CBIS EXAM LATEST PRACTISE
QUESTION 2024 SOLVED 100%
VERSION 2 (V2) 200 QUESTION AND
ANSWER
1. Nuerocognitive Issues Assoicated with Frontal Lobe
Emotional control, behavioral control, verbal expression, problem solving, decision making, social
control, attention, motivation
2. Acquired BI
An injury to the brain that is not hereditary, congenital or degenerative or induced by birth trauma
3. TBI
An alteration in brain function or other evidence of brain pathology, casused by an external force
4. Mild TBI Characteristics
Brief or no loss of consciousness for 0-30mins, altered state of consciousness is most common and must
be <24 hours, account for 75% of TBIs, 13-15 on the GCS, normal imaging, highest prevalence of
maltreatment as 16-25% never seek care, often considered a concussion
5. Moderate TBI Characteristics
Loss of consciousness for up to 24 hours, may appear on scans, skull fractures and bleeding are
common, 9-12 on the GCS
6. Severe TBI Characteristics
Loss of consciousness >24 hours, 3-8 on the GCS
7. Likelihood of Additional Injury
1 BI increases risk of 2nd by 3x and 2nd BI increases risk of 3rd by 8x!
8. Most Frequent Cause of TBI
Falls
9. How many people sustain a BI per year?
2.5 million. 81% visit ED, 16% hsopitalized, 3% result in death
10. How many people are living with effects of a TBI?
13.5 million
11. Likelihood of BI by gender
Men are 1.4x more likely than women
12. Most common cause of TBI and death by age - 75+
Falls!
13. Most common cause of TBI and death by age - 0-3
AHT!
14. Most common cause of TBI and death by age - 20-24
MVAs and Firearms
15. Most common cause of TBI and death by age - 16-19
MVAs!
16. CARF
Accreditation agency for post acute BI programs, residential, outpatient, vocational, home and
community, stroke and pediatric programs - ensures quality of services through requirements for
accreditation and surveys
17. Joint Commission
Accreditation agency for hospital based programs, may accompany CARF accreditation, ensures quality
of services through requirements for accreditation and surveys
18. Olmsted Decison
Supreme court case stimulated by two women living in a nursing home in Georgia for community
inclusion - resulted in federal and state initiatives to improve and normalize community living
19. Model Systems of Care 1987
Resulted in research projects for TBI by the NIDDR, established rehab facilities to provide care and
complete clinical research in the process
20. Symptoms of Mild TBI
Headache, fatigue, seizures, nausea, numbness, poor sleep, light sensitivity, noise sensitivity, impaired
hearing, blurred vision, dizziness, loss of balance, neurological abnormality, in attentiveness, decreased
concentration, poor memory, impaired judgment, slow proccessing speed, executive dysfunction,
depression, anxiety, agitation, irritability, aggression, impulsivity
Primary causes of Mild TBI
Traumatic intertial - brain moving inside skull
Traumatic impact - head hits directly
21. Early Treatment for Mild TBI
Relaxation techniques, rest, slow return to normal activity, and reduction of normal activity if symptoms
recur
22. Peristent Post Concussive Symptoms (PPCS)
Symptoms of Mild TBI last >1 month, occurs 10% of the time in Mild TBI cases
23. Chronic Traumatic Encephalopathy (CTE)
Often cause by repeated blows to the head, is a progressive, degenerative condition characterized by
broken nuerons which continually release tau protein cashing dementia over time
Diffuse axonal injury -> tau protein release -> inflammation of the brain -> progressive dementia
24. Define Skull
Bony shell that protects the brain, has bony prominences inside which can worsen brain injury
25. Cerebral Spinal Fluid (CSF)
Provides cushion to nerve tissue, produced by ventricles (4) which also store and circulation CSF through
the brain
Meninges
Pia Mater - molds around suclhi and gyri, deepest layer
Arachnoid Mater - spiderweb-like, middle layer
Dura Mater - hard plastic, top layer
26. Nuerons vs Glial Cells
Nuerons communicate electrical impulses throughout brain while Glial cells support and nourish
Nuerons
27. Synapse
A junction between the axon of one neuron and the dendrite of another, allows for passing of
communication fro, nueron to neuron
28. Functions of the Parietal Lobe
Sense of touch; differentiation of size, color, and shape; visual perception; spatial perception
29. Functions of the Occipital Lobe
Visual functions
30. Functions of the Frontal Lobe
Planning; organizing; problem solving; working memory; impulse control; decision making; personality;
behavior; initiation; anticipation; self-monitoring; motor planning; emotions; awareness of abilities;
attention; concentration; mental flexibility; speaking - all executive functions
31. Functions of the Temporal Lobe
Hearing functions, memory, understanding language, organization and sequencing
32. Functions of the Brain Stem
Breathing, HR, arousal, consciousness, sleep/wake functions, attention, concentration
Transmits all sensory information from body to brain and movement signals from the brain to the body
Contains sensory centers for hearing, touch, taste, and balance
Even if the cerebral cortex is gravelly damaged, the brain stem can keep someone alive - or in a
vegetative state
33. Functions of the Cerebellum
Balance, coordination, skilled motor activity
Reticular Activating System (RAS)
Part of the brain stem - collection of nerve fibers that modulate changed in arousal, alertness,
concentration, and biological rhythms
Can be turned down or up much like a light dimmer switch - i.e during a coma, it is turned down - if
turned down too much, can result in death
Medulla
Part of the brain stem- responsible for basic living functions such as breathing, HR, BP, swallowing, and
vomiting
Pons
Part of the brain stem- responsible for facial movements, facial sensation, hearing and coordinating eye
movements
Serves as a bridge between the cerebral cortex (thinking part of brain) and cerebellum (moving part of
brain)
Damage can cause decreased coordination and poor control of body movements
Midbrain
Part of the brain stem - responsible for elementary forms of seeing and hearing, alertness, arousal
Thalamus
Part of the diencephalon - major relay station for incoming and outgoing sensory information except for
smell
Hypothalamus
Part of the diencephalon - control center for hunger, thirst, sexual responses, endocrine levels,
temperature regulation, hormone release
"The conductor of the emotional orchestra"
Functions of the Limbic System
Drives basic instincts, "animal-like" aspects of a human - if damaged can cause emotional responses that
can become uncontrollable
Amygdala
Part of the limbic system - responsible for emotional memories, closely tied to sense of smell
"Fight of flight structure"
Hippocampus
Part of the limbic system - responsible for the organization of memories
Described at the pole in a closet - without pole, all clothing falls - without hippocampus memories
become disorganized
Basal Ganglia
Part of the limbic system - relays information from cerebral cortex to brain stem and cerebellum for
movement, the checking system that comes to attention when things are not working as they should be
i.e. restoring equilibrium
Cerebellum
Governs a person's movements by controlling rate, direction, force and steadiness of movements
Cerebral Cortex
Made up of right and left hemisphere and corpus collosum
Functions of the Right Hemisphere
Holistic, visual spatial and , intuitive in nature
Associated with art, shapes, music, and faces
Functions of Left Hemipshere
Linear, verbal-analytic, logical in nature
Associated with speaking, reading, and calculating
Corpus Collosum
Pencil-thick band that exhanges info between L and R hemispheres
Afferent Signals
Signals sent along the spinal cord through foremen magnum towards the central nervous system
Efferent Signals
Signals sent from the central nervous system to the rest of the body through the foramen magnum via
the spinal cord
Cervical Vertebrae
Made up of 7 vertebrae, primary function to support and move the skull
Thoracic Vertebrae
Made up of 12 vertebrae, primary function is stability
Lumbar Vertebrae
Made up of 5 vertebrae, primary function is weight bearing
Sacral Vertebrae
Made up of 5 vertebrae, located at the base of the spine meeting the pelvis
CT Scan
X-ray used in conjunction with a computer, only capable of showing what the naked eye can see
MRI
Uses magnetic field in conjunction with a computer, a more detailed scan ideal for seeing soft tissue
damage, can detect changes in blood flow and track cellular activity
Blood Brain Barrier
A filter within the red blood cells which allows blood to enter the brain but blocks harmful substances
from entering
Neuroplasticity
The ability of the nervous system to change, grow, or compensate for an injury
The brain can change and re-map! Based on the Hebbian Principle which states that every rehearsal of a
skill strengthens memory trace in the brain
*Hippocampus may contain stem cells which can generate new brain cells if optimized by therapy!
Synaptogenesis
A part of nueroplasticity - the formation of synapses between nuerons
The more synapses there are the more efficiently nuerons can communicate!
Nueroprotection
Preventing secondary damage post injury
Apoptosis
Process in which a brain cell self destructs if it is not working as it should be
Experience Dependent Learning
Neural connections that are established which depend entirely on and are due to an environmental
experience
Autonomic Storming
Also called dysautonomia, autonomic hyperreflexia, sympathetic storming
A disorder of the autonomic nervous system that involves failure of the sympathetic/parasympathetic
components of the ANS.
Characterized by resting tachycardia, labored breathing, gastroparesis, sweating irregularities,
hypotension, constipation, and erectile disfunction
15-33% of TBIs sustainees experience AS
Deep Vein Thrombosis (DVT)
Bloodclots
Symptoms include shortness of breath, pain/discomfort that worsens with coughing or breathing, light
headedness, dizziness, feeling faint, coughing up blood, rapid pulse
Pulmonary Embolism (PE)
Occurs when a blood clot travels to the lungs- same symptoms for DVT
Disinhibited Nuerogenic Bladder
Neurological impairment in CNS or PNS causing decreased bladder capacity, increased urgency,
increased frequency and incontinence with intact bladder sensation
Treatment for Bowel and Bladder Incontinence
Best when initiate early on - treatment includes exterior cathing and suppository schedules, toileting
schedules, and close monitoring of intake
UTI's extremely common due to cathing - risk of UTI is increased with use of in-dwelling catheters,
especially if cognitive impairment is present
Aspiration
Caused by dysphagia - when liquid enters into the lungs
Commonly leads to aspiration pneumonia
Specialized diets are often prescribed if there is a risk of dysphagia - may include thickened liquids and
diets with altered consistency
Seizures and TBI
Caused by an imbalance of nuerotransmitters or an abnormal and disorderly discharge of electrical
activity in the cells of the brain
TBI sustainees 22x more likely to die from a seizure than general population
Immediate post TBI convulsions are most common but not believed to be a predictor of prolonged
seizure disorder
Seizures occurring 1 wk post TBI are strong predictor of future patterns
Status Epilepticus
A seizure lasting longer than 5 minutes or seizures that occur close together, when one seizure occurs
before fully recovering from previous seizure
Associated with the following risk factors: penetrating TBI, severity of injury, hematomas, contusions,
post traumatic amnesia lasting more than 24 hours, alcohol use, being a child or adolescent
Cranial Nerve Damage
Associated with higher level severity BIs
Cranial nerve 1 is most commonly injured, all are susceptible to injury due to placement near bony skull
prominences
Can heal and repair selves if stretched or bruised, tingling and pain can be a sign of repair
Cranial Nerve Functions
I Olfactory (smell)
II Optic (sight)
III Occulomotor (eye movement)
IV Trochlear (downward, inward eye movement)
V Trigeminal (sense of touch in the face)
VI Abducens (horizontal eye movement)
VII Facial (facial expressions)
VIII Auditory-Vestibular
IX Glossopharyngeal (throat, taste, BP)
X Vagus (heart, lungs, abdominal organs)
XI Spinal Accessory (throat & neck muscles)
XII Hyposglossal (speech)
Nocioceptive Pain
Pain relating to damage to body tissue
Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, and opioids
Neuropathic Pain
Pain relating to dysfunction of nervous system itself - damage to actual nerves
Treated with NSAIDS, Tylenol, topical agents, anti-spasticity meds, opioids, anti-depressants, nerve
blocks, trigger point injections, anti-convulsants, and epidural steroids
Primary vs. Secondary Headaches
Headache that as no idenfitiable cause vs one with an identifiable cause
Acute vs. Chronic Headaches
Short vs lasting atleast 15 days out of a month for atleast 3 months, cannot be linked to withdrawal of
medication and must have occurred within 14 days of TBI to be considered post traumatic head ache
Tension Headache
Described as bilateral head pain, "clamping", caused by head or neck muscle strain. Not associated with
any other symptoms and does not worsen with PA.
Craniomandibular Headache
Associated with temporal-madibular joint, often causes difficulty with eating and talking
Cervicogenic Headache
Generated from the cervical spine, clinical diagnosis in made with the use of nerve block
Migraines
Located on one side of head or the other; lasts 4-72 hours; worsens with heat, light and exercises
4 phases: Prodrome (pre-headache symptoms), Aura, Headache, Postdrome (symptoms following
headache)
Can be treated with caffeine, NSAIDS, bata blockers, environmental changes, and narcotics (last resort)
COLDER
Acronym used to help diagnose and assist in treating headaches
Character
Onset
Location
Duration and frequency
Exacerbation
Relief
Percentage of physical complications existing >2 years post TBI
30%!
Spasticity
Increase in muscle tone, tendon reflexes, and involuntary velocity of movements
Treated multimodally with with meds (i.e. baclofen, diazepam, etc.) OT and PT services
Heterotrophic Ossification (HO)
Formation of new bone around joints due to trauma or immobility
Can cause severe pain, decreased ROM, and increased spasticity
Treated with NSAIDS, PT, and sometimes surgery
Contractures
Shortening of tendons and muscles causing decreased ROM
Treated with combination of meds, splinting, casting, PT, OT, etc.
Hyperreflexia
Bladder emptying that is triggered easily, overactive and overresponsive reflexes
Pressure Sores
Occur most often near bony prominences due to decreased mobility and lack of sensation
Can be avoided by keeping skin clean and dry, turning schedules (every 2 hours), specialty
cushion/mattress, and tilt in space W/Cs
Stage 1 (non blanchable redness)
Stage 2 (shallow open ulcer with red or pink wound bed or blister)
Stage 3 (subcutaneous fat visible, may have undermining or tunneling)
Stage 4 (exposed bone, muscle, or tendon)
Unstageable (colorful wound bed)
Deep Tissue Injury
Purple, maroon localized area caused by damage of underlying soft tissue
Agnosia
Perceptual defecit associated with BI
Inability to recognize
Anosagnosia
Perceptual defecit associated with BI
Inability to recognize own defecits or disabling condtion
Somatoagnosia
Perceptual defecit associated with BI
Inability to recognize body part of structure
Apraxia
Perceptual defecit associated with BI
Absence of
Spatial Relations Disorder
Perceptual defecit associated with BI
Inability to perceive space between objects
Form Discrimination Disorder
Perceptual defecit associated with BI
Challenge with orientation and similar shapes
Vertical Disorientation
Perceptual defecit associated with BI
Difficulty with upright position and balance
Depth and Distance Perception Difficulty
Perceptual defecit associated with BI
Difficulty sensing depth and distance of an object in relation to oneself
Co-Commitance of SCI and TBI
60% of patients with SCI also have a TBI
12,000 new cases of SCI per year
Complete vs Incomplete SCI
All feeling and control completely lost below level of injury vs partial feeling and control lost below level
of injury
Coma
Disorder of consciousness
No arousal, no awareness, lasts weeks to months, impaired brain stem reflexes
Vegetative State
Disorder of consciousness
Arousal, no awareness, lasts months to years
Minimally Conscious State
Disorder of consciousness
Arousal, fluctuating awareness, lasts months to years
Statistic of People Living with a DOC in the U.S.
315,000 People
Management of DOC
Focuses of full participation in daily routine, provide sensory stimulation, look for generalized and
localized responses to stimulation, perform ROM, apply orthotics, upright positioning, bed mobility to
combat atrophy/contractures/skin breakdown
Fatigue
Decreased capacity for physical of mental activity due to an imbalance of resources needed to complete
activity at hand
Sleep Disruption
Disorders of initiating and maintaining sleep
Primary Fatigue vs. Secondary Fatigue
Results directly from injury vs exacerbation of primary fatigue
Physiological Fatigue vs. Psychological Fatigue
Caused by decreased production of hypocretin which increases arousal vs that caused by anxiety,
depression and weariness
The Coping Hypothesis
Explanation for cause of fatigue in TBI sustainess - says that it may be caused by increased effort
required to meet demands of life caused by TBI
Measures of Fatigue
Visual Analogue Scale
-Fatigue at a single point in time
Fatigue Severity Scale
-Impact of fatigue on daily functions
Barrow Nuerological
-Difficulty level of maintaining energy and alertness
Global Fatigue Index
- 4 Domains of Fatigue severity
Causes of Fatigue Questionairre
-physical and mental activities that cause fatigue and to what extent
Strategies to Increase Energy
Reduce work hours, take breaks, physical conditioning, addressing pain/anxiety/depression, modifying
pace or demands of task, reduce distraction, manage info overload
Narcolepsy
Sleep Disturbance
Sleeps for <1 hour at a time
Sleep Apnea
Sleep Disturbance
Upper airway obstruction which stops breath during sleep
Hypersomnia
Sleep Disturbance
Traumatic event of CNS
Limb Disorder
Sleep Disturbance
Periodic limb movements during sleep
Insomnia
Sleep Disturbance
Periods of wakening and difficulty getting back to sleep
Treatment for Sleep Disturbance
Exercise, limiting fluid intake before bed, avoiding naps, relaxation, sleep hygiene, CBT, meds, and CPAP
Sleep Disturbance Assesment Tools
Epworth Sleepiness Scale, Pittsburgh Sleep Quality index, Polysonography, Mutiple Sleep Latency Test
Causes of Sleep Disturbance
Change in circadian rhythms, depression, frequent napping, anxiety, pain, changes with REM
Aging and TBI
TBI exacerbates normal aging
increase likelihood of developing AD
Nuerocognitive Issues Associated with Frontal Lobe Damage
Emotional control, behavioral control, verbal expression, problem solving, decision making, social
control, motivation, and attention
Nuerocognitive Issues Associated with Partial Lobe Damage
Tactile performance, spatial orientation, academic skills, object naming, visual attention and hand eye
coordination
Nuerocognitive Issues Associated with Occipital Lobe Damage
Visual stimuli processing
Nuerocognitive Issues Associated with Temporal Lobe Damage
Memory, face recognition, selective attention, locating objects, object catgorization, receptive language,
emotional responses, language comprehension
Attention Heiarchy
Focused (turning to see someone behind you) -> Sustained (reading a book) -> Selective (studying with
music) -> Alternating (reading recipe and cooking) -> Divided (driving and talking on the phone)
Domains of Cognitive Functioning
Metacognition (self-awareness), executive functions, attention, categorization, processing speed,
memory
Sensory memory
Holds a memory a few moments after perception
Short Term Memory
Enables memory recall lasting a few minutes to hours
Working Memory
Temporary storage and active processing of information i.e. calculating change
Long Term Memory
Permanent consolidation and storage of information
Explicit Memory vs. Implicit Memory
Memory requiring conscious recall vs muscle memory
Semantic Memory
Memories of words, ideas, and concepts
Episodic Memory
Memories of personal experiences
Procedural Memory
Memory of skills and tasks
Compensatory Approach to Treatment vs. Restorative Approach to Treatment
Assumes certain functions cannot be recovered and focuses on strategies to "compensate" for losses vs.
belief that repetition, exposure and experiential learning can change brain circuitry
Coma-Emergent Agitation
Emerging from coma can case confusion, anger, hyperactive movements, heightened responses to
external stimuli, poor cooperation and violence
Can last up to 10 days
Management of Coma-Emergent Agitation
Use consistent and familiar staff, environmental alteration to decrease triggers, provide familiar objects,
reduce stimuli, establish predictable routines
Stability Triangle
Model that suggests you must establish medical stability, develop stable activity plan and promote
stable behavior in order to achieve stability
ABA
Method of behavior change - discovers variables that predict behavior to modify antecedents to illicit
behavior change
3 components - the environment, the individual, and the target behavior
Behavior Change Process
Assess behavior -> define target behavior -> collect data -> change behavior
Operation
Any that variable that temporarily alters effectiveness of some stimulus of event as a reinforcer
Example of Intermittent Reinforcement
Slot Machine
Example of Continous Reinforcement
Soda Machine
Positive Reinforcement
A stimulus is added, likelihood of behavior increases
I.e. student gets As on report card and earns $20
Positive Punishment
A stimulus is added, likelihood of behavior decreases
I.e. driver speeds, officer gives $100 ticket
Negative Reinforcement
A stimulus is removed, likelihood of behvaior increases
I.e. child puts toy away, avoids being nagged by parent
Negative Punishment
A stimulus is removed, likelihood of behavior decreases
I.e. siblings fight over toy, parent takes away toy
Functionally Equivalent Altneratives to Behavior Modification
Prompting, Cuing, Shaping, Fading, Generalization and Discrimination
Nueropsychology Assessment Process
Medical record review -> clinical review -> standardized testing -> report and feedback
Assessment short in acute settings but more in depth when post acute
Cognitive Rehab Process
Cognitive Education (awareness of defecits) -> Cognitive Training (restoring cognitive/psych defecits) ->
Strategy Training (compensatory approaches) -> Functional Training (real-world application)
Areas of the Brain Associated with Increased Psychiatric Co-morbidity
Left frontal gray matter reduction, lateral and medial frontal lobe lesions, amygdaloid and hippocampus
lesions, basal ganglia lesions, changes in balance and production of nuerotransmitters. (Dopamine,
glutamate, serotonin)
Depression and TBI
Symptoms: changes in appetite, weight gain, suicidal ideations, depressed mood, tiredness
Risk Factors: change in socioeconomic status , preinury pathologies
MOST COMMON co-morbid psychiatric illness
Organic Personality Disorder and TBI
Symptoms: Depression, emotional instability, irritability, impulsivity, changes in behavior prior to injury
due to an organic impairment or disease of CNS
23% of people with TBI experience OPD
Pseudo Bulbar Affect and TBI
Symptoms: Uncontrollable episodes of laughing or crying, catastrophic reactions
A result of TBI or other nueroglogical disorder
Substance Use Disorder (SUD) and TBI
Involves continued use of substance despite health, psychological or social consequences
Exacerbates effects of TBI including memory, judgment, behavior, and generalization impairments
12% of people 16 and older with TBI used a month prior to injury
Use of substances before injury increase risk of reusing x10
As many as 50% of users will use again after injury
Screening Tools for SUD
ASSIST, CAGE, AUDIT, CRAFFT
4 Quadrant Treament for SUD and TBI Co-Committance
Quadrant 1 - low severity TBI and SUD - receive treatment in acute medical setting - brief intervention
Quadrant 2 - high severity TBI and low severity SUD - receive treatment in TBI rehab - education,
screening, and brief intervention
Quadrant 3 - low severity TBI, high severity SUD - receive treatment in SUD treatment setting screening, accommodations and linkage
Quadrant 4- high severity TBI and SUD - receive treatment in TBI and SUD treament setting - integrated
program to treat both
Biomedical Model of Diability
Concerned with changing the individual and treating the problem (TBI)
Functional Model of Disability
Aimed at adapting the functions of individuals for meaningful participation in life, focused on person
centered care
Environmental Model of Disability
Addressing physical and social environments to meet the needs of an individual
Sociopolitical Model of Disability
Goal is inclusion, civil rights, and equal social status - places accountability on society
Religious/Moral Model of Disability
Disability is a result of sin
Person Centered Care
Encourages individual participation in rehab and hold the individual accountable for their progress.
Physicians, healthcare professionals, and family are considered tools and allies. Focuses on participation
in the process as opposed to immediate "progress." Encouraging self awareness and autonomy
improves outcomes.
Components of Therapeutic Relastionships
Autonomy -empowering the indivdual
Beneficence- preventing harm
Non-Maleficience - do no harm
Fidelity - keeping a promise
Justice - equality and fairness
Veracity- truth and honesty
Use person first language, humaneness, open communication, questions vs directives, and a nonjudgmental approach!
Latrogenesis
Due to.a physician or therapist, inadverdently induced problem or disease
Extenders
Unlicensed, non-certified staff that operate under the supervision of a licensed clinician that are
specially trained
Culture
Any group that shares a theme or issue; can include language, food, clothing, music, art, dance, etc.
Sociorace
Recognizes the social and historical aspects of a group of people; providing info about customs, norms,
and social aspects of the group
Universalism
Loyalty and concern for others without regard to national or other allegiances
Multiculturalism
A social-intellectual movement promoting cultural diversity as a core principle while insisting on equality
and respect for all cultural groups
Academic Intelligence
Ability to solve problems in an academic, classroom setting
Practical Intelligence
Ability to solve practical life problems in everyday settings
Social Intelligence
A distinct set of skills necessary in order to successfully navigate the environment
Emotional Intelligence
The ability to monitor and identify emotions, both one's own and others' and the use of emotional info
to guide thinking and behavior
The Process of Racial and Cultural Identity Development
Conformity -> Dissonance -> Resistance and Immersion -> Introspection -> Integrative Awareness
Worldview
How you perceive your relationship to the world, can greatly influence a person's life
Should be considered when treatment plannning
Benign Neglect
An attitude or policy of ignoring an often delicate or undesirable situation
Males vs. Females and TBI
Men experience TBI 2:1 compared to women
RTW rates 26.6% for men vs 4.4% for women- may be due to womens' increased responsibility in the
home and at work
For women TBI often causes depression, PTSD, sexual difficulty, increased symptamology over time, and
body image concerns
Primary and Secondary Causes of Sexual Dysfunction
Nueroendocrine changes, hypothalamus and pituitary damage
Physical changes, cognitive impairments, emotional and behavioral changes, marital dysfunction, social
isolation, financial stress, role changes, and decreased communication
Brain Peak Maturation Periods
3-5 years old - rapid overall growth
8-10 years old - rapid sensory motor growth, executive functions begin to develop
14-15 years old- rapid growth of visual spatial, somatic systems, and auditory
*TBI disrupts normal developmental milestone progression
Individuals with Disabilites Education Act (IDEA)
Made free and appropriate education available to all children with disabilities, ensures access to public
education and related services
504 Accommodation Plans
Designed to help children learn alongside peers, provides written documentation for needs required by
child with a presumed disability i.e. preferential seating, increased time, verbal testing, note takers, etc.
Can be carried into higher education but may not have a formal 504 plan..
A result of section 504 of Rehabilitation Act of 1973 that prohibits discrimination based on disability
Individualized Education Plan (IEP)
Written for specialized academic instruction, can be used by students in public school until age 21 - all
public schools MUST provide services outlined in IEP by law
Individualized Transition Plan (ITP)
Section of an IEP that outlines transition goals and services and how to achieve goals from transition to
high school into real world. All students with IEP must have an ITP by age 16
Abusive Head Trauma (AHT) and Shaken Baby Syndromes Statistics
AHT is most common cause of TBI in 0-5 year olds, boys most commonly abused
Accounts for 58% of TBIs in boys compared to 42% in girls
Most often committed by a male caregiver - 56% of offenders are biological fathers
Outcomes: 75-80% experience LT disability, 40% have severe defecits and 15-30% die
Common Stressors for Families
Caregiver Burden is reported by 90% of caregivers!
Stressors include catastrophe and unexpected responsibility in the acute phase; added unfamiliarity,
confusion, uncertainty, and pressure in the rehab phase; and isolation and distress post discharge.
Relief Strategies for Use with Families
Developing realistic goals, facilitating optimism, education about resources, and encouraging use of
school supports
Keep families informed, use active listening, validate and normalize, keep conversation positive, refer to
resources, consider cultura competence
Family Systems Theory
Families are considered to be the experts, every family has their own way of communication and
functioning that will influence reception of rehab
Assumes that families have the strength and capacity to solve problems and be successful
Family Centered Services
The survivor, family and provider are partners in healthcare. Care should be tailored to individuals and
family strengths and values.
Cognitive Behavioral Family Theory
A - Activating Event - family has no control (medical deicisions and the accident itself)
B- Belief - family has control over (i.e. "this will be the end of our family" vs "we can do this")
C- Consequence of Belief - family has control over (feeling hopeless vs seeing progress and feeling
encouraged)
Brain Injury Family Interventions (BIFI)
90-120 minute sessions focused on familial support for families of individuals with BI
Session focuses may include what's normal after BI, coping strategies and loss etc.
Primary Blast Inury vs. Secondary Blast Injury
Caused by direct impact from over-pressure wave, compresses air filled organ or catapults body
backwards vs energized debris and explosive fragments that impact on head or body
Tertiary Blast Injury
Body impacts the wall, ground, or object
Quarternary Blast Inury
Inhalation of toxic gases or substances
Mild TBI and PTSD
This severity of TBI has highest rate of co-mittal PTSD at 44%
Components of Return to Military Duty
Medical Evaluation Board - physician informally determines if a soldier can meet medical retention
standards
Physical Evaluation Board - a formal fitness for duty and disability determination and eligibility for
compensation
Screening and Testing for Military Related TBI
Military Acute Concussion Evaluation, Nuerobehavior Symptom Inventory, State Strait Axiety Inventory,
The ANAM Simple Reaction Time and Continuous Performance Subtests, Repeatable Battery for the
Assessment of Nueropsychological Status
Patients' Bill Of Rights
Written guarantee of basic rights for individuals in treatment programs. Staff are accountable to adhere
to rights by law.
Power of Attorney
A document where a competent person appoints other person to act for him or her in legal and
fincancial situations
Guardianship
A legally-enforceable arrangement in which the guardian has the right and duty to care for another - can
be a guardian or the person and estate
Plenary Guardianship- accounted by the court for person and estate
Exploitation
The process of making bad, or improper use of, violating, injuring, or taking bad advantage of. Using for
one's own profit or selfish purposes
Neglect
The failure to provide necessary care, assistance, or guidance that causes or is likely to cause physical,
mental, or emotional harm or damage to/loss of assets.
Legal Use of Restraint
Restraint must be used as a last resort after all other non-restrictive strategies prove unsuccessful and
person is putting self- or other in immediate danger i.e. using prescribed medications, bed rails, W/C
seatbelts
Misuse of restraint is a violation of constitutional rights
Care Management Process
Assess -> Plan -> Faciliate/Implement -> Coorindate -> Monitor -> Evaluate
Focuses on resource utilization, management, psychosocial and economic supports, rehab, outcomes,
and ethical/legal processes
Life Care Plan
Plans written to encompass full understanding of injuries and resultant disabilties, considers all possible
complications and co-morbities - from time of injury to death. Focuses on short term and long term
needs and is individualized.
A "road map" for services
Reliability
Measures consistently when applied to different individuals, at different times and in different situations
- refers to the repeatability and consistency of a measure
Validity
The degree to which an instrument actually measures what it is intended to measure i.e. the FIM is a
valid measure of level of A and functional ability but not of quality of life
Widely Accepted
Instruments that have withstood substantial rigor in the scientific community and are endorsed for use
without being subject to question
Popular Measures Early After Injury
Glasgow Coma Scale (GCS) - scored 3-15, measures eye opening, verbal response, and motor response
Ranchos Los Amigos - scored 1-10, based on intent and appropriateness of responses and level of A.
Used to assess cognitive functioning of people with BI post coma
Early Measures
Abbreviated Injury Scale, Loss of Consciousness, JFK Coma Recovery Scale, Measure of PTA, GCS
Extended Scale
Acute Meaures
FIM, Functional Assessment Measure, Dsaibility Rating Scale, Level of Cognitive Functioning Scale
Popular Post-Acute Measure
Mayo-Portland Adatibility Inventory - measures physical, cognitive, social, behavioral, and emotional
defecits associated with BI
*can measure participation
Post Acute Measures
Craig Handicap Assessment and Reporting Technique - objective measure of community participation
Participation Assessment with Recommended Tools Objective - measures frequency of activity
engagement
* both can measure participation
Required Aspects of Outcome Tools
Must measure baseline and post intervention, should be reliable/valid/widely accepted
When choosing an outcome measure consider cost, expertise and training required to administer,
timing and common data elements
Common Data Elements
A data element that is common to multiple data sets across different studies
Sequentially vetted, standardized report forms that streamline data collection structure and material
development
Return to Work (RTW)
The gold standard of TBI rehab progress and outcomes
10-40% of TBI sustainees return to work, numbers are variable due to varying definitions of "full time
work"
Barriers to RTW
Older age, severe injury, minority race, lack of social support, decreased employment education prior to
injury, history of substance abuse, significant defecits
Rehab Act of 1973 and Vocational Rehabilitation
Provided federal grants to states to operate comprehensive programs of vocational rehab
State VR Services and Supports
Assessment, vocational counseling, guidance and referreal to needed services, rehab technology, on the
job training, job placement, and supported employment
4 Approaches to VR
Minimal intervention ->education/prep -> advocacy level services -> workplace supports
Supported Employment
Individualized support for persons with disabilities and long term barriers to work.a sustainable, paid job
in the open labor market
Vocational Case Coordinator
Follows individual on a long term basis to ensure success with employment. Provides support via
assessment, job development, on the job training and case management