Neuro 8 ? TBI

Explain how a person acquires chronic traumatic encephalopathy?

- Acquired by repeated head trauma ( this is a degenerative dx) -- Recent attention has been brought to this issue after lots of retired football players began showing Alzheimer's/Parkinson's-like symptoms

Why are individuals with sports- related injuries at risk for suffering multiple concussions?

- Acute symptoms might go unrecognized or their significance is unknown to players/coaches; players are sent back in - may be no loss of consciousness (at the time) - athletes w/ hx of concussion are at highest risk for suffering additional concussions - SHOULD be pulled from game, eval, & placed on at least a 3-day period of physical/cognitive rest

List three formal tests used to assess individuals with TBI.

- Burns Brief Inventory of Communication and Cognition - Brief Test of Head Injury, Cognitive-Linguistic Quick Test - Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI)

How are closed head injuries and open head injuries different?

- Closed head: damage to the brain that does not break an individual's skull open/ penetrates the cerebral meninges surrounding the brain -- skull remains intact. -Open head: an object penetrates the skull into the brain -- common cause: ballistic trauma.

What are the differences among coma, vegetative state and persistent vegetative state?

- Coma: a period of unconsciousness lasting more than 6 hours; pt cannot be awakened & is unresponsive to sensory stimuli - Vegetative state: person is minimally responsive to stimuli but lacking consciousness and cognition - Persistent vegetative state: person is minimally responsive to stimuli but lacking consciousness and cognition lasting longer than 4 weeks

Traumatic Hydrocephalus

- Damage disrupts the cerebrospinal fluid(CSF) system, which nourishes the brain - brain might become unable to reabsorb old cerebrospinal fluid while it still produces fresh cerebrospinal fluid in the lateral ventricles (traumatic hydrocephalus) -- can raise intracranial pressure to a life-threatening level

How might level of arousal be tested?

- Deficits in arousal are generally assessed with coma scales -- Most common scales for adults are: Glasgow Coma Scale & the Ranchos Los Amigos Levels of Cognitive Functioning Scale PEDS: The Adelaide Coma Scale

Please describe a 'general picture' of TBI as described by Manasco.

- No 2 will be the same (duh) - Directly following TBI: usually unconscious; confused/disoriented; using ventilator/trached/feeding tube; may require ER brain surgery to stop 2nd issues (hemorrhage); shunt/craniotomy (remove CSF/reduce intracranial pressure); medically induced coma - Following coma: severe lang & cog deficits; confusion/disorientation/aggression; restrained; sleep a lot; - W/ Recovery: less aggravated/confused; dysarthria; impulsivity; no awareness of deficits; fatigue quick - Long term: social pragmatic & higher-level cog functioning deficits

quaternary level of damage

- any trauma created that is not a result from primary, secondary, or tertiary mechanisms. - EX: difficulty breathing after exposure to smoke or dust; burns to the body as a result of the blast

What are the populations most at risk for sustaining a TBI?

- children younger than age 4 - individuals older than 75 - adolescent males -- Male children 4 years and younger experience the highest rates -- males are far more likely bc engage in high-risk activities - Other risk factors: use of alcohol/drugs - lower SES; Individuals w/ TBI 3x already; Finally, high-risk professionals (police/military)

How can SLP treat problem-solving deficits?

- dictated by the capabilities & deficits of the pt - Paper/pencil tasks available in worksheet-style therapy books - Problems range from simple math problems/short word problems-visual stimuli (line drawings that present a problematic or dangerous situations) - Functional tasks: counting change, balancing a checkbook, navigating hospital hallways, calling a friend/ loved one

How does an impact-based TBI cause brain damage?

- individual's head is struck by a moving object - moving object impacts the head, then the skull is pressed inward on the brain - Compressive forces are put on that area of the brain during to the inward pressing of the skull; forces can bruise/tear the surface of the brain, producing FOCAL damage - Common cause: violent assault

Increased intracranial pressure

- major risk following any damage to the brain - If intracranial pressure becomes higher than blood pressure, the heart rate will have difficulty pushing blood into the brain --> hypoxia or anoxia occurs, causing brain damage or death if not treated quickly

How do acceleration-deceleration injuries cause brain damage?

- occurs when a person's body/brain are moving very fast through space & then come to a very abrupt halt that is sudden enough to cause the brain (b/c of inertia) to slam into and bounce around inside the skull with damaging levels of force -- brain stem can also suffer damage

tertiary level of damage

- results from the physical displacement of the body when impacted by the IED - IED's often cause ppl to be thrown.. making impact w/ surrounding structures or ground -- Closed or open head TBI can occur on the tertiary level

Primary level of damage

- the most immediate impact of an IED explosion - direct result of the shock wave from the explosion -- shockwave creates intense pressure changes which cause trauma named barotrauma

What are the major symptoms of shaken baby syndrome?

- vomiting, difficulty feeding, respiratory difficulties, seizures, retinal hemorrhages, irritability, lethargy, altered consciousness, impaired tracking of eyes, and lack of smile and vocalizations -- also: signs of abuse; bruises/broken bones

Traumatic Hemorrhage

-bleeding (hemorrhaging) as a result of trauma -from warping or movement of brain w/in skull

What techniques are available to assess agitation an aggression?

1. Non-coercive Verbal Deescalation 2. Medication 3. Reduce stimuli (visual and auditory) 4. Familiarize your self with the client's history 5. Using touch for reassurance -- Agitated Behavior Scale (ABS); Overt Aggression Scale

What are three cognitive deficits that can occur with a TBI?

1. Orientation to self, place, and time 2. Types of attention: sustained, selective, alternating, divided 3. Types of memory: working, short-term, long-term, Depending on the type of TBI, these people may also experience speech and language deficits, problem solving deficits, personality changes, and visual processing deficits among other things.

Compensatory INternal memory strategies (examples)

1. Rehearsal training: pts repeat (rehearse) info to themselves to try to retain it. 2. Mnemonics: Consciously converting info into a format that is easy to remember 3. Imaging and visual associations: pt creates visual image of desired info 4. Verbal chaining: stringing together of info into the form of a narrative, e.g. to remember 3 random words "cup," "baseball," and "dog," you could say "The baseball-catching dog sipped from the cup."

Internal Memory Strategies

Cognitive acts that help to increase the likelihood of retaining information, both short and long-term

What are two forms of damage that can occur from an acceleration-deceleration injury?

Coup-Countrecoup & Diffuse Axonal Shearing - Coup-injury: car accident-> head lunges forward & hits wheel, brain slams against the inside of the front of the skull causing damage - Countrecoup-injury: head then rebounds or ricochets backwards and slams against the head rest causing damage to the back of the skull Diffuse Axonal Shearing: neuronal connections throughout the brain break -- traffic accidents when a car enters into a high-speed spin w/ high rotational g-forces

List 6 possible secondary mechanisms of damage following TBI.

Increased intracranial pressure Cerebral edema Traumatic Hydrocephalus Traumatic Hemorrhage Hematoma Post-traumatic Epilepsy

visual stimulation

Present visual stimuli to engage attention & encourage pt to track stimulus w/ eyes. ex: moving large/bright objects across pt's field of vision

List 4 levels of damage that can cause trauma to a soldier or person exposed to an IED blast.

Primary Secondary Tertiary Quaternary

Post-traumatic Epilepsy

Seizures occurring consequent to TBI - These seizures cause additional damage to the brain & significantly/negatively affect prognosis for recovery of lost functions

How might a speech-language pathologist treat decreased levels of arousal?

Sensory stimulation therapy: 1. visual stimulation 2. auditory stimulation 3. oral stimulation 4. olfactory stimulation 5. cutaneous stimulation 6. gustatory stimulation

How does shaken baby syndrome cause brain damage or death?

The strong rotational and acceleration-deceleration forces caused by back-and-forth shaking -- Diffuse axonal shearing & broken blood vessels can occur -> resulting in subdural hematoma or cerebral edema (increases intracranial pressure)

EXternal memory strategies (examples)

checklists, schedules, calendars, memory books, alarms, etc

Secondary level of damage

considered the bomb fragments or debris hits the soldiers or persons near by

What is a traumatic brain injury?

damage to the brain that occurs as a result of an external and usually forceful event Results from: falls, vehicle accidents, the result of an individual being struck by an object, a sports accident, and violent assaults

Hematoma

gathering of blood outside a blood vessel following a hemorrhage

List major areas of deficit often encountered in TBI.

motor deficits, cognitive deficits, and language deficits

auditory stimulation

present auditory stimuli to arouse pt; talking; greeting by name; asking yes/no ?; pair w/ other techniques: "Keep eyes on me, i'm moving the ball"

gustatory stimulation

stim to the sense of taste; using flavored swabs

oral stimulation

stimulation to the lips/mouth; brushing teeth; cleaning oral cavity w/ flavored swabs

Cerebral edema

swelling of brain tissue & can occur following trauma to the brain - This expansive swelling of brain tissue increases intracranial pressure

cutaneous stimulation

tactile stim; systematic stimulation of a pt's skin; light brushing; applying warm/cold objects

External Memory Strategies

use material devices to allow for compensation of memory deficits

olfactory stimulation

using fragrances w/ personal meaning (perfumes/smell of fav foods)

Restorative Memory approaches

work to rehabilitate memory abilities - EX: spaced retrieval training--> asks the pt to recall info over increasingly longer intervals of time