final exam
About _____% of those with a spinal cord injury (SCI) also have a co-occurring traumatic brain injury (TBI).
60
There are several different models of disability each with a corresponding rehabilitation or treatment philosophy associated with it. Please read the description then select the correct corresponding model of disability Biomedical Treatment methods are concerned with changing the individual (i.e. getting better). Functional Intervention methods are aimed at adapting the function of the individual for meaningful participation. Environmental Intervention is sought to address both the physical and social environments of the individual. Sociopolitical The goal for the individual is inclusion, civil rights, and equal social status.
Answer 1:Biomedical Answer 2:Functional Answer 3:Environmental Answer 4:Sociopolitical
Integrating a sound theoretical base into treatment planning and decision making allows professionals the flexibility to respond to pressing needs of the patient and family, while also ensuring continuity of treatment and consistent connection to rehab goals. The concepts below are characteristic of which family support theory? Grounded in the notion that the whole is greater than the sum Encourages practitioners to think of interactions which occur between family members' thoughts, beliefs and actions; they influence decisions and behaviors Families have shared beliefs and ways of communicating that affect the way they understand rehab goals and outcomes Families are considered to be the experts Assumes families have strength and capacity to solve problems
Family Systems Theory (FST)
Person-centered care empowers individuals to guide the rehab team to focus on their priorities, values, and desired outcomes and maintains that: Please select all correct answers below
Provider's attitude and therapeutic relationship are major factors in outcomes All people have capacity for self direction and intervention is most effective when requested The person served can be trusted to lead their own lives
A direct method of behavior assessment, a Functional Assessment or Functional Analysis is:
a method of direct observation within the field of behavior analysis, to pin-point the potential function or purpose of a behavior via experimental manipulation
Changes in behavior are the most persistent and misunderstood consequences of a brain injury, not only for adults but also for children, and may be attributed to a number of factors, including:
a. difficulty/deficits in short-term memory, behavior control, executive functions and communication b. limited awareness or misperception of other's expectations, interactions or social cues c. inattention, impulsivity, disinhibition, inflexibility and emotional lability
The strongest predictors of post-injury outcome in older adults are:
age of injury, pre-existing medical conditions and medication use
In the brain-injured aging group, challenging psychological conditions persist over time and adversely impact long-term outcome. Please select the correct psychological conditions below:
apathy aggression drug and alcohol abuse psychosis
Providing interpreters as needed, video interpreting services, qualified note takers, computer-assisted real time transcription services and written materials in a rehab setting is an example of:
appropriate auxiliary aids and services
The elements of a behavior program follow a specific order to be most effective. Please select the correct order of behavioral programming below.
assess behavior through indirect or direct methods (Functional Assessment), define target behavior, collect data , change behavior
The findings of a comprehensive neuropsychological evaluation can be used to:
assist in treatment planning, and establish a baseline to document skills at a specific point in time, in order to compare to future assessments
Cognitive impairments include difficulties with:
attention memory problem-solving decision-making
Cardiac problems (involving heart and respiratory problems) are frequently reported after brain injury and are associated with increased mortality and morbidity. Below are several symptoms of medical complications. Please select only those that pertain to cardiopulmonary and vascular complications.
autonomic functions (autonomic arousal) can be disrupted and may cause dysautonomia weakened cough or gag reflex and difficulty swallowing may require immediate life support and a tracheostomy may present with hypertension or hypotension
2%-15% of the population is homosexual/bisexual, and LGBT individuals with brain injury face unique challenges that are at times mismanaged or ignored in rehabilitation. Please mark all correct responses below that contribute to this mismanagement.
benign neglect (heterosexism and homophobia) Sexual minorities and sexual subcultures are often superficially addressed in staff cultural awareness or diversity trainings family of origin is not aware of their sexual or gender orientation or relationships
Please select the best answer below which describes a dual diagnosis.
c. TBI Combined with a subsequent psychiatric disorder
The spinal column is divided into five sections. Please select the correct descending order of these five sections.
cervical, thoracic, lumbar, sacral and coccygeal
TBI is the signature injury sustained in modern warfare. As you read in your text, 22% of service members returning form Operation Iraqi Freedom (OIF) had TBI or concussion, and 8% had persistent symptoms. Please select the issues below that are UNIQUE to this specific population:
co-occurring effects of deployment military culture mechanism of injury
In children, many times attention deficit disorders and concomitant learning disabilities may have their roots in:
earlier mild brain injuries not properly diagnosed
Another approach to behavior change is a consequence based intervention. This involves implementing a systematic intervention where a target behavior is followed by a specific type of consequence. The type of consequence applied depends on whether the consequence is targeted for increase or decrease . Punishment: refers to any process that decreases the likelihood that a particular response will occur again in the future. Negative Punishment: There is the addition of a stimulus; this decreases the likelihood that the response will occur again. Positive Punishment: There is the removal of a stimulus; this decreases the likelihood that the response will occur again
false
Cognitive aging is specifically related to those who have sustained a brain injury.
false
Current research indicates that, for individuals receiving either TBI or substance misuse rehabilitation, up to one third had a history of both TBI and substance misuse.
false
Heterotropic ossification is treated with anticoagulants, while vascular thrombus/emboli is treated with etidronate disodium and NASID agents.
false
Recent studies show that up to 24% of service members with concussion may meet the diagnostic criteria for posttraumatic stress disorder (PTSD).
false
Symptoms alone can be used to diagnose mTBI.
false
Please select all the true statements below which reflect differential outcomes by gender
females with mild TBI are associated with a higher level of subjective cognitive complaints females with sports-related concussion demonstrated greater decline in simple and complex reaction time and reported more post-concussion symptoms than their male peers hormonal issues play a significant role in a mild TBI diagnosis
The biopsychosocial model is a model of human behavior that takes into consideration biological, cognitive-affective, social-interpersonal, social-institutional and cultural factors. Please select the items below which are not correct for the biopsychosocial model.
focuses on the pathophysiological aspects of disease
Brain injury affects every part of a person's life; the treatment approach should seek to identify and successfully intervene in all those areas which will increase the quality of the rehabilitation outcome for the person with a brain injury, including their circle of support, which sometimes needs help as much or more than the individual who sustained the brain injury. This is an example of:
full picture approach
Listed below are several de-escalation techniques used in crisis intervention for brain-injured patients who are demonstrating increased frustration and agitation.. Please select all of the incorrect responses that do not pertain to these techniques.
generalization fading
Collaboration between medical care, rehabilitation systems, and school systems has been historically lacking for children with brain injuries. There are efforts in many states to improve this care continuum. Please select below all true statements that pertain to this care dilemma.
many children with mild or mild-to-moderate brain injuries do not receive care often the long-term needs of brain injured children and their families go unmet children only seen in the ER may not be referred to their school's special ed department for relevant educational services the medical team's hand-off of care recommendations to schools is often difficult for schools to implement
The Stability Triangle provides a guiding philosophy for the development of a comprehensive treatment plan; it specifies three primary areas that must be addressed in order for overall stability to be established and maintained. The basic structure itself emphasizes that each element is interdependent, yet without any one side, stability is ultimately or eventually compromised. Below, please match up these three areas with their correct description.
medical stability: variables of pain, sleep disturbance, incontinence, drug or alcohol use, vestibular issues, seizure disorders behavior stability: assessment of resistance or refusal, mood instability, threatening or demanding behaviors, verbal and physical stable activity plan: exploring and individuals abilities, interests, and need for support associated with specific activities
If your patient responds to a verbal directive, has object localization and sustained visual fixation, and has some intentional but unreliable communication - which level of consciousness are they presently in?
minimally conscious state
_____________ is defined as a set of internal processes associated with practice or experience leading to relatively permanent changes in the capability for skilled behavior.
motor learning
Which of the factors below are not related to the development of a psychiatric disorder following a brain injury?
no prior psychological or psychiatric issues
Hydrocephalus is:
obstruction of the flow of cerebral spinal fluid (CSF) around the brain
In a clinical interview, when trying to obtain information on a patient dealing with substance misuse, a trained healthcare provider should employ:
open-ended questioning reflective listening a standardized assessment such as AUDIT
Family structures are often impacted and challenged when a loved one survives a brain injury. Select all statement below that pertain to the challenges that couples or intimate relationships face after brain injury:
partners often live in limbo without physical and emotional support partner often assumes caregiver role challenges include relationship satisfaction, sexual satisfaction, parenting difficulties and diminished communication satisfaction
Cross cultural psychology has documented extensive cultural disparity in human cognition, thought, and behavior. There are different constructs of intelligence, each of which speaks to a different ability that can be impacted by culture. Viewing these constructs as universal to all cultures, worldviews, etc., is counter to person-centered care. Please match the definitions to their correct intelligence construct.
practical intelligence: is used to signify the person's ability to solve problems in everyday settings (practical life problems) emotional intelligence: is important in terms of human experiences academic (analytical) intelligence: is used to signify the person's ability to solve problems in academic (classroom) settings social intelligence: is a distinct set of skills necessary in order to successfully navigate the environment.
The mechanisms of injury in a military blast injury are very complex, and the resulting injuries further compound medical issues creating a polytrauma situation. Correctly match each definition below with its correct mechanism of injury.
primary blast injury: direct impact from over pressure wave, compresses air filled organs, catapults body backwards second blast injury: energized debris or explosive fragments impacts head or body causing causing penetrating ballistic or blunt tertiary blast: body impacts wall, ground or object causing traumatic amputation, closed and open head injuries quaternary blast: inhalation of toxic gases or substances causing asthma, copd, or other breathing difficulties
As many patients with TBI develop depression, which aspect of fatigue is very important to consider?
psychological fatigue
In order to understand the impact of culture on the rehabilitation process, there are a few constructs that need to be understood. Please match the following definitions to their correct construct.
race: historically been used to group people based on biological or physical traits, but is now conceptualized by multiculturalists as sociorace culture: is defined as any group that shares a theme or issues; this can include language, food, clothing, music, art, dance, behavioral norms, shared values, and shared world view multiculturalism: a social-intellectual movement that promotes cultural diversity as a core principle and insists on equality and respect of all groups sociorace: recognizes the social and historical aspects of a group of people, providing information about customs, norms, and social aspects of the group ethnicity: relates to national origins, which then provides information as to the customs, norms, and languages that are shared across generations
People with brain injuries are susceptible to infection, especially when there are open wounds, they have an in-dwelling device, or are immuno-suppressed. Below are several symptoms of medical complications. Please select only those that pertain to infection
respiratory, urinary tract, and urosepsis, surgical site incisions and cellulitis meningitis
33% to 70% of individuals pass through a period of agitation as they emerge from coma. Please select below characteristics of coma-emergent agitation.
sleep -wake schedules confused arousal and attention grossly impaired often hyperactive, movements without purpose behavior bizarre, unpredictable, impulsive, and disinhibited dealt with in a behavior-based manor through environmental management
Please identify below all the pre-existing difficulties that may contribute to the development of a psychiatric disorder.
social functioning issues job satisfaction problems low economic status less education lack of close personal relationships
Behavioral analysts implement a number of procedures in order to teach new skills to brain injured patients. Please match up the teaching procedures listed below with their correct definition.
taks analysis: list of very specific steps involved in completing a task, can be used to break down larger tasks into smaller shaping: reinforcement can be used to increase the likelihood of a behavior occurring more often in the future prompting and cuing: a process in which an individual is supported to display a correct response fading: a process by which one learns to produce the same response under gradually changing conditions
It is estimated that nearly 90% of caregivers of individuals with TBI report significant caregiver burden. Individuals with brain injury can suffer negative outcomes when their caregivers are substantially burdened. Some ways that these negative outcomes can be decreased are:
teach family members effective coping strategies help families develop realistic expectations for outcomes assist families in developing hopeful attitudes encourage caregivers to rely on other family members and friends for support
Individuals with severe TBIs have been found to have lower rates of depression because:
they tend to have greater self-awareness deficits
The two types of acquired brain injury are
traumatic and nontraumatic
African American caregivers spend more hours per week caregiving, are at an increased risk for emotional distress, and are less likely to use community support services.
true
As a brain injury specialist it is important to take into account the level of assimilation and acculturation that each person has in regard to their culture as well as the majority culture
true
Family dysfunction is reported in anywhere from 25 - 74% of families after brain injury, depending on the population.
true
Having a TBI and co-occurring substance misuse is associated with poorer functioning overall, including: Higher rates of re-injury Suicide attempts Decreased life satisfaction
true
High school is responsible for helping the student choose an appropriate post-secondary setting if the student was injured prior to graduation. The student's IEP team must develop an Individual Transition Plan (ITP) that will address life after high school. Since special education and IEP services end once a student exits high school, the team must convert the IEP to a 504 plan that can be used in post-secondary education and the workplace, assisting with access to the Americans with Disabilities Act (ADA). The transition planning team must consider, among other things, the availability of community support systems and the range of available vocational services for students who will not transition to college.
true
If an individual misused alcohol or other drugs prior to their injury, the risk of returning to substance misuse after injury is 10 times higher.
true
In studies with participants who were 5 to 10 years post-injury, the predominant factors relating to disability were cognitive, behavior and personality changes, rather than physical changes
true
In the aging brain-injured population, psychosocial outcomes are diminished by behavioral health problems, and compounded by lowered socioeconomic status, reduced employment, and social isolation.
true
Post Acute Brain Injury Rehabilitation (PABIR) is for individuals who: Need longer term intensive rehabilitation Manifest hazardous behavior Are unable to manage living independently Lack adequate support while receiving outpatient therapy
true
Predictors of women's sexual dysfunction post-TBI include degree of depression and evidence of endocrine disorders.
true
Primary causes of sexual dysfunction are neuroendocrine changes, and hypothalamus and pituitary damage. Secondary causes of sexual dysfunction are physical changes, cognitive impairments, emotional and behavioral changes, and other changes (like stress, social isolation, medication side effects, etc.).
true
Research has shown that patients with TBI are at an increased risk for certain psychiatric disorders including depression, bipolar disorder, panic disorder, generalized anxiety disorder and schizophrenia.
true
Tests used by first responders and medics for triage to higher level of care include Military Acute Concussion Evaluation (MACE), developed by the Defense and Veterans Brain Injury Center (DVBIC). MACE provides gross measures of cognitive domains - orientation, immediate memory, concentration and memory recall - and its results are combined with other information including loss of consciousness (LOC) and posttraumatic amnesia (PTA).
true
The goal of applied behavior analysis is to discover variables that reliably influence behavior, and to use this information to either predict behavior or to promote behavior change.
true
The potential for development of a neuropsychiatric disorder may be enhanced by age, gender, severity of injury, injury location and premorbid symptoms.
true
The primary goal of interdisciplinary brain injury rehab is to maximize each individual's cognitive, physical, and psychosocial ability while helping the individual to successfully respond emotionally to their specific life challenges. Rooted in a functional approach, this is the most common service delivery model for brain injury rehab and may find an entire team collaborating on a specific goal.
true
Three schedules of behavior reinforcement are: extinction, continuous reinforcement and intermittent reinforcement
true
Traumatic brain injury is the leading cause of death and acquired disability in children and adolescents in the US, with children aged 0 - 4 and adolescents aged 15 - 19 at greatest risk.
true
While military TBI may result in significant physical impairments, quite often the more problematic consequences of brain injury involve the individual's cognition, emotional functioning, and behavior, which significantly impact all aspects of life.
true
In TBI studies of the psychological sequela of TBI, the results showed that:
women had higher rates of depression, PTSD, and sexual issues
Athletes under the age of 24 are more at risk for second-impact syndrome because: Please select the best answer.
2. They have metabolic vulnerabilities. 3. They likely have had a previous recent concussion.
The spinal column consists of ____ vertebrae joined together with discs and ligaments
33
What percent of the US population today is living with a disability due to an acquired brain injury?
4.5%
Occupational Therapists typically assess coordination disorders. Below are several movement disorders that fall into this category. Match the movement disorders below with their correct description.
athetoid: writing movements ballisms: quick flailing movements choreiform: continuous rapid unpredictable movements dystonia: extreme tone or stiffness limiting movements tremors: unpredictable movements with motion or at rest
The table above is called the and table.
cognitive skills and processes
Neurologic complications are among the most common sequelae after brain injury. They are also among the most serious. Below are several symptoms of medical complications. Please select only those that pertain to neurologic complications.
convulsive syncope and seizure tonic posturing myclonic jerks pain from blast injuries, burns, traumatic amputation, high temp gas inhalation post-traumatic headache
The cerebellum, which comprises about one-eighth of the brain's mass, coordinates, modulates and stores all body movements. Which one of the characteristics below is not associated with the cerebellum?
dedicated to the highest levels of thinking, moving and acting
__________________ are often associated with deficits in information processing speed
diffuse axonal injuries
Spasticity is a fixed loss of passive joint range of movement, while contractures are a velocity-dependent increase in tonic stretch with exaggerated tendon reflexes from excitability of the stretch reflex.
false
When brain cells are injured, they die and are eventually replace by new brain cells.
false
The MOST common complaint after mTBI, and the PRIMARY reason for patients seeking medical attention is [complaint1].
headaches
The hypothalamus is connected structurally and functionally to the pituitary gland. It is the major brain region that manages the release of body hormones. Injury to this part of the brain may cause many complex problems, such as disruption to the hormonal, endocrine or neurochemical systems. Which one of the characteristics below is not associated with the hypothalamus?
is directly tied with the olfactory fibers
Approaches to cognitive rehabilitation must consider the complexity of cognition as well as the hierarchical and inter-related nature of information processing within the brain.
true
In cognitive rehabilitation, compensatory approaches are based on the principle of adaptability.
true
The Central Nervous System is made up of the brain and spinal cord.
true
Thirty to seventy percent of individuals with TBI report sleep disturbances after injury.
true
Vestibular dysfunction after brain injury includes peripheral vestibular disorders (pathology of the inner ear system) and central vestibular disorders (damage to brain areas such as the reticular activating system, the cerebellum and others).
true
There are currently ___________Americans living with long-term disabilities secondary to brain injury.
5.3 million
More than ______ percent of individuals with brain injury will experience a urinary tract infection (UTI) within 6 weeks of their injury.
60
An injury to the brain may impact metabolism and hormone production. Below are several symptoms of medical complications. Please select only those that pertain to metabolic and endocrine system complications.
struggle with weigh gain sexual dysfunction and osteoporisis diabetes insipidus (DI) increased risk for heart attack, stroke, chronic kidney disease, peripheral artery disease and retinopathy metabolic syndrome, hypopituitarism, gonadotropic dysfunction or growth hormone dysfunction
The foundation for the diagnosis and treatment planning of headaches begins with an in-depth history with specific questioning of the mechanism of injury which involves impact speeds, physical forces and objects involved, acceleration/deceleration restraints used, and severity of injury factors and measures. The next step is to gather an understanding of the subjectivity of the headache through a review of symptoms, which includes the character of the headache, onset, location, duration and frequency, exacerbation, and relief help
true
The reticular activation system (RAS), a collection of primitive structures and nerve pathways within the brain, is responsible for maintaining arousal.
true
The severity of a traumatic brain injury (TBI) is classified as mild, moderate or severe.
true
The statements below are all considered risk factors for brain injury: injury severity age at injury alcohol misuse domestic violence service in the military
true
The three separate categories of seizures that occur following a TBI are - immediate post-traumatic convulsions (IPTC), early post-traumatic seizures (EPTS), and late post-traumatic seizures (LPTS).
true
Typical post-concussive symptoms can be divided into three categories: physical/somatic, cognitive and behavioral-emotional.
true
The gastrointestinal system is regulated by the hypothalamus and parasympathetic and sympathetic nervous system. Also, structures that regulate nutritional intake may be directly impacted. Below are several symptoms of medical complications. Please select only those that pertain to the gastrointestinal system.
unable to achieve adequate nutrition may need a gastrostomy or jejunostomy gastroesophageal reflux disease (GERD) hyperphagia, excessive or inadequate fluid intake, loss in appetite
The center for bowl and bladder function is the brain. When injured, the regulatory systems for elimination may be disturbed. Below are several symptoms of medical complications. Please select only those that pertain to elimination.
urinary or fecal incontinence urinary tract infections constipation and impaction
Musculoskeletal complications are commonly seen after brain injury. Below are several symptoms of medical complications. Please select only those that pertain to muscle and skeletal complications.
worsening tone affecting posture, balance and mobility diminished motor planning and attention, weight gain and pain may include spasticity, hyperreflexia and contractures problems with fine and gross motor coordination, motor strength and control, sensory-motor integration and motor learning
Persistent fatigue results in ________. Please select all the correct answers below.
a pattern of reduced activity greater home confinement development of depression
After a brain injury, resources needed to perform an activity may be physiological. Select the best answer below which describes physiological fatigue.
a. direct result of injury or dysfunction in the brain c. caused by depletion of energy, hormones, neurotransmitters, or reduced neural connections from a brain injury
The _____________ is a process-specific approach to Cognitive Rehabilitation, is hierarchically organized by difficulty and begins with sustained attention tasks and progresses to selective, alternating, and divided attention. Persons progress to a higher level when the easier task is mastered.
attention process training program
TBI is not an event or final outcome; rather it is the beginning of a chronic process: Please select the ONE condition below which is NOT part of this chronic process.
autoimmune disorder
The brain is involved in all aspects of sexual functioning. Brain Injury can impact the entire sexual response cycle. Below are several symptoms of medical complications. Please select only those that pertain to complications of the reproductive system.
changes in libido, arousal and sexual performance altered testosterone levels and menstrual cycles dysmenorrhea, polycistic ovarian syndrome, migranes increased risk for cardiovascular disease and cancer
Individuals who present with Disorders of Consciousness (DOC) progress in stages along a continuum based on neurobehavioral presentation. The three generally accepted levels from lowest to highest functioning are:
coma, vegetative, minimally conscious
Autonomic dysfunction syndrome (ADS) occurs in 15 - 33% of persons with a severe TBI who score 8 or less on the Glasgow Coma Scale (GCS). Please select all the correct answers below which pertain to this syndrome.
due to an imbalance in the autonomic nervous system system is located in the medulla oblongata and lower portion of brain stem treated with environmental control and pharmacological intervention
After a TBI, many individuals will experience a cranial nerve dysfunction called _____________, which is a swallowing disturbance typically treated by a speech-language pathologist. (Misspelled words are counted incorrect by Canvas)
dysphagia
In the hierarchy of cognitive function, complex reasoning abilities, such as categorization, require coordination of several fundamental systems. Please select all responses below which are correct for categorization.
enables individual to organize and manage tremendous amounts of information important in speed of processing, problem solving, and other higher-order cognitive processes deficits can interfere with performance of ADLs and the acquisition , processing and learning of new information remediation includes The Categorization Program, a therapeutic approach aimed at remediating deficits in object categorization and in decision-making
According to the CDC, mTBI represents 16-25% of all TBIs that occur in the U.S.
false
Cognitive rehab rests on two fundamental principles: neuroplasticity and adaptability. Neuroplasticity is defined as people's capacity to change their behaviors in order to adapt to changes in their internal or external environment. Adaptability is the ability of the nervous system to regenerate and reorganize its structure, functions and connections.
false
In the cervical spine, the first vertebra is the axis (responsible for movement of the head on the horizontal plane, allowing it to swivel as if saying "no"). The second vertebra is the atlas (allows the head to nod up and down as if saying "yes").
false
The right and left cerebral hemispheres communicate with each other over a thousand times per second through the prefrontal cortex.
false
The standard for assessment of persons with DOC is neuroimaging.
false- bedside neurobehavioral assessment is the standard
The thalamus sits on top of the brainstem just beneath the cortex. It's a major relay station for incoming and outgoing sensory information. Each sense relays its impulses through the thalamus with the exception of smell. An injury to the thalamus may cause many problems, several of which are shown below. Please select the one incorrect answer.
fight or flight reactions
Deficits in attention are common for persons who have sustained a brain injury. It is one of the most fundamental cognitive skills, and influences all other cognitive skills. Attention can be sub-divided into five subtypes. Please match each of the five subtypes below with their correct information.
focused attention: requires selection of one source of info while withholding responses to irrelevant stimuli sustained attention: the ability to maintain attention to complete a task accurately and efficiently over a period of time selective attention: the ability to maintain attention in the presence of distractions alternating attention: ability to shift between tasks that demand different behavioral or cognitive skills divided attention: requires the ability to respond simultaneously to multiple task demands while maintaining speed and accuracy
The cerebrum (brain) is comprised of four lobes, the frontal lobes (with the prefrontal cortex and primary motor cortex areas), the parietal lobes (with the primary sensory cortex) , the occipital lobes, and the temporal lobes (Broca's area and Wernick's area). Because there are two hemispheres, the lobes comprise both a left-side and a right-side involvement. Injury to the different lobes may cause many different problems. Correctly match below the individual lobes with their corresponding injury symptoms.
frontal lobe injury: impacts executive function and many aspects of personality parietal lobe injury: impacts the bodys movement as well as attention and awareness occipital lobe injury: causes visual-motoric-perceptual distortions temporal lobe injury: impacts auditory processes, the ability to remember, and to speak and understand lang
After a TBI, there may be injuries to the somatosensory system. Assessing sensory function and proprioceptive movement during therapeutic sessions is critical. Some of the most basic functional activities may be difficult for persons with poor sensory functions. These difficulties could be:
impairment of touch and ability to detect bruising or pressure areas impairment of thermal sensation creating a safety issue
The skin is the largest of the body's organs. Brain injury may result in many skin complications. Below are several symptoms of medical complications. Please select only those that pertain to complications of the integumentary (skin) system.
incisions, wounds, abrasions and lacerations of the the trauma. pressure sores increase in acne, sweating or rashes MRSA cellulitis and dermatitis
Functional movement dysfunctions are common after TBI. Below select those items which are true for this condition.
includes impaired bed mobility, transfers, sitting, postural control, gait and community mobility compensatory strategies are often used in therapy atrophy, neuropathy and paresis can result from this dysfunction fatigue impairs the ability to perform functional mobility
Sleep disturbances are reported by 30% to 80% of individuals with a TBI, suggesting that sleep problems may contribute to fatigue. Please select the correct items below that relate to sleep disturbances.
insomnia, hypersomnia, and excessive daytime sleepiness decline in sleep quality, taking longer to get to sleep, and increased night-time awakenings changes in Rapid Eye Movement (REM) sleep may be attributed to injury to brain regions, pathways, and neurotransmitter systems associated with sleep regulation lower levels of evening melatonin production associated with pain, depression and anxiety
Chronic pain following a TBI: (Please select all the correct answers below)
is prevalent in 58% of persons with a brain injury is more prevalent among persons with mild TBI than moderate-to-severe TBI can interfere with the ability of the individual to participate in therapy can impact mood, concentration and sleep quality
The Limbic System sits on top of the brain stem and is interconnected with the diencephalon. It is involved in emotions and basic feelings. Two major structures, the hippocampus and amygdala, as well as a third group of brain structures called the basal ganglia comprise the Limbic System. Please match these four items with the appropriate definition.
limbic system:referred to the mammalian brain-the animal like part of the brain that houses basic elemental drives hippocampus: injury causes one to have a great deal of difficulty with short term memory, consolidating short amygdala: closely tied with emotional memories and reactions including aggressive responses and fight or flight basal ganglia: helps handle physical movements by relaying info from cerebral cortex to brain stem
Impairments levels in metacognition for a brain-injured person are:
A. awareness of deficits B. awareness of functional implications C. awareness to set realistic goals
The Neuropsychological Assessment Process follows a specific order. Please select the correct order below.
Record Review, Clinical Interview, Standardized Testing, Report and Feedback
Memory is another cognitive skill often impacted after a brain injury. Please select below all items that correctly pertain to memory.
Short term memory passively holds information while working memory actively processes it. There are five sensory memory senses: Hearing; Smell; Touch; Taste; and Sight. Working memory is a central cognitive process responsible for the temporary storage and active processing of information. Long term memory involves permanent consolidation and storage of information, often lasting a lifetime. It is divided into explicit and implicit memory.
10% - 15% of those who sustain mTBI have a slow or incomplete resolution of symptoms and may develop Persistent Post-Concussive Symptoms (PPCS). Please select all statements below that are true for PPCS.
Symptoms associated with PPCS are nonspecific, and can be attributed to causes other than mTBI. Rick factors for PPCS include: over 40, female, traumatically injured, low socioeconomic status, history of substance abuse, pending litigation, and previous psych history. Presence of headache, dizziness, or nausea; post-traumatic amnesia lasting more than an hour. Treatment should always include a neuropsychological assessment.
Which statement below is NOT a risk factor for someone with a brain injury developing a disability?
The injured person is a particular sex and age.
Located at the top of the spinal column, the brainstem relays information into and out of the brain. It is the central point for all incoming and outgoing information and basic life functions. The brainstem is made up of three integral areas - the medulla, the pons and the midbrain. There is also a collection of nerve fibers and nuclei called the reticular activating system (RAS). Please match these four items with the appropriate definition.
medulla: it contains reflex centers which control involuntary functions such as breathing, heart rate, and blood pressure pons:essential for facial movements, facial sensation, hearing, and coordinating eye movements midbrain: it is involved in elementary forms of seeing and hearing. catastrophic injury to the cerebrum can render this reticular activating system (RAS): modulates or changes arousal, alertness, concentration, and basic biological rhythms
After a brain injury, many people report sleep disturbances. Below are several symptoms of medical complications. Please select only those that pertain to sleep complications.
narcolepsy periodic limb movement disorder insomnia post-traumatic hypersomnia central and obstructive sleep apnea
This brain injury causes damage to the brain by internal factors, such as lack of oxygen or nutrients to the nerve cells of the brain, exposure to toxins, pressure from a tumor or blockage, or other neurological disorder. The above statement describes which type of brain injury?
nontraumatic injury
Decreased awareness of the extent of a brain-injured person's disability, unsafe actions in simple tasks, or repeatedly making the same mistakes are an example of a or deficit.
perceptual or interpretation
Executive function represents the most complex of cognitive processes. Please select all items below that are correct for executive function.
persons often exhibit impulsivity, disinhibition, hyperverbosity, and poor emotional control cognitive rehab approaches include the use of training in formal problem solving strategies and their application to everyday situations and functional routines involve reasoning, planning, judgement, initiation and abstract thinking
Which factors can significantly influence cognitive recovery from brain injury, and must be factored into an individual's medical and rehabilitation treatment plan? Please select below all the correct factors below.
physical (e.g. vision and hearing) language and speech deficits neurological (e.g. metabolic and endocrine function) emotional and behavioral factors
Match the meninges (brain coverings) correctly to their description on the right.
pia mater: tender matter that molds around every nook and cranny of the brain's surface arachnoid layer: like a spider that bridges the brain's wrinkles and folds dura mater: hard outer layer of material like a heavy plastic covering
Goal setting for individuals with DOC is typically:
response-based, tolerance for stimuli or intervention, risk management and caregiver development
The single most important piece of federal legislation for persons with brain injury, which was passed by Congress "to expand efforts to identify methods of preventing traumatic brain injury, to expand biomedical research efforts or minimize the severity of dysfunction as a result of such injury: and to improve the delivery and quality of services is:
traumatic brain injury act of 1996
A 2007 longitudinal study on veterans indicated more than one third of individuals diagnosed with a severe TBI will have ongoing physical or neuromotor abnormalities at the two-year time point.
true
A Functional MRI is a neuroimaging method, where the person performs a task while in the scanner and the activated brain regions can be viewed.
true
A computed tomography (CT) image is the standard of care for a person who has sustained a significant head injury to determine if a skull fracture has occurred. A CT image will determine whether there is hemorrhaging or a blood clot forming, brain swelling, or even if a foreign object has penetrated the brain.
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According to the Coping Hypothesis, in persons with brain injury, the performance of tasks may require greater mental effort which may in turn contribute to the experience of subjective fatigue. This may be due to cognitive defects, including impaired attention and processing speed.
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Acquired Brain Injury services are delivered in many settings that are held accountable to regulations of federal or state agencies, are licensed, and/or are accredited. For hospitals, home care agencies or nursing care centers, the gold standard of accreditation for organizations is Joint Commission Accredidation. The accreditor of choice for brain injury rehabilitation programs (which may be located in hospitals, skilled nursing facilities, LTACs, outpatient clinics, home and community services, residential services, vocational services and case management companies) is CARF.
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Between 32% and 73% of people with all types of brain injury severity report fatigue, making it one of the most common post-concussive symptoms across the spectrum of injury severity.
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Chronic Traumatic Encephalopathy (CTE) is a rare, progressive, degenerative condition of the central nervous system, and is typically seen in repetitive brain trauma. In CTE, diffuse axonal injury causes release of Tau proteins, which are located in the axons of neurons.
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Diffuse axonal injury is the most common form of damage to a brain structure.
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Effort and motivation can have a significant impact on the validity of a neuropsychological assessment.
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For the child with a prefrontal cortex (PFC) injury, the capability for more independent frontal lobe functioning may have been diminished by the earlier injury. This potential deficit often remains unrecognized until after puberty begins and expectations for self-regulation increase
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In cognitive rehabilitation, restorative approaches are based on the premise of neuroplasticity
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Like the brain, the spinal cord also has three levels of meninges; dura mater, arachnoid mater, and pia mater.
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Memory impairments can arise from difficulty in the encoding, storage or retrieval of information.
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Mild TBI (or mTBI) is associated with distinctive symptoms that typically occur immediately after injury. Most of these symptoms resolve within a short period of time (2 - 4 weeks), with only 10% - 15% of persons experiencing persistent problems after that point.
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Neurogenic bladder is the loss of bladder control due to injury to the neurological system
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Persons with a TBI are twice as likely to die as similar non-brain injured persons, and have a life expectancy reduction of approximately seven years.
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Primary fatigue results directly from injury or disease. Secondary fatigue relates to factors that may exacerbate fatigue, such as pain, sleep disturbances or stress.
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Processing speed is cognitive reaction time, or the time it takes a person to gather the information presented, process it, and respond. When impaired, the rate at which new information can be attended to and later recalled is also impaired. Therapy for processing speed must be targeted across all cognitive skills
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Pseudobulbar affect (PBA), also known as emotional incontinence or emotional lability, is a neurologic condition in which people are prone to sudden, unexpected, inexplicable, and often inordinate period of crying or laughing.
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The Major Descending Tracts are efferent nerve bundles in the spinal column heading away from the brain. The Major Ascending Tracts are afferent nerve bundles transmitting signals to the brain.
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The cerebral cortex, is divided into two hemispheres. The right hemisphere is more holistic, visual-spatial, and intuitive. The left hemisphere is more linear, verbal-analytic, and logical. It is full of wrinkles and folds.
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