Q

Assessment

A

In the ER - CT scan over MRI

Cognitive screen - Ranchos Los Amigos scale of cognitive functioning, Glasglow coma scale

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11
Q

Ranchos Los Amigos Scale of Cognitive Function

A

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

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12
Q

RLA Scale Levels

A

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

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13
Q

Cognitive assessments

A

Galveston Orientation and Amnesia Test (GOAT)

Scales of Cognitive Ability for Traumatoc Brain Injury (SCATBI)

Ross Information Processing Assessment (RIPA-2)

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14
Q

Recovery is impacted by

A 
Age
Alcohol Abuse
Education Level
Neuropsychiatric History
Post-injury Stress
Post- injury litigation
Post-injury Compensation Claims
Malingering
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15
Q

Persistent effects of concussion

A 
Cognition
Executive Functioning
Disturbed Sleep Pattern
Post Concussive Disorder
Depression
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16
Q

Medical treatments

A 
Ritalin
Ambien
Anti-depressants
Antivert (Meclizine)
Pain Medications
Anti-seizure medications (Keppra, )
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17
Q

Ritalin

A

As a stimulant to increase processing

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18
Q

Ambien

A

As needed to re establish a consistent sleep cycle

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19
Q

Anti-depressants

A

As needed for psychological changes, not during daytime hours

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20
Q

Antivert (meelizine)

A

For dizziness/nausea

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21
Q

Pain medicines

A

Used sparingly because of addiction

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22
Q

Anti seizure medicines

A

Anyone with a brain injury is more susceptible to seizures

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23
Q

Visual changes

A

Patients may complain of diplopia, visual blurring, nystagmus, difficulty reading, poor visual acuity

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24
Q

Visual treatment

A

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

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25
Q

Physical therapy

A

Increased mobility, flexibility, and balance

Vestibular functioning for dizziness)

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26
Q

Occupational therapy

A

For deficits completing ADLs

Individualized for each client

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27
Q

Cognitive/speech therapy

A

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

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28
Q

Mild TBI

A

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
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29
Q

Head and neck injuries account for over __% of soldiers evacuated with injuries

A

25

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30
Q

Soldiers who report a TBI are

A

More likely to survive more than 1 explosion, are younger, have a lower rank, are more likely male

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31
Q

PTSD and symptoms

A

An anxiety disorder that may develop after a traumatic event

Avoidance behaviors, Re-experiencing symptoms, hyperarousal, irritability, sleep disturbance

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32
Q

A study done in 2008 found __%of soldiers who reported PTSD in combination with TBI

A

43

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33
Q

ImPACT - Immediate Post Concussion Assessment and Cognitive Testing

A

Validity is questioned
Does not take into account additional factors that might interfere with cognitive scoring
Other computer tests: CogSport, ANAM, HeadMinder CRI

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34
Q

Baseline Cognitive Testing- SAC, SCAT

A 
Assesses- 
reaction time
Memory capacity
Speed of mental processing
Executive functioning
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35
Q

Youth sports - return to play

A

Based on frequency of concussions and level of current concussion.

Can be the same game or can last up to a month

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36
Q

Public awareness of TBI

A 
Policy Efforts
State Laws
Educate Coaches, Parents, Athletes
As SLPs- use BI Month to educate
www.cdc.gov/headsup
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37
Q

What would we be treating an adolescent for after an TBI?

A

Attention/study skills

Complex comprehension

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38
Q

Chronic traumatic encephalopathy

A

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

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39
Q

Stage 1 CTE

A

Headache; Loss of concentration

Restricted to specific areas- mainly the lateral frontal cortices

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40
Q

Stage 2 CTE symptoms

A

Depression; Explosivity; Short Term Memory Loss

More than one area has increased tau; still frontal areas

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41
Q

Stage 3 CTE symptoms

A

Executive Functioning and Cognitive Impairments

Impairment spreads to temporal and parietal cortices. Common to see tau fiber tangles in the amygdala and hippocampus

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42
Q

Stage 4 CTE Symptoms

A

Dementia; Word-retrieval difficulties; Aggression

Widespread tau bundles; especially in the medial temporal lobe; and gray matter areas

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43
Q

Cognitive-linguistic skills

A

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

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44
Q

Examples of cognitive linguistic skills

A

Attention, memory, organization, reasoning and social skills

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45
Q

Especially with ____ injuries patient’s may present with both language and cognitive-linguistic deficits

A

diffuse

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46
Q

Macrolinguistics

A 
Topic maintenance
tangential speech
verbosity
coherence and cohesion
story grammar and gist comprehension
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47
Q

topic maintenance

A

the ability to appropriately tell a story or make conversational exchanges on a given topic for a specific amount of time

48
Q

Tangential speech

A

the speech seemed cluttered and disorganized and one thought does not follow another appropriately

49
Q

Verbosity

A

the verbose speech is noted to lack conversational discourse exchange and the person will sustain the conversation with his/her thoughts with little awareness

50
Q

coherence and cohesion

A

the ability to tie narratives together

51
Q

Especially troubling with a TBI (macrolinguistics)

A

deficits with verbally sequencing steps

will also have trouble with pronouns and comparatives from previous thoughts

52
Q

Story grammar

A

making sure your story has a beginning, middle and end or a problem a solution to a problem and consequences

53
Q

Gist comprehension

A

the ability to recognize if your audience understands the point of your story and could retell it

54
Q

microlinguistics

A

involve the formulation of sentences

deficits are with the quantity and quality of the sentences/speech

55
Q

logorrhea

A

incoherent repetitive speech, does not make sense

56
Q

What are characteristics of word finding deficits

A

anomia
delayed responses
frustration

57
Q

compensatory strategies for word retrieval

A

circumlocution
rephrasing
synonym generation
use of an alphabet board/writing down the word

