Unit 1 Flashcards
Traumatic Impact can result in both _____ head injuries and _____ head injuries.
Traumatic impact can result in both closed head injuries and open head injuries.
A coup contrecoup injury is a type of _____(closed or open?) head injury.
A coup contrecoup injury is a type of closed head injury.
What happens during a coup contrecoup injury?
During a coup contre coup injury the head/brain moves forward striking an object, resulting in frontal lobe lesions (coup).
Then head/brain rebounds - moves backwards causing occipital lobe lesion (contrecoup)
What is the difference between a closed head injury and an open head injury?
Closed head injury is non-penetrating, an open head injury is a penetrating injury.
Brain lacerations, contusions and diffuse axonal injury are examples of ______ head injuries.
(closed, open or traumatic inertial?)
Brain lacerations, contusions and diffuse axonal injury are examples of closed head injuries.
What are traumatic inertial injuries?
Traumatic inertial injuries are injuries resulting from inertial forces.
Traumatic inertial injuries are considered non-impact injuries. One common type is acceleration-deceleration forces where the brain is rapidly accelerated within the skull followed by rapid deceleration.
Diffuse axonal injury is caused by what types of forces?
Diffuse axonal injury, caused by rotational or angular forces is an example.
Non-traumatic brain injury is brain injury caused by what type of forces?
Non-traumatic brain injury is brain injury caused by internal factors.
3 examples of non-traumatic brain injuries caused by internal factors are…
Lack of oxygen, exposure to toxins, pressure from a tumor.
What is a primary injury? (vs. a secondary injury)
Primary injury is the initial injury to the brain that defines it as either traumatic or non-traumatic.
What is a secondary injury (vs. a primary injury)
Secondary injury are the secondary aspects or delayed aspects when the injury process extends past the point of time from the initial injury.
There are pathological and delayed non-mechanical processes extending from phase 1 (impaired blood flow, tissue death, metabolic imbalance, membrane permeability) to phase 2 (necrosis, release of excitatory neurotransmitters) until cell death.
Three examples of Phase 1 Secondary Injury:
1) impaired blood flow 2)diffuse axonal injury, 3) metabolic imbalance
A concussion is a…(up to 5 points)
A concussion is also known as a mild TBI.
Caused by a bump, blow or jolt to the head.
A traumatic alteration in mental status.
Concussion may or may not involve loss of consciousness.
75% of all TBIs are mTBI (concussion)
__% of TBIs that occur each year are mild TBIs
75% of TBIs that occur each year are mild TBIs.
An estimated ___ million people sustain a TBI yearly.
An estimated 2.5 million people sustain a TBI yearly.
Brain injury is the ___ most prevalent disability in the U.S.
Brain injury is the 2nd most prevalent disability in the U.S.
There are ___ million Americans living with brain injury.
There are 13.5 million Americans living with brain injury.
List 5 risk factors for determining the effects of brain injury.
1) age
2) alcohol misuse
3) domestic violence
4) service in the military
5) participation in sports are all risk factors for determining the effects of brain injury
After the initial injury the risk of a 2nd brain injury increases to ___x greater.
After the initial injury the risk of a 2nd brain injury increases to 3x greater.
After the second injury the risk of a 3rd brain injury increases to __x greater.
After the second injury the risk of a 3rd brain injury increases to 8x greater.
Age groups most likely to sustain TBI are 1) __ to __ (MVA), 2) __ to __ (firearms) and 3) __ to __ (highest risk of hospitalization and death)
Age groups most likely to sustain TBI are 1) 15 to 19 (MVA), 2) 20 to 24(firearms) and 3) 65 to 75+ (highest risk of hospitalization and death)
Child abuse (non-accidental trauma) is the cause of at least __% of deaths from head trauma in children under 2.
Child abuse (non-accidental trauma) is the cause of at least 80% of deaths from head trauma in children under 2.
Who has higher rates of TBI? Males or females?
Males have higher rates of TBI.
Among children 9 or younger, the most injuries are from…
bicyling and playground injuries
What is the % of women victims of domestic violence with symptoms of brain injury?
67% of women victims of domestic violence have symptoms of brain injury.
What are the 6 screening tools for TBI?
- A
- H
- W
- I
- T
- O
A -ACE H - HELPS W - WARCAT I - ImPACT T - TBIQ O - OSU TBI-ID
What is the difference between the rehabilitation accreditation and licensure organizations JCAHO and CARF?
JCAHO - hospital based programs
CARF - post-acute programs (outpatient, residential, vocational, home and community)
What does CARF stand for?
Commission for the Accreditation of Rehabilitation Facilities
What are the annual costs of TBI?
Over 76 billion annually
Only __% of persons with severe brain injuries have adequate funding for long-term treatment and supports.
5% of persons with severe brain injuries have adequate funding for long-term treatment and supports.
What is the Rehabilitation Act of 1973?
The Rehabiltiation Act of 1973 was the foundation for state vocational programs. It assists people with disabilities who are pursing meaningful careers.
The Olmstead Decision
The Olmstead Decision is a Supreme Court decision (1999) that ruled that the plaintiffs must be granted the option to live in the community.
Has gradually created more opportunities for persons with disabilities to be served through cost-effective community-based services. Utilizes Title II of ADA in asserting states administer their services, programs and activities in integrated community settings.
How many state affiliates make up the Brain Injury Association of America?
26 state affiliates. BIAA is the leading organization in the country.
What is the TBI Act of 1996?
The TBI Act of 1996 is the only federal law that specifically and exclusively addresses TBI in the civilian population.
Remains the single most important piece of federal legislation for persons with BI. Set the stage for research and improving systems of care for BI.
Gave authority for:
- CDC to establish projects for prevention and improved services
- NIH to award grants based on research
- HRSA (Health Resources and Services Administration) to make grants to states
What is the TBI Model Systems of Care?
Traumatic Brain Injury Model Systems (TBIMS) is funded through the US Department of Education’s National Institute on Disability and Rehabilitation Research. It contains prospective longitudinal research to demonstrate the course of recovery and outcomes following TBI. It was established in 1987 to conduct research and follow standardized national database for analysis of treatment outcomes.
People with a TBI have a life expectancy reduction of how many years?
People with TBI have a life expectancy reduction of 7 years.
The three layers of the meninges are…
Dura Mater
Arachnoid Layer
Pia Mater
The outer layer of the meninges that is latin for “tough mother”.
Dura Mater is the outer layer of the meninges that is latin for “tough mother”.
The subdural layer is below this layer of meninges.
The subdural layer is below the Dura Mater.
The middle layer of the meninges with consistency similar to a spider web.
The arachnoid layer is the middle layer of the meninges with consistency similar to a spider web.
The subarachnoid layer is beneath this layer of meninges..
The subarachnoid layer is beneath the Arachnoid Layer of meninges.
The third layer of meninges that is latin for “ tender mother”
Pia Mater
The three portions of the brainstem are 1), 2), and 3).
The medulla, pons and midbrain.
This is the smallest part of the brainstem, involved in elementary forms of vision and hearing.
Midbrain
This part of the brainstem plays a pivotal role in alertness and arousal
Midbrain
The part of the brainstem above the medulla. Sits between the medulla and the midbrain.
Pons
The part of the brainstem essential for facial movements, facial sensation, hearing, and coordinating eye movements
Pons
The part of the brainstem that mergers with the spinal cord creating the base of the brainstem
Medulla
The part of the brainstem that serves as a control center for involuntary reflexes (breathing, heart rate, blood pressure, swallowing, vomiting and sneezing).
Medulla
The part of the brainstem responsible for basic living functions
Medulla
The collection of nerve fibers and nuclei within the brainstem that modulates arousal, alertness, concentration and basic biological rhythms.
Reticulating Activating System
Collection of nerve fibers responsible for controlling arousal, alertness and ability to concentrate. Causes sleep and fatigue disturbances.
Reticulating Activating System
The Diencephalon is comprised of the …. and the …..
The Diencephalon is comprised of the thalamus and the hypothalamus.
The part of the diencephalon that sits on top of the brainstem. Sensory input pass through it to the higher levels of the brain. It is the relay station for incoming and outgoing information.
Thalamus
The part of the diencephalon that controls the autonomic nervous system and regulates body temperature. Also regulates hunger and thirst and the sleep wake cycle.
Hypothalamus
The system that its on top of the brain stem and is interconnected with the diencephalon. This system controls emotions and basic feelings.
Limbic System
The limbic system is comprised of (4 parts)
The limbic system is comprised of the hippocampus, amygdala, thalamus and hypothalamus.
The structure of the limbic system that sits within the temporal lobe, associated with memory functioning and susceptible to anoxia/hypoxia.
Hippocampus
The structure of the limbic system controls the “fight or flight” structure
Amygdala
The structure of the limbic system that affects voluntary motor nerves causing slowness and loss of movement, tremor, and muscular rigidity
Basal Ganglia
The portion of the limbic system that helps to handle physical movements by relating information from the cerebral cortex, brainstem and cerebellum
Basal Ganglia
Coordinates and modulates all body movement. Controls the direction, rate, force and steadiness of movements.
Cerebellum
Right Hemisphere information processing (name 5-6 distinctions)
holistic visual spatial intuitive controls left side of body music, art, shapes
Left Hemisphere information processing (name 5-6 distinctions)
linear verbal-analytic logical controls right side of body speaking, reading, writing
The right hemisphere communicates with the left hemisphere via a bond of fibers within the brain that relay information called the…
corpus callosum
List 5-6 frontal lobe functions
planning organizing problem solving judgment impulse control decision making
What are the functions of the temporal lobe?
The temporal lobe functions for memory, language and hearing.
What are the functions of the parietal lobe?
Sensation and perception, responds to touch, temperature and pain, processes sensory information, sensory input integration
Impairments of the parietal lobe include:
Agraphia, acalculia, anosgnosia, aphasia, impaired attention, neglect, left-right disorientation.
Difficulty identifying sensation, location, temperature, pain, movement
Divisions of the spinal column
Cervical (7 topmost vertebrae)
Thoracic (12 vertebrae)
Lumbar (5 vertebrae)
Magnetic Resonance Imaging (MRI) uses…
MRI uses magnetic field
radio frequency pulses
computer to produce detailed pictures of organs, soft tissue and bone
MRI provides better detail than CT
MRI measures and maps ….
MRI measures and maps brain activity by detecting changes associated with blood flow.
What is an acceleration-deceleration (traumatic inertial) injury?
Rapid acceleration of the brain followed by rapid deceleration. Results in the shearing of axons and blood vessels rendering white matter tracts non-functional.
The ability of the nervous system to change itself, form new connections and create new neurons in order to compensate for injury or adapt to changes in the environment.
Neuroplasticity
What is synaptogenesis?
The greater the numbers of synapses within a grouping of neurons, the greater the speed and efficiency with which those neurons communicate.
The formation of synapses between neurons.
Define cortical reorganization.
The brain’s cortical map can change through rehabilitation (directed exercise, constraint induced movement therapy)
__% of brain injury in the United States are mTBI.
75%
Potential neuroprotective agents for TBI include…1), 2), 3)
1) Magnesium
2) Progesterone
3) Nicotinimide
Definitive characteristics of a mTBI: Structural Imaging LOC - loss of consciousness AOC - PTA GCS - Glasgow Coma Scale
Definitive characteristics of a mTBI:
- Normal structural imaging
- LOC = 0-30 minutes
- AOC= 1 moment up to 24 hours
- PTA = 0-1 day
- GCS = 13-15
Definitive characteristics of a MODERATE TBI: Structural Imaging LOC AOC PTA GCS
Definititive characteristics of a MODERATE TBI:
- Normal or abnormal structural imaging
- LOC >30 min and <24 hrs
- AOC > 24 hr severity based on other criteria
- PTA > 1 and <7 days
- GCS = 9-12
Definitive characteristics of a SEVERE TBI: Structural Imaging LOC AOC PTA GCS
Definitive characteristics of a SEVERE TBI:
* Normal or abnormal structural imaging
LOC >24 hrs
PTA >7 days
GCS = 3-8
___to ___% of mTBI do not seek care.
16-25% of mTBI do not seek care.
mTBI definition from ACRM.
Alteration of mental state
Feeling dazed or confused
Difficulty answering simple questions
unclear thinking
What does ACRM stand for?
American Congress of Rehabilitation
3 primary causes of mTBI
Primary causes of mTBI include:
Acceleration - deceleration (MVA)
Striking head against hard surface (falls)
Blasts or explosions
What is mTBI - Second Impact Syndrome?
After one mTBI, the brain is significantly more affected by the neurochemical cascade of each successive injury.
What is the most common form of damage in a mTBI?
Diffuse axonal injury
What is diffuse axonal injury?
Axonal shearing occurs, disrupting neuronal communication due to damage to myelinate white matter
Difficult to visualize during neuroimaging
The MRI and CT for mTBI are likely to show up as…
normal
What happens with neurotransmitters during mTBI?
There is a massive release of the neurotransmitter glutamate (high levels become toxic, impacting amount of fuel available to the brain)
When do mTBI symptoms resolve?
2-4 weeks
What % of people continue to have problems after most mTBI symptoms have resolved?
10-15%
What is the most common mTBI symptom?
Headache
more likely to arise due to mental not physical fatigue
Besides headache, what are 3 more most common mTBI symptoms?
Fatigue
Poor restorative sleep
Vision changes (blurred vision, eyes can’t focus)
What is a change to balance in the inner ear caused by mTBI called?
Benign Paroxysmal positional vertigo is a common inner ear disorder after mTBI.
How are mTBI headaches treated?
Similarly to migraine. There may be hypersensitivity to sound
What is the mTBI cycle of symptom overlap?
Cycle of headache, lack of sleep which increases headache which causes it to be hard to sleep…
What does research say about early intervention and management for mTBI
Early intervention and management is the most effective means of reducing disability in mTBI.
Physical therapy for vestibular rehabilitation in mTBI focuses on (3)
Physical therapy for vestibular rehab of mTBI focuses on
Gaze and Posture instability
Motion sensitivity
mTBI sensory sensitivity means that _____ is common due to the brain’s slower processing.
mTBI sensory sensitivity means that overstimulation is common due to the brain’s slower processing.
What is Persistent Post-Concussive Symptoms (PPCS)?
PPCS is a complex disorder following a concussion, lasting for weeks or months, consisting of symptoms such as headaches and dizziness.
Disorders of consciousness classification system includes 3 generally accepted levels: 1) - 2) - 3)
Coma - Vegetative - Minimally Conscious
of people in a vegetative state each year ____. # of people living with a DOC.
4,200 in U.S. 315,000 living with a DOC.
How to treat Persistent Post-Concussive Symptoms (PPCS)?
Persistent Post-Concussive Symptoms (PPCS) is a complex disorder following a concussion, lasting for weeks or months, consisting of symptoms such as headache or dizziness.
Treated with a neuropyschological evaluation with multidisciplinary team and symptom focused.