CBIS Exam 2023 with complete questions and answers

Acute Brain Injury An injury to the brain that is not hereditary, congenital, degenerative, or induced by birth trauma Traumatic Brain Injury An alteration in brain function, or other evidence of brain pathology, caused by an external force 2 Mechanisms *trauma impact * traumatic inertial forces Non-traumatic brain injury Lack of O2, decreased nutrients to cells, exposure to toxins, pressure from tumor or blockage or other neuro disorder ABI Prevalence 2nd most prevalent disability in U. S. * 13.5 million Americans Children & TBI * non-accidental trauma cause of 80% of deaths in children under 2yo * 2/3 of children under 3yo that are abused have TBIs *falls cause 1/2 of TBI in 0-14yo domestic violence 67% of women in domestic violence had TBI symptoms Mild TBI *concussion *LOC 30 min *loss of memory 24hrs *CGS 13-15 *normal CT or MRI *any AMS at time of incident Moderate TBI *LOC up to 24hrs *neuro signs of brain trauma * CGS 9-12 *may have focal findings on CT Severe TBI *LOC 24hrs *GCS 3-8 Screens for TBI ACE - acute concussion eval HELPS WARCAT - warrior administered retrospective casualty assessment tool TBIQ - traumatic brain injury questionnaire ImPACT OSU TBI ID JCAHO (Joint Commission) The non-profit organization that assists healthcare facilities by providing accreditation 3 year award CARF (Rehabilitation Accreditation Commission) The Organization that oversees the accreditation of brain injury programs 3 year award TBI Act of 1996 Federal Legislation "To expand efforts to identify methods of preventing TBI, to expand biomedical research efforts or to minimize the severity of dysfunction as a result of such an injury, and to improve the delivery & quality of services through the State Demonstration projects." HRSA - Health Resources Services Administration Money to states to improve integration services, establish policy & procedure financial support CDC - Center for Disease Control Carries out projects to reduce incidence of TBI Rehabilitation act of 1973 Set foundation for state vocational rehab system, a federal/state supported system of services which assists persons with disabilities who are pursuing meaningful careers Diffuse axonal injury Severe brain injury caused by extreme shearing forces Persistent post concussive symptoms A complex disorder following a concussion, lasting for weeks or months, consisting of symptoms such as headaches or dizziness, Nausea, post Trumatic amnesia and GCS of 13/14 Must be diagnosed by neuropsychologist Somatization The expression of psychological distress through physical symptoms Chronic traumatic encephalopathy - CTE Rare, progressive, degenerative condition of central nervous system that is seen and repetitive brain trauma Dementia, memory loss, aggression, confusion, depression Hebbian Learning Neurons that fire together, wire together Experience independent learning " use it or lose it" Synaptogenesis The process by which neurons form new connections Disorders of consciousness Coma, Vegetative State, minimally conscious state Coma * no evidence of arousal * no response to internal or extrnal stimuli * May have reflexive response * resolves in 2 to 4 weeks Vegetative state Transition of severely brain damaged patients from a coma to wakefulness without awareness Can be months to years in this state Minimally conscious state condition in which someone has brief periods of purposeful actions and speech comprehension Emergence from DOC Requires at least one criteria: * functional communication by verbal or gestural Y/N response * functional use of 2 or more objects Automatic dysfunction syndrome Episodes of: dystonia (abnormal muscle tone), tachycardia, diaphoresis (sweating), hyperthermia, hypertension, tachypnea (rapid breathing) *occurs in 15%-33% of severe TBI Sleep Complications Hypogenic hallucinations - vivid dream like auditory, visual, or tactile sensations on experiences between sleep and wake Cataplexy - feature of narcolepsy. Sudden loss of muscle tone. Consciousness remains clear, memory not impaired and respirations intact Immediate post Trumatic convulsions (seizures) LOC & involuntary movements within seconds of impact *can be asymmetrical, short period of AMS & retrograde amnesia Early post Trumatic seizures *occurs within the first week *results from primary direct effect of trauma *risk factors: severe TBI, depressed skull fx , penetrating head injury, sub dural hematoma, entercerebral hematoma, epidural hematoma, portable contusion Late post Trumatic seizures * within 18 to 24 months however can be years later * also called post dramatic epilepsy * strongest risk factors are missile wounds, multiple contusions, multiple craniotomies tension headache nonmigraine headache in which pain is felt in all or part of the head *Trigeminal nerveC1-C3 nerve roots, occipital nerves Cervicogenic Headache Generated primarily from the cervical spine *C1 -C2 periorbital region *C2 - C3 parietal & frontal regions *C3 - C4 upper thoracic & lateral cervical region Craniomandibular Headache * subtype of tension headache that can cause difficulty with eating and talking Nocioceptive pain Pain related to peripheral nerves neuropathic pain Pain associated with primary lesion neuralgia nerve pain Neuromas Nerve endings adhered to scar tissue Hydrocephalus ex vacuo Appearance of increased CSF in atrophy. Intracranial pressure normal, brain smaller Spasticity Damage to upper motor neuron Faster and extremity is moved = stronger the spasm heterotopic ossification caused by bone formation in soft tissues Dysautonomia Imbalance between sympathetic and parasympathetic NS " autonomic storming" * present with muscle over reactivity, posturing, dystonia, rigidity and spasticity Common Infections Meningitis, respiratory infections, UTI, surgical site infections, cellulitis, urosepsis Stages of motor learning *cognitive (what to do) *Associative (how to do) *Autonomis (how to succeed) Cranial nerve dysfunction Visual disturbance, facial dropping, postural instability, dysphagia, autonomic dysregulation Athetiod Slow, involuntary, writhing movements Ballisms Quick flailing movements choreiform movements Continuous rapid & unpredictable movements Agnosia Loss of ability to identify people or objects. Visual, auditory or tactile Apraxia Inability to perform purposeful movement *ideomotor- unable to perform tasks on command *ideational- unable to perform automatic tasks *buccofacial- limitations and performing purposeful movement of lips, cheeks, tongue, larynx and pharynx central cord syndrome Presents as weakness & numbness in arms * results from fall in with neck in hyperextention or with arthritis or spondylosis * bowel/bladder issues * able to walk however unable to grasp things Brown-Sequard Syndrome 1 side of spinal cord injured Ipsilateral paralysis, loss of light touch sensation on side of lesion, loss of pain & temperature sensation on contralateral side Anterior cord syndrome Loss of muscle control, pain & temperature sensation below lesion No loss of proprioception or touch sensation posterior cord syndrome Strength with no proprioception cognition A complex collection of mental activities such as attention, perception, comprehension, remembering and language Domains of cognition Attention, categorization, memory, processing speed, executive functions, metacognition Attention Divided, alternating, selective, sustained, focused Attention process training program (APT) Process specific approach to cognitive rehab. Hierarchy organized by difficulty Categorization Important in the speed of processing, problem-solving, and other higher order cognitive processes. * BI pt tend to categorize by single attribute only Stages of Memory Encoding, Storage, Retrieval Long term memory Explicit vs implicit Executive Functions * complex cognitive processes that involve reasoning, planning, judgment, initiation and abstract thinking Cognitive rehab approaches *approach in systemic manner *analyzing problems *consider alternative solutions *prioritizing solutions *review outcomes Metacognition (n) Awareness of thoughts 3 levels of metacognition 1) awareness of deficits 2) awareness of functional implications 3) awareness to set realistic goals Anosognosia Diminished self awareness and failure to recognize a personal disability Cognitive Rehab - Compensatory Approach *assumes some cognitive functions can't be recovered *focus on development of strategies *functional application is important Cognitive Rehab - Restorative Approach *repeated exposure & repetition through experience *therapeutic exercise to re-establish/strengthen specific cog skills Principles of Cognitive Rehab *tx of impairments must be hierarchical *basic cognition skills first *target attention, perception, categorization, abstract thinking, & memory Stability Triangle Extinction When a previously reinforced response no longer produces a consequence, leading to an eventual decline in rate continuous reinforcement the reinforcement of each and every correct response intermittent reinforcement reinforcement for some responses and not for others Topography What a behavior looks like physically Behavior TX Approach 1) assess behavior 2) define target behavior 3) collect data 4) change behavior Consequences 4 types Branches of Neuropsychology Experimental - intact/healthy brain Clinical - brain with lesions dual diagnosis the client with both substance abuse and another psychiatric illness Axis I disorders Clinical disorders *major depressive disorder is most common Axis II Personality disorders and intellectual disabilities Major Depressive Episode At least 2 wks which a person has loss of interest or depressed mood accompanied by 4 additional symptoms: Change in appetite, change in weight, decreased energy, feelings of worthlessness, suicidal ideation manic episode At least 1 wk where a person is noticeably elevated, expansive or irritable mood and 3 additional symptoms: extremely amplified self-esteem, decrease desire for sleep, grandiose ideas, distractibility, risky activities bipolar I disorder One or more manic episodes bipolar II disorder One or more depressive episode followed by one or more hypomanic episode cyclothymic disorder Chronic fluctuation mood disturbance including both depressive and hypo manic states Schizophrenia Disorder lasting for at least 6mo with minimum of a 1 month phase of symptoms that include: delusions, hallucinations, incoherent speech, Catalonia or avolition. personality disorders 23% of TBI pts Organic personality disorder Frontal Lobe Syndrome Symptoms of other psychiatric disorders including depression, psychosis, mood disorders and other various conditions however the patient does not recognize these conditions * The difference between frontal lobe injury and regular depression is the patient's ability to recognize and acknowledge the deficit SUD interventions Screens for SUD *AUDIT - alcohol use disorder identification test *CAGE: yes or no questions *CRAFFT: screen for adolescents *ASSIST: alcohol, smoking and substance use involvement screening test Cranial Nerves concomitant spinal cord injury Present of co-occurring spinal cord injury and brain injury *60% of SCI pt's Visual Functions Somatoagnosia Lack of awareness of body structure and body part relationships Meninges Vestibular conditions *labrynththine concussion *post-traumatic Ménière's disease *basilar skull fx *vestibular migraine *perilymphatic fistula *benign paroxysmal positional vertigo (BPPV) *B vestibular hypofunction *central vertigo Olmstead Decision A ruling made by the US Supreme Court requiring the provision of community based services with such services are available and not opposed by the patient in question, As opposed to being institutionalized. TBI model systems of care *16 centers in US * developing and demonstrating a model system of care for persons with TBI *Emphasizing continuity and Comprehensiveness of care * maintaining a standardized national database for innovative analysis of TBI treatment and outcomes Peak Maturation Milepost Most brain maturation occurs from birth to 6 years. Injury in that time frame may be the most devastating time for injury to occur ages 3-5 *period of rapid brain growth *perfecting ability to form images, use words, place things in serial order, beginning problem solving Ages 8-10 *sensory and motor systems maturing *frontal executive systems begin accelerated development *begin to perform operational functions Ages 14-15 *maturation of visuo-auditory and somatic systems *review formal operations and find flaws & create new ones Ages 17-19 *maturation of frontal executive functions *questions information, reconsiders & forms new hypothesis AHT/SBS most common in infants and young children 0-5years More common for boys to be victim mTBI Adolescents Student athletes with concussion must be evaluated, treated, and followed -up by health care professionals Second Impact Syndrome Can occur when an athlete sustains an initial concussion and then sustains a second head injury before the symptoms from the first have fully resolved Tenet I Current physical brain is related to the past physical state of our brain Tenet II Our psychological state is the result of a 3 part constant reciprocally interacting relationship Moral Model of Disability Oldest model Disability is result of sin, evil or character flaw Biomedical Model of Disability Uses objective, clear-cut, standardized measures and expert to provide finding characteristics, causes, prognosis and treatment 2 demential (normal vs. illness) Environmental Model of Disability Environment, social and physical can cause, defined or exaggerate a disability Prejudice, discrimination stigma lies with the environment and not the disability Functional Model of Disability Most individualized and personal model (patient centered care) Extend in consequences for disability in consideration of person specific interest and participation Emphasizes DMEs sociopolitical model of Disability Minority group for independent living model Disability is collective concern of society Societies responsibility for accommodating patient rather than the patient accommodating to society Six principles of person centered care Autonomy, beneficence, non-maleficence, fidelity, justice, veracity Beneficence (Definition) The clinicians obligation to do good for the patient Fidelity Clinician should keep promises made Veracity The clinician to be truthful and professional interactions Section 504 of Rehabilitation Act Equal treatment, and appropriate education for people with disabilities Preferential seating, extended time on exams, test in quiet, rest breaks, shortened assignments, books on CD Individuals with disabilities education act (IDEA) Federal education mandate to provide free appropriate public education and special education and support services to children with eligible disabilities Military Primary Injury Direct impact from over-pressure wave. Compressed air filled organs, catapults body diagnostic indicators for SBS Bleeding from brain Brain swelling Bleeding in eyes Long term disabilities in SBS Behavioral problems, learning disabilities, blindness, deafness, seizures, cerebral palsy Individual Education Plan - IEP Student's academic goals based upon assessment and the method to obtain these goals via specially designed instruction and related services Timeline: 60 days to complete assessment and hold IEP meeting Military Secondary Injury Debris impacts head or body Military tertiary injury Body impacts ground or object Military Quaternary Injury Inhalation of toxic gases or substance Military acute concussion evaluation (MACE) TBI screening developed by defense and veterans BI center. Provides gross measures of cognitive domain TBI military prevalence mTBI only 56% mTBI & PTSD 44% Community integrated rehabilitation (CIR) Post acute brain injury rehabilitation programs designed to support persons with brain injury in the community. Can include neural behavioral programs, residential programs, day treatment programs and home based programs Neural behavioral programs For Severe behavioral disturbances that require 24 hour supervision. Residential community program For those that cannot participate as outpatient, require 24 hour supervision or support Comprehensive holistic treatment/day treatments There is a need for intensive services and can benefit from improved awareness Home based program Client is able to resign at the home and able to self direct care Care management Continuous system of care for a particular condition Case management, life care planning, advocacy and public policy, support groups case management A way of managing unique and high risk conditions often associated with costly acute care and hospital stay. Case Manager Functions Educator, coordinator, research, communicator, collaborator, clinician, utilization manager, transition planner, leader, quality manager, negotiator, advocate, risk manager 6 Domains if Case Management Processes and services, resource utilization in management, psychosocial and economic support, rehabilitation, outcomes and ethical and legal practices Life care planning A lifelong needs assessment of the needed goods and services required for a person with brain injury to move the most independent life possible. The plan should've called blueprints for families Must utilize evidence based standard of care LCP plan Should be continually monitored and revised when the persons health needs or situation changes. Special needs trust A legal arrangement in financial agreement that allows a person with a brain injury to receive income without reducing their eligibility for the public assistance disability benefits provided by Social Security, supplemental security income, Medicare or Medicaid Types of special needs trusts First party SNT, third-party SNT, Inter vivos (during life) SNT, pooled trust/community trust Social security act of 1935 Provided cash benefits & health care plans for individuals who are aged, disabled, and those with low income. Medicare Four part insurance program established as part of the Social Security act Medicaid Provide healthcare for people with low income, chronic illnesses, and disabilities black private help insurance Medicare Part A No cost Covers hospitalizations, SNF, home health and hospice Medicare Part B Premium is charged This covers doctors appointments and outpatient Medicare Part C Premium charged Optional cost saving managed care plan Medicare Part D Prescription drug coverage