58
Q

Nonverbal communication

A

just as important
deficits can also affect pragmatic skills and effective communication
eye gaze
affect
research = limited on gesture use post TBI

59
Q

eye gaze

A

looking directly at your communication partner

we assess - eye contact throughout initial assessment, can be too much or too little

60
Q

affect

A

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

61
Q

Pragmatics - assessment

A

informal
compiled by the clinician based on client interview
unstructured discourse
family interview when applicable

62
Q

pragmatics - treatment

A

group therapy and metacognitive
the goal is to improve self-perception of social skills
to put clients in social situations often

63
Q

Assessment in acute care setting

A

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

64
Q

FIM levels

A

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

65
Q

FIM levels

A

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

66
Q

Initial aphasia assessment

A

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

67
Q

Top aphasia assessments

A

boston diagnostic aphasia examination (BDAE)

western aphasia battery (WAB)

68
Q

Orientation

A

knowing who you are and tracking the passage of time

we assess if someone is orientated x4 (person, place, time, situation)

69
Q

Attention - sustained

A

maintaining attention to complete a single task (reading a book)

70
Q

attention - selective

A

maintaining attention to complete a single task in a distracting environment (reading a book on the subway)

71
Q

attention - alternating

A

completing two tasks efficiently, but switching attention between them (reading a page at a time then writing notes on what you read)

72
Q

attention - divided

A

completing two or more tasks simultaneously, multi-tasking (reading a book and walking at the same time)

73
Q

Memory- immediate

A

Recalling information right after hearing it

74
Q

Memory- short term

A

Recalling newly learned information after approximately a 30 second delay; working memory

75
Q

Memory- long term

A

Recalling newly learned information after a 10 minute delay

General knowledge or content based

76
Q

Recent memory

A

recalling what has happened to the person within the day

77
Q

Episodic memory

A

Recalling specific dates or events

78
Q

Procedural memory

A

recalling previously learned topics or steps/sequences to a task

79
Q

Prospective memory

A

Recalling information for a future event

80
Q

Problem solving

A

Identifying problems
Generating solutions
Organizing - what you need for the solution

81
Q

Sequencing

A

Correctly putting items in order

82
Q

Time management

A

Tracking the current time and the passage of time correctly

83
Q

Safety awareness

A

Identifying potential dangers to oneself or others

84
Q

Self monitoring

A

The ability to recognize errors and fix them

85
Q

Executive functioning

A 
Awareness/insight
Goal setting
Planning 
Self Initiation
Self evaluation
Carryover
86
Q

Critical thinking

A

Inferencing
Deductive reasoning
Abstract reasoning
Mental flexibility

87
Q

Cognitive assessment

A

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

88
Q

California verbal learning test (CVLT)

A

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

89
Q

Galveston orientation amnesia test (GOAT)

A

Given after TBI
Can be given daily to assess change
Looks at current orientation and post traumatic amnesia
15 questions

90
Q

Scales of cognitive ability for TBI ( SCATBI)

A

Consists of 5 sections- perception, discrimination, organization, recall, reasoning
Easily organized to give subtests separately

91
Q

When making your own assessment

A 
Look at
Clock drawing
Visual attention/target cancellation
Various attention types 
Functional computation
Time management
92
Q

Neuroplasticity

A

The ability for new cells to form, and for existing cells to take over for injured or damaged cells

93
Q

Spontaneous recovery

A

new axons sprout and begin to take over for the injured nerve cells
no definite time window
for most lasts 6-8 weeks

94
Q

Biofeedback

A

gaining greater awareness of your physiological functions - usually with equipment

95
Q

Neurofeedback

A

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

96
Q

Our role in brain injury treatment

A

facilitating the neuroplasticity

training compensatory strategies

97
Q

orientation - compensatory strategies

A

using external aids (calendars, clocks etc)
fade cues over time for carryover
review daily info/events

98
Q

severely affected sustained attention treatment

A

establishing a period of focus or eye contact to attempt to complete communicative intent

99
Q

Selective attention treatment

A

asking a patient questions verbally while playing music

100
Q

Divided attention treatment

A

having a patient sort cards while spelling words you are giving them

101
Q

visual attention treatment

A

having a patient complete a visual cancellation task

102
Q

interactive metronome

A

computer based program
provides constant feedback
can help with processing, comprehension, attention, reading and sports

103
Q

recall treatment

A

can use logbook/planner

many won’t use this outside therapy so smartphones and apps help carryover

104
Q

Memory compensatory strategies

A

Internal - repetition, visualization, grouping

External - writing things down

105
Q

Problem solving treatment

A

placing client in real-life scenarios to generate solutions

106
Q

deductive reasoning treatment

A

draw conclusions based on cancellations
higher level
tasks - sudoku, logic puzzles

107
Q

abstract reasoning treatment

A

analyzing info presented
finding patterns, making comparisons
tasks - explaining proverbs, completing analogies

108
Q

Executive functioning treatment

A

self monitoring

planning and organizing

109
Q

pragmatics treatment

A

best in a group setting
want client to recognize their inappropriate behavior
focus on - eye contact, topic maintenance, appropriate verbal/nonverbal exchanges

110
Q

errorless learning

A

eliminates frustration

more severe deficits

111
Q

forward and backward chaining

A

having a person learn new information 1 building block at a time

112
Q

behavior plans

A

ABC approach may be used
antecedent, behavior, consequence
interdisciplinary

113
Q

positive reinforcement

A

when a behavior produces a new stimulus or motivating force

consequence strengthens behavior by adding a stimulus

114
Q

negative reinforcement

A

occurs when a behavior removes or eliminates a stimulus

115
Q

control of environment

A

if they’re distracted go to quieter room

selective attention - go to noisy environment

Speech Pathology (3 decks)

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