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Neuro-TBI

Exam 2

QuestionAnswer
Traumatic Brain Injury mechanical trauma to the brain that occurs when the head strongly impacts an object or when an object strikes the head. Could also be caused by strong force shakes the brain
Coupe Injury if head hits something solid, the brain is often injured at the site of impact
contre-coup injury if the force of the initial impact is large enough, it may cause the brain to bounce against the opposite side of the skull
Coupe or contre-coup more severe? contre-coup
focal lesions specific region of brain tissue is injured by the force of impact (neurons, glial cells, and blood vessels)
diffuse axonal injury brain damage that is widespread and cannot be localized; caused by shearing and rotation of the brain within the skull
hypoxia decreased oxygen
anoxia lack of oxygen
How long can neurons survive without oxygen? 3 minutes
encephalopathy swelling and inflammation caused by an infection will damage cells producing ___
coma eyes are closed, pt is unaware of anything; can last up to 4 weeks
vegetative state eyes are open, pt can sleep or wake but is unaware of environment
minimally conscious state pt has some awareness of the environment and may be able to respond to simple questions or commands
neurogenesis growth of new neurons
Where can neurogenesis take place? hippocampus and olfactory epithelium
what are benefits of aerobic exercise? 1.improved blood supply to the brain 2.increased number of cells in the hippocampus and parts of the frontