Units 2 and 3 Flashcards
What are the 5 principles of motor learning?
P G R G F
Performance (repetition of a task)
Generalizability (ability to apply skill to similar task)
Resistance to change (motor skills should be performed in multiple environments)
Guidance (care provider physically assists)
Feedback (intrinsic and extrinisic)
Types of Hydrocephalus (2 types)
Obstruction (obstruction of CSF fluid)
Hydrocephalus ex-vacuo
What is spasticity?
Sudden flexing or extending of a limb that is not voluntary. Occurs after damage to the upper motor neurons.
What is treatment for spasticity?
Remove irritating factors that would cause increased spasticity.
Oral antispasmodics Baclofen pump (implanted to deliver baclofen at the spinal level)
What is Deep Vein Thrombosis? (DVT)
a blood clot in deep veins of the body (often legs)
What causes a DVT?
immobility
What is prophylaxis for DVT?
Prophylaxis includes anti-coagulants the risk of pulmonary embolus
What is Heterotrophic Ossification (HO)?
Formation of new bone around joints as a consequence of trauma and/or immobility.
What are the signs of Heterotrophic Ossification?
The surface around the affected joint becomes red or swollen with increased pain and decreased range of motion and/or spasticity.
What is cranial nerve dysfunction?
Causes disorders of functional movement, coordination and visual disorder.
What is ataxia?
Ataxia = decreased or lack of muscle coordination for voluntary movements caused by damage to the cerebellum
What are the 4 types of coordination disorders?
Athetoid
Ballisms
Choreiform
Tremors
What is Athetoid movement?
slow, involuntary writing movements
What are Ballisms?
Quick flailing movements
What is Choreiform movement?
Rapid and unpredictable movements
What are tremors?
Unintentional trembling or shaking
What is the difference between sensation and perception?
Sensation is appreciation of stimuli through senses and peripheral receptors.
Perception incorporates sensation and interprets information.
Visual impairments include…(3)
Visual field loss
Decreased visual acuity
Decreased contrast sensitivity
What problems do perceptual deficits cause?
Decreased discrimination Decreased spatial skills Agnosia Body schema/ body image disorders Apraxias
What is anosognosia?
Anosognosia is a type of perceptual deficit that causes lack of awareness or denial of paralysis of a limb.
What are types of agnosia (3)?
Visual Agnosia
Auditory
Tactile Agnosia
What is are the types of apraxia (3)?
Ideomotor Apraxia
Ideational Apraxia
Buccofacial Apraxia
What is Ideomotor Apraxia?
Ideomotor Apraxia: inability to perform a task on command or imitate gestures
What is Ideational Apraxia?
Ideational Apraxia is inability to perform tasks automatically and on command.
What is Buccofacial Apraxia?
Limitations in performing purposeful movements of the lips, cheeks, tongue, larynx and pharynx
What is Visual Agnosia?
Visual Agnosia - inability to recognize objects visually
What is Tactile Agnosia?
Tactile Agnosia - inability to recognize an object through touch or manipulation
What is Auditory Agnosia?
Auditory Agnosia - inability to distinguish between sounds
TBI is present in __% of individuals with spinal cord injury.
TBI is present in 60% of individuals with spinal cord injury
Why is skin vulnerable to pressure sores?
Skin is vulnerable to pressure sores due to lack of sensation and pressure over bony prominences.
How often to perform frequent re-positioning?
Frequent position changes while in bed (every 2 hours).
Spinal cord injury above T-12 characteristics
Upper motor neuron
Anal sphincter remains tight
Continent evacuation can be stimulated
Can cause spastic bladder
Spinal cord injury below T-12 characteristics
Lower motor neuron
Anal sphincter may be affected
Likely incontinent
Can cause flaccid bladder
What are bladder management options?
Foley catheter - Tube in, suprapublic catheter
External condom cath - Tube out
What is orthostatic hypertension?
Low blood pressure when you stand up (postural hypotension)
What are two causes for early cardiopulmonary issues?
May be caused by direct trauma or result from damage to the parts of the brain that control heart and lung function.
Some individuals require immediate life support (ventilator) or subsequent tracheostomy
What is the etiology of a DVT?
1: Blood flow moves too slowly
2: Clustering of blood cells
3: Blockage develops
4: Part of blockage breaks free and can move to the lungs causing a pulmonary embolism
What is Dysautonomia (also called automatic storming?)
Autonomic functions such as heart rate, respiratory rates, blood pressure and temperature and perspiration are disrupted.
May also present with muscle overactivity, posturing, dystonia, rigidity and spasticity
Usually resolves in early recovery
What are musculoskeletal complications?
Hint: 7 types of complications
Neurologically-based disruptions in neurologically based
reflexes sensory integration range of motion muscle tone strength endurance spasticity postural control
What is hyperreflexia?
Involuntary exaggerated deep tendon reflexes.
What are contractures?
Abnormal, usually permanent condition of joints characterized by decreased range of motion, often in a flexed position, and fixation due to wasting away and shortening of muscle fibers and loss of skin elasticity
What is spasticity?
Involuntary increase in muscle tone (rigidity)
Give 2 examples of musculoskeletal complications.
Spasticity Heterotopic Ossification (HO)
How are musculoskeletal complications managed?
Exercise casting and orthotic techniques ultrasound functional electrical stimulation oral anti-spasticity medications botox baclofen pumps
to improve flexibility and normalize tone
What is hypertonia?
Spasticity or too much muscle tone.
Urinary incontinence management
1) Begin bladder training (timed toileting)
2) Avoid catheters
3) Look for signs and symptoms of UTI
Bowel management
monitor diet and fluid intake
stool softeners, bulk laxatives
Gastrointestinal system is responsible for
regulation.
Achieving adequate nutrition is complicated by arousal, dysphagia, safety awareness and medical issues
What is metabolism?
A set of chemical reactions to convert food to energy/fuel.
What are the risk factors for pressure sores (6)?
Use of casts and/or splints Sensory Impairment Incontinence Poor nutritional status Contractures Spasticity
Individuals with brain injuries are susceptible to infections when they have…
open wounds
use indwelling devices
immuno-suppressed
Common infections (5)
Cellulitis Surgical site infections Meningitis Respiratory infections Urosepsis (UTI)
After TBI, individuals are __ times more likely to die of a seizure disorder as compared to the general population
After TBI, individuals are 22 times more likely to die of a seizure disorder.
What is the occurrence rate of seizures in TBI?
4-53% of individuals with TBI have seizures.
What are Immediate Post-Traumatic Convulsions? (IPTC)
IPTC are events that involve loss of consciousness and movement seconds after impact. More similar to syncope than seizure.
When do Early Post-Traumatic Seizures start?
What can Early Post Traumatic Seizures lead to?
What are the risk factors for Early Post-Traumatic Seizures (EPTS)? (Hint: 6 risk factors)?
Leads to Late Post-Traumatic Seizures (LPTS)
Occurs LESS than 1 week after initial head trauma.
Risk factors include: severe brain injury Depressed skull fracture Penetrating head injury Hematomas Cortical contusion Chronic alcohol use
What is Late Post-Traumatic Seizures (LPTS)
Occurs LATER than 1 week after initial head trauma.
Strong predictor of recurrent seizures
Strong risk factors also include missle wounds, craniotomies
What is Status Epilepticus?
More than 30 minutes of continuous seizure activity, or two or more sequential seizures or without full recovery of consciousness between seizures.
What is seizure treatment?
Antiepileptic Prophylaxis
What are the two most common pain pathways in persons with TBI?
Nocioceptive and Neuropathic.
What is Nocioceptive pain?
Pain related to the peripheral nerve fibers
What is Neuropathic Pain?
Pain associated with primary lesion of dysfunction of the nervous system.
What is the difference between primary and secondary headache?
A primary headache has no specific cause.
A secondary headache may have an identifiable cause that can be determined.
How long does a chronic headache occur?
A chronic headache occurs at least 15 days per month for at least 3 months.
Can a chronic headache be linked to overuse or withdrawal of medication?
No
Selective attention
Maintaining attention in the presence of distractions
How does attention retraining work?
Retraining systematically increases the level of distracters in an environment to simulate high-level demands
What is Attention Processing Training Program? (APT)
a hierarchically organized process-specific approach to cognitive rehabilitation. Shown to also result in improved memory
Sensory Memory
holds information from the senses for a few seconds immediately after the item is perceived
There are five types of sensory memory
Processing Speed
also known as cognitive reaction time
Metacognition
a higher order self-regulatory function that includes awareness of one’s own cognitive processing. Metacognition and executive functioning are not the same but they do depend on each other.
Anosognosia
Diminished self-awareness and failiure to recognize a personal disability
An estimated __% experience hearing loss after non-blast injuries and __% experience hearing loss in blast related injuries
An estimated 44% experience hearing loss after non-blast injuries and 62% experience hearing loss in blast related injuries
Cognitive Distance
the concept relates to the complexity of information available. concrete ———–>abstract
Neurobehavioral issues are often considered to be
Neurobehavioral issues are often considered to be the most problematic consequence of brain injury by family members, employers, friends
List 6 common neurobehavioral changes after brain injury
aggression poor initiation psycosis poor judgment and reasoning denial of deficits nighttime disturbances
Factors influencing behavior (4)
Site and severity of damage
Pre-injury characteristics of personality
Intelligence and learning style
The current environment
Often the safest and most effective technique for dealing with coma-emergent agitation is
environmental management
What is the stability triangle?
The stability triangle provides a guiding phylosophy for the development of a comprehensive treatment plan
What are the points of the stability triangle?
Establish Medical Necessity
Promote Stable Behavior
Develop Stable Activity Plan
Applied Behaviora Analysis
Anything that an individual does that can be measured is defined as a behavior. ABA - The environment, the individual, the target behavior.
Goal is to discover variables that predict, influence or promote behavior change
What are the elements of a behavior program?
1) in order to implement a behavior change procedure it is critical to identify the behavior that is targeted for change
2) to measure behavior it has to be observable, measurable, specific
Collecting data from a behavior program involves (5) F R D L PC
Data on frequency, rate, duration, latency, percent correct
What is Consequence Based Intervention?
Applies reinforcement and punishment. - negative reinforcement/positive punishment, negative punishment/positive punishment
What is reinforcement?
Any process that increases the likelihood that a particular response will occur again in the future.
What is punishment?
refers to any process that decreases the likelihood of that particular response will occur again in the future
What is fading?
the process by which one learns to produce the same response under gradually changing conditions, in a manner implied by the same name of the procedure. Involves providing gradually lessening support
What is shaping?
A technique in which successively closer apprxoimations of the target response are reinforced until the target response occurs
De-escalation techniques (6)
active listening orientation redirection setting limits withdrawing attention contracting
Factors that play a role in developing neuropsychiatric symptoms after TBI
age gender injury location premorbid symptoms injury severity
What is a dual diagnosis?
the relationship of a set of symptoms including behaviors, which are or resemble symptoms of a known psychiatric disorder.
When individual have those symptoms + TBI
Most common Axis I Neuropsychological Disorder?
Major Depressive Disorder
List 5 factors related to development of Dual Diagnosis?
Social functioning job dissatisfaction low economic status less education lack of close personal relationships
TBI relates to increased risk of the following 5 psychiatric disorders
Depression Bipolar disorder Panic disorder Generalized anxiety Schizophrenia
What is a mani episode and how long does it last?
A period of at least 1 week where the individual has a noticeably elevated, expansive, or irritable mood with at least 3 symptoms extremely amplified self esteem decreased desire to sleep grandiose ideas distractibility risk activities
Major Depressive episode and how long does it last?
At least 2 weeks in which individual experiences loss of interest or depressed mood accompanided by at least 4 symptoms:
- change in appetite
- weight gain
- decreased energy
- feelings of worthlessness
- suicidal ideation
Bipolar Affective Disorder
Mood disorder with further clasfications - risk factors are behavioral swings, medication compliance and substance use
Panic Disorder
When repeated panic attacks followed by worry about future attacks or changes in behavior related to the panic attack
What are the characteristics of panic disorders
Sweating Palpitations Trembling/haking Nausea chest pain Dizziness Chills Hot flashes
Schizophrenia
A disorder lasting for at least 6 characterized by a minimum of a 1-month phase of symptoms that include delusions, hallucinations, incoherent speech
What are the 4 Return to Work Models?
Comprehensive Integrated Day Treatment
Vocational Case Coordination
Resource Facilitation
Supported Employment
The Vocational Case Coordination Model is part of the Return to Work Model.
Services must include
Early identification of vocation as a goal Early medical rehab work trials early in recovery Employer education Supported employment
Reliability speaks to a measurements…
consistency
when a measure is reliable you can expect similar results when two providers administer the assessment
a reliable measure is consistent when used for different individuals
Glasgow Coma Scale Scores range between…
Scores range between 3 and 15 with lower scores = more severe the injury
Glasgow Coma Scale has three components…
- eye opening
- verbal response
- motor response
Explain Mild, Moderate, Severe Glasgow Coma Scale scores
Mild 13-15
Moderate 9-12
Severe 3 - 8
What is the Glasgow Coma Scale?
Widely used measure of level of consciousness.
Level of consciousness also serves as an indicator of severity of brain injury.
Scale going out of favor due to use of word Mild
Ranchos Los Amigos Level of Cognitive Functioning Scale
Used for assessmetn of cognitive function of people with brain injury post-coma
Mayo-Portland Adaptability Inventory (MPAI)
Has 3 subscales (abilities, adjustments, participation)
Assists in clinical evaluation post-acute period following brain injury
World Health Organization Biopsychosocial Model takes what into account to explain disability or disease?
takes into account the interaction of biological, psychological, social and cultural factors to explain disability or disease
World Health Organization Biopsychosocial Model measures of participation include 3 measures
1) Craig Handicap Assessment and REporting Technique - Short Form (CHART-SF)
2) Participation Assessment with Recombined Tools - Objective (PART - O)
3) Mayo Portland Adaptability Inventory - 4 Participation Index
What is often considered to be the most problematic consequence of brain injury by family members, employers, friends?
neurobehavioral issues
What are the four factors that influence behavior after brain injury?
1) Site and severity of damage
2) pre-injury characteristics of personality
3) intelligence and learning style
4) current environment
What is coma -emergent agitation?
When individuals experience a period of agitation upon emerging from coma.
Characterized by hyperactive movement without purpose, and responding to internal stimuli rather than external
How long does coma-emergent agitation last?
Not long, usually less than 10 days
What is the safest technique for coma emergent agitation?
medication and behaviorally based interventions (through environmental management) - the focus is on offering a quiet, organized and structured environment with limited stimulation
What is the Stability Triangle?
provides a guiding philosophy for the develpment of a comprehensive treatment plan
What are the three levels of the stability triangle?
1) Establish Medical Stability
2) Develop Stable Activity Plan
3) Promote Stable Behavior
Describe Level 1) Establish Medical Stability of the Stability Triangle
It is difficult to establish behavior stability when an individuals medical complications impact their ability to respond
These factors are important as they can influence how individual interacts with environment: pain sleep disturbance drug or alcohol use vestibular issues seizure disorders
Describe Level 2) Develop Activity Plan of the Stability Triangle
Increase opportunities for meaningful engagement in routine activities
The team must explore individuals abilities, interests and need for support
Describe Level 3) Promote Stable Behavior of the Stability Triangle
Requires team to assess and address problematic behaviors like resistance or refusal mood instability threatening or demanding behaviors verbal and physical aggression elopement
What is a behavior?
Anything an individual does that can be measured is defined as a behavior.
What is the goal of behavioral analysis?
To discover variables that reliably influence behavior to predict behavior or promote behavior change. There are three variables to be considered.
What are the three variables to consider in behavioral analysis?
The individual
The environment
The target behavior
In order to measure a behavior, it must be operationally defined. The behavior must be…(3 things)
Observable
Measurable
Specific enough that multiple observers would agree on what would count as an occurence
Behavioral Program Elements include 4 stages
1) Assess behavior
2) Define target beahvior
3) Collect data
4) Change the behavior
What is Fading?
Fading is the process by which one learns to produce the same response under gradually changing conditions.
Providing gradually less support to get the target behavior
What is Shaping
A technique in which successively closer approximations to the target response are reinforced unil the target response occurs
What is Task Analysis?
A task analysis is a list of very specific steps involved in completing a task
What is Intermittent Reinforcement in schedules of reinforcement?
Produces greater variability in behavior
Utilized to promote generatlization and maintenance of behavior
Behavior is highly resistant to extinction (hourly pay/slot machines)
Use of restraint and seclusion
Used as a last resort
Used when less restricted measures are exhausted
Highly regulated
Only when individual or others are in imminent danger
De-escalation techniques (6 total)
1) active listening
2) orientation
3) redirection
4) setting limits
5) withdrawing attention
6) contracting
What is extinction in schedules of reinforcement?
When a particular response never produces a reinforcer
The disappearance of a previously learned behavior when the behavior is no longer reinforced
What is prompting and cueing?
Process by which an individual is supported to display a correct response
Children with TBI before age ___ are more likely to develop a substance disorder.
Children with TBI before age 5 are more likely to develop a substance disorder.
Having a co-occuring TBI + Substance Misuse is associated with (3) total
higher rates of re-injury
suicide attempts
Decreased life satisfaction
If an individual misused alcohol or drugs prior to their injury, their risk of returning to substance misuse after injury is __times higher
10x higher
What is substance misuse?
the consumption of alcohol and illegal drugs and the use of prescription drugs exceeding the prescribed amount.
What is substance use disorder (SUD)?
involved continued use of drugs and alcohol despite health, psychological or social consequences
Name 4 assessments of Substance Misuse.
CAGE
AUDIT
CRAFFT
ASSIST
Describe 4 Quadrant Model of Substance Misuse
Describes the various settings where people with TBI and substance misuse could receive treatmetn
Quadrants are divided by whether the TBI and substance misuse are more or less severe
Describe Quadrant 1 of Substance Misuse Quadrant Model. (Quadrant 1 is bottom left corner)
SUD=Low Severity
TBI = Low Severity
Primary Care & Emergency Settings
-Acute Medical Settings & Primary Care
-Substance Miseuse
Use motivational interveiwing to support readiness to change
Screening and brief intervention methods
Describe Quadrant 2 of Substance Misuse Quadrant Model (Quadrant 2 is bottom right corner)
SUD=Low severity
TBI = High Severity
Rehabilitation settings
- TBI rehab programs & services setting
- Substance Misuse addressed by education screening, brief interventions & linkage
Describe Quadrant 3 of Substance Misuse Quadrant Model (Quadrant 3 is top left corner)
SUD=High Severity
TBI=Low Severity
Substance Use Disorder Treatment Settings
Substance Use Disorder Treatmetn Setting
-TBI Addressed by Screening, Accommodations & linkage
May have chemical dependency counselors
Describe Quadrant 4 of Substance Miuse Quadrant Model (Quadrant 4 is top right corner)
SUD= High Severity TBI= High Severity
Specialized TBI and Substance Use Disorder Services
Integrated Programming
More severe TBI and SUD
Intensive case management
Holistic treatmetn focusing on increasing healthy productive lifestyles
Consultation and education between and for treatmetn rpfoessionals
Skill building
Few exist
Inappropriate use of these violates constitutional rights
Seclusiona nd restraint
What is guardianship?
A legally enforeable arrangement in whcih the guardian has the legal right and duty to care for another (the ward)
What is power of attorney?
A document where a competent person appoints another person to act for him/her in legal and financial issues
What does HIPAA stand for?
Health Information Portability and Accountacbility Act
What does HIPAA do?
Regulations developed to protect indivudally identifiable health information, known as protected health information (PHI) 2003
American with Disabilities Act (ADA)
The American with Disabilities Act was enacted in 1990 to prohibit discrimination of those with disabilities
Legal use of restraint
Only as a measure of last resort
If individual or others are in danger
If less restrictive measures were attempted first
Must monitor physical and psychological status of patient
There are four models of disability as foundations for rehabilitation.
Biomedical
Functional
Environmental
Sociopolitical
Describe the Biomedical or Medical Model of Disability as Foundations for Rehabilitation
USed to understand most health conditions but does not lend itself well to psychiatric or congnitive conditions
Experts define characteristics, prognosis, and treatmetn
Normal vs. pathological
Desrcibe the Environmental Model of Disability as Foundations for Rehabilitation
The environment can cause, define, and exaggerate disability
Rehabilitation addresses both physical and social environments
Describe the Sociopolitical or Minority Group/ Independent LIving Model
HIghlight’s society’s responsibility for accommodating people with disability
Inclusion, civil rights, and equal social status
Describe the Functional Model of Disability as Foundations for Rehabilitation
Most individualized model and serves as the basis for person-centered care
What is person-centered care?
Empowers individuals to guide the rehab team to focus on their priorities, values and desired outcomes
What is the Extender Model?
Founded on the idea that maximizing contact with clinically skilled treatment providers will improve treatment outcome
Trained staff as extenders for therapeutic services
What is Post Acute Brain Injury Rehab?
For individuals who need longer intensive rehabilitation, manifest hazardous behavior, are unable to manage living independently
The age groups at highest risk for TBI are
Ages 0-4 (falls) (shaken baby syndrome/abusive head trauma)
Ages 15-19
struck by something, falls, MVA
What does AHT stand for?
Abusive Head Trauma
What does SBS stand for?
Shaken Baby Syndrome
AHT/SBS most common in infants and children ages
0-5
AHT/SBS more common for ___ to be the victim
boys
Most student athletes concussion symptoms will begin to dissipate within…
days or weeks of injury
It is reported that ___% of athletes experiencing a concussion have persistent syndromes
10%
Consussion symptoms include
Problems with attention Memory Fatigue Sleep Headache Dizziness Irritability Changes in mood and personality
Why are the effects of second impact syndrome cumulative?
The effects of multiple concussions may be cumulative and if there is not sufficient time for the brain to recover after or intial concussion, the athlete runs the risk of suffering second impact syndrome
What is second impact syndrome?
When an athlete sustains an initial concussion and then sustains a second head injury before symptoms from the first have fully resolved
When can second impact syndrome occur?
Minutes, days or weeks after the initial event
What is the Individuals with Disabilities Education Act?
Federal mandate to provide public education through special education and support services for children with disabilities
What is Section 504 of the Rehabilitation Act of 1973?1
Requires schools to provide reasonable accommodations to allow individuals with a disability to participate (preschool through post-secondary education and employment)
What is the Family Systems Theory?
The whole is greater than the sum
Assumes families have strength and capacity to solve problems
Encourages practitioners to think of interactions which occur between family members thoughts, beliefs, and actions, they influence decisions and behaviors
What does Family Centered Services (FCS) emphasize?
The survivor, family, and provider are partners in health care.
Care should be comprehensive.
Care should be tailored to the person with the injury and their family’s strengths, needs, priorities and values
In Cognitive Behavior Theory and COgnitive Behavior Family Theory , what do ths ABC represent?
A = Activating Event (families do not have control) B = Belief (families do have control)(we are strong and will persevere) C = Consequences of Belif (families do have control)
What does Family-Centered Service (FCS) emphasize?
The family, survivor and provider are partners in health care. Care should be comprehensive & tailored to person with the injury, families needs and values.
What does Section 504 of the Rehabilitation Act of 1973 require of schools receiving federal fundings?
Reasonable accommodations
Men with brain injuries outnumber women at what ratio?
2:1
Males are ___% more likely to return to work full time
Males are 23% more likely to return to work full time
What % of service members with TBI also has co-occuring Post-Traumatic Stress Disorder?
44% of service memebrs with TBI also have PTSD
What is a tertiary injury?
When displaced body impacts wall, ground or object
What is a primary blast injury?
direct impact from over-pressure wave - catapults body backwards
What is a secondary blast injury?
Debris or explosive fragments impact head or body
What is a quaterneray injury?
Inhalation of gases or toxic substances
What are the four domains measured by the Military Acute Concussion Evaluation (MACE)?
- orientation
- immediate memory
- concentration
- memory recall
The most common symptom of mTBI is
headache
What is a caregiver?
Typically an unpaid individual who provides care services to those who cannot adequately care for themselves
What is the Family systems theory? (FST)
The whole is greater than the sum
Encourages practitioners to think of interactions with family members
assumes families have strength and can solve problems
What is Family Centered Services? (FCS)
About mutual respect, information sharing, participation and collaborative partnerships with family
emphasizes the survivor, family and provider are partners in healthcare
What is cognitive behavioral therapy?
Talk therapy that is used with individuals w/ brain injury structured with helping individual become aware of inaccurate or negative thinking
What is Resilience Theory?
No matter how catastropic the event, there are always individuals and families who rise above the expective negative outcomes
Women experience _______ rates of depression and PTSD compared to men.
higher
Women experience reduced _____. They also report pain,
sexual energy
sensation
ability to satisfy partner
body image
What are causes and types of combat related injuries?
blast events
gunshot wounds
closed head injury
open head injury from penetrating forces - foreign objects, bone, fragments
How many levels of blast injury are there?
Four levels
List the four levels of blast related injuries
primary
secondary
tertiary
quartemary
What is a primary blast injury
results from impact of the over-pressurization wave with body surfaces
gas filled structures are most susceptible (lungs, GI tract, middle ear)
blast lung, ruptured ear, abdominal perforation, concussion
What is a secondary blast injury?
results from flying or falling debris and bomb fragments
any body part may be affected
penetrating fragments, blunt injuries, eye penetration
What is a tertiary blast injury
results from individuals being thrown by the blast wind, body impacts ground or object
any body part may be affected
fracture, traumatic amputation, closed/open BI
What is a quatemary blast injury?
explosions-related injury, illness or diseases not due to primary, secondary, tertiary blast mechanisms
any body part may be affected
burns
Neuropsychological Testing used within the military (4)
Neurobehavioral Symptom Inventory (NSI)
State-Trait Anxiety Inventory (STAI)
Automated Neuropsychological Assessment Metrics (ANAM)
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
What % of service members with concussion meet the diagnostic criteria for PTSD and mTBI?
44%
What is meant by the cascading effects of mTBI symptoms?
There is a co-occuring of disorders with mTBI that include chronic pain, PTSD, depression, anxiety, substance misuse that provide a diagnostic challenge given the overlap of symptoms
problems are aggravated by other symptoms
What are the four community integrated models?
Neurobehavioral program
Residential Community program
Comprehensive hollistic treatment
Home-based Program
What are the participant characteristics of a Neurobehavioral program?
Severe behavioral disturbance (24 hour SPV), residential setting
What are the participant characteristics of Residential Community Program?
Require 24-hr SPV in residential setting with community access
What are the participant characteristics of Comprehensive Hollistic Treatment
Need for intensive services in a day program, integrated with multimodal rehabilitation
What are the participant characteristics of a Home-based program?
Able to reside at home and self direct care
phone and web based supports & services in home
What is a life care plan?
developed with a case manager
used when a catastropic injury leaves an unexpected need for a plan
specific to the individual
reflects full understanding of injuries
short and long term needs
Medicaid funding
Joint state and federal funding
low income
chronic illness and disability with no private insurance
Medicare funding
Federal funding (4 part program)
A (no cost)
B
C
D
Affordable Care Act
Obama Care
March 2010
Individuals and employers must obtain or provide health insurance by 2014
health insurance reform
Rehabilitation Act of 1973
Prohibits discrimination based on disabilities in programs run by federal goverment agencies
schools
hospitals
nonprofict organizations
those receiving federal financial assistance
Contains Section 504
Section 504 of Rehabilitation Act
Free appropriate public education
IDEA
IEP
Special education services provided by states and agencies accepting federal funding for children with diabilities
ADA American with Disabilities Act
Prohibits discrimination in employment, state and local goverment
mandates public accommodations in commercial facilities
Tramautic Brain Injury Act of 1996
Authorized the National Institutes of Health to focus on research, prevention, improved services
What is neuropsychology?
The science of the brain-behavior relationships
What are the two branches of neuropsychology?
experimental (testing intact healthy brains)
clinical (testing brains with lesions)
What is the purpose of neuropsychologist assessment?
to determine the nature and extent of cognitive deficits, presence of neurologically based disorder, establish a baseline, assist in treatmetn planning
What does adaptability mean?
An individuals capacity to change behaviors in order to adapt to changes in their environment
How long does a chronic headache last?
Lasts at least 15 days per month for at least 3 months
WHat is a primary headache?
a headache with no specific cause. a secondary headache may have an identifiable cause
What type of pain is neuralgia?
Neuralgia is a type of pain that is caused by damage to a nerve or structural change in a nerve.
What is neuroma?
When a nerve becomes entrapped in scar tissue
What is the difference between physical pain and physiological fatigue?
Physical fatigue may be associated with muscle weakness or other changes/injuries in the peripheral nervous system.
Physiological fatigue results from depletion of energy, hormones, neurotransmitters of # of neuronal connections
What is the difference between primary and secondary fatigue?
Primary fatigue results directly from injury or disease.
Secondary fatigue reslates to factors that may exacerbate fatigue such as pain, sleep disturbance or stress
What is ideomotor apraxia?
inability to perform a task on command or imitate gestures
What is ideational apraxia?
inability to perform tasks automatically and on command
What is buccofacial apraxia?
limitations in performing purposeful movements of the lips, cheeks, tongue, larynx and pharynx
What is the difference between a complete spinal cord injury and an incomplete spinal cord injury?
Complete Spinal Cord Injury - no motor or sensory function below the level of injury
Incomplete Spinal Cord Injury - functioning of sensory and possibly some or much motor sensation below the level of injury
What % of people with TBI also have personality disorders?
23% of peole with TBI have personality disorders
Difference between substance misuse and substance use disorder (SUD)?
Substance use disorder (SUD) involves continued use of substances despite health, psychological or social consequences
What do the terms competency or capacity mean in the legal system?
Competency or capacity is a legal term that describes a persons mental ability to understand the nature and effect of one’s decisions and acts
Generally the law presumes an adult is competent unless proven otherwise
What is informed consent?
Refers to apatient’s right to consent to care only afte rthe health care prover fully discloses risks and facts necessary to make an informed decision about health care
Difference between abuse and neglect
Abuse is the willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish
Neglect is a failure to provide for the basic needs of a dependent individual
What is IDEA?
A federal education mandate - schools must provide a free appropriate public education through the use of special education supports and services to chidlren with disabilities
Describe Family Support Theory
Family Support Theory takes a positive view of families and assumes that every family has the strength and capacity to solve problems and make positive changes.
Military families often face rehabilitation from poly-traumatic injuries. What does this mean?
Multi0systemic injuries may include severe pain, amputations, PTSD, burns and other challenges
Who experiences higher rates of PTSD? Males or females?
Females experience higher rates of PTSD than males post-TBI
What is benign neglect
A reference to the treatment of LGBT patients where staff ignores or mismanage the unique challenges of these individuals.
What does CIR stand for?
Community Integrated Rehabilitation
What is CIR?
Community Integrated Rehabilitation programs focus on the treatment environment, use a treatment team model with neuropsychological focus and address awareness, cognition, social skills and vocational skills
What does research on CIR show?
Improved functional outcomes, reduced social dependency, increased participation, better vocational outcomes and improved self and family ratings
What criteria is essential to a Life Care Plan?
Must be specific to the individual
Must reflect full understanding of injuries
Must consider possible complications of co-morbidities
Short and long term needs
What is the Glasgow Coma Scale?
Measures level of consciousness and is an indicator of the severity of brain injury. Scores range between 3 and 15 (the lower the score the more severe the injury)
Eye opening
Verbal response
Motor response
What is the JFK Coma Recovery Scale
Measure used with individuals who have an extended disorder of consciousness (vegetative state or minimally conscious state)
23 items in subscales auditory, visual, motor, oromotor, communication and arousal functions
What are Measures of Post-Traumatic Amnesia? (PTA)
PTA refers to post-traumatic amnesia
The duration of PTA is a good predictor or indicator of long-term issues following brain injury.
The longer the period of PTA, the more likely long-term issues
What is the Disability Rating Scale? (DRS)
Research instrument 8-item assessment of impairment, disability, handicap or participation
What is the FIM?
18-item ordinal scale 23 physical items and 6 cognitive items
What is the Rancho Los Amigos Level of Cognitive Functioning Scale?
Outcome measure used for assessment of cognitive function of people post-coma. Scores range from 1 to 8
Describe the supported employment model.
The supported employment model emphasizes the use of a vocational rehabilitation professional, known as an employment specialist or job coach, to provide intensive individualized assistance to help him or her with gaining or maintaining employment in a real job for real pay in the community
What is a dual diagnosis?
The relationship of a set of symptoms including behaviors that resemble symptoms in a known psychiatric disorder
What is a manic episode?
Period of at least 2 week where the individual has a elevated expansive or irritable mood with at least 3 symptoms
grandiose ideas distractibility risk activities extremely amplified self esteem decreased desire to sleep
What is Major Depressive Episode?
At least 2 weeks when the individual experiences loss of interest or depressed mood accompanied by four symptoms
feelings of worthlessness
weight gain
change in appetite
suicidal ideation
What is a panic disorder?
Repeated panic attacks followed by worry about future attacks
What is obsessive-compulsive disorder? (OCD)
Repetitive ritualistic behavior that is so severe it becomes time consuming OCD
