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characteristics of mTBI - - can be closed or open - involve alteration in brain function - caused by external force TBI is present in what percentage of spinal cord injuries? - 60% most brain maturation occurs in what range of years - 0-5 years the four quadrant model refers to what - the various settings where peopel with TBI and substance misuse could receive treatment the family systems theory asserts that.... - every family has the capacity to solve problems and make positive chnages deficits in exp/recep lang are most likely due to damage to which lobe - temporal lobe In TBI, males outnumber females by what ratio - 2:1 people with TBI have a life expectancy reduction of approximately how many years - 7 years who is at greatest risk for secondary impact syndrome - athletes 24 years of age what is neuroplasticity? - 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 change sin the environment what is considered to be the gold standard of success in rehab after brain injury? - return to work the blood brain barrier does what? - protects the brain from harmful substances family reports of post injury challenges include.... - - changes in mood and emotional health of family members - changes in mood and health of the person with brain injury - unequal sharing of household responsibilities - lack of resources to combat brain injury-related complications Which legislation addresses intervention, special education, and related services with the principle that children have a right to free and appropriate public education? - IDEA of 1990 describe neurons - - communicating cells - contain cell body, axon, dendrites - receive and transmit information through synapses What type of neuroimaging involves a person performing a task while in the scanner activated brain regions can be viewed? - fMRI what percentage of caregivers for a person with TBI experience caregiver burden - 90% Which rehabilitative treatment philosophy asserts that disability is a result of sin, evil, or character flaw? - religious model Which assessment would be appropriate to utilize in an inpatient rehab setting? - Rancho Los Amigos Scale What indicates successful community re-entry for military personnel sustaining a TBI? - return to active duty productive work social roles and family responsibilities pre-morbid lifestyle a reliable measure means what - measures consistently when applied to different individuals, at different times, and in different situations example of intermittent reinforcement - when a particular response sometimes produces a reinforcer, like a slot machine how many people are estimated in the US to be living with a brain injury - 2.5 million people An acquired brain injury can be caused by.... - traumatic impact (closed or open) Stroke Ischemia hemorrhage or white matter lesions Chronic Traumatic Encephalopathy (CTE) is and results from... - results from diffuse axonal injury is rare and progressive results from excess release of the Tau protein which is the most fundamental cognitive skill - attention to detail describe brown-sequard syndrome - ipsilateral paralysis with only one side of the spinal cord damaged, including loss of light touch sensation on the side of lesion, and loss of pain and temperature sensation on the contralateral side participation is what? - involvement in life situations what is a dual diagnosis? - TBI and subsequent psychiatric disorder what is true about neurons? - are communicating cells communicate through synapses have action potential what does acquired brain injury mean? - it's acquired in the lifetime Traumatic inertial injuries are... - Concussions, motor vehicle accidents Non-contact injury but the brain is moving inside the skull t/f: a stroke is considered a non-traumatic brain injury - TRUE (it's an internal cause of a brain injury) Why is brain injury referred to as the "silent epidemic" - Cognitive challenges are less apparent to others (than physical challenges) Examples of a secondary injury: - Impaired blood flow, tissue damage, apoptosis apoptosis is... - programmed cell death describe the risks for secondary and third injury - secondary injury is 3x greater after initial injury and 8x greater after a third injury-- risk just continues to go up (think environment, changes in balance, cognition, social factors, high risk behavior) t/f: People with a TBI have a life expectancy reduction on 7 years - true (as compared to uninjured peers) When do most mild TBI symptoms resolve? - most symptoms resolve within 2-4 weeks (85-90% of people), 10-15% of people will continue to have symptoms after that t/f CTs are more detailed than MRIs? - FALSE-- CT scans are NOT more detailed than MRIs What is the biggest stress when caring for loved ones, causing increased caregiver burden? - social and behavioral changes Coma emergent agitation - immediately out of a coma, they will not respond to consequence based interventions because they won't remember that they cannot do something Must incorporate environmental controls, medications (e.g. safety enclosure beds so they don't fall and injure themselves out of bed) t/f: Major depressive disorder is the most common axis 1 disorder following a TBI - true t/f: children who have a TBI 5 years are more likely to have a substance abuse disorder - true common symptoms of UTI? - Difficulty with arousal, fever, pain while urinating, changes in cognition, decreased level of alertness, possibly increased agitation t/f the more severe the brain injury, the more calories needed for healing - true What % of people post TBI report changes in libido, sexual fxn, changes in sex drive etc? - 40-60% t/f post traumatic headaches are reported more with moderate to severe injuries - false-- more prevalent in mild TBIs Cranial nerve X vagus nerve - Able to swallow and speak w/o hoarseness Cranial nerve XI accessory nerve - Move head up down side to side and shrug Cranial nerve XII hypoglossal nerve - Move tongue side to side with ease Cranial nerve XIV glossopharyngeal - Elicit gag reflex Cranial nerve VII facial nerve - Close eyes tightly and open them up Smile, frown, puff out cheeks What causes iatrogenic (unfavorable response) behavior? - inadvertently caused by the physician or medical setting itself, maladaptive behaviors that those in the hospital can develop (can manifest there because they are not real life settings) t/f which is more common: hyposexuality or hypersexuality - hyposexuality (hypersexuality may seem like it is more prevalent, because it may be more of a concern that needs to be addressed, but it is less common) When does the most brain maturation occur? - birth to five years What percentage of individuals with abusive head trauma sustain long term disability effects? - 75-80% Which group has the highest reported percentage of CG burden? - parents of adult children an acquired brain injury includes the following.... - TBI (traumatic), nTBI (non-traumatic), open (penetrating) injuries, closed injuries an mTBI has the following characteristics.... - memory loss for events after trauma, may or may not have LOC. What age group has a higher rate of death due to TBI (all causes)? - adults 75+ The Olmstead Decision (1999)... - Used Title II of the ADA to assert that programs are to be provided in the least restrictive environment. the following are neuroendocrine disorders associated w/ TBI - pituitary dysfunction, hypothyroidism, growth hormone deficiency pituitary dysfunction - manifested primarily by growth disturbance hypothyroidism - A disorder caused by a thyroid gland that is slower and less productive than normal growth hormone deficiency - absence or deficiency of growth hormone produced by the pituitary gland to stimulate the body to grow. What percentage of people experience persistent problems re: mTBI for longer than 2-4 weeks? - 10-15% Persistent Post Concussive Symptoms (PPCS) risk factors include: - over 40 years, female, traumatically injured, hx of substance abuse what is secondary impact syndrome? - rare but possibly fatal condition that can occur if an athlete sustains another mTBI while still neurologically fragile cerebrospinal fluid - produced and stored in the ventricles and circulates throughout the brain and spine a subdural hematoma occurs when - When there is bleeding in the subdural space What is the blood-brain barrier (BBB)? - High-density endothelial cells that line most capillaries that prevent harmful substances from entering the brain what is true about neurons - They communicate with each other via synapses b. Myelination speeds the transmissions of signals c. The junction between neurons is called a synapse What part of the brain is a collection of nerve fibers and nuclei within the brainstem that modulates arousal, alertness, concentration, and basic biological rhythms? - Reticular Activating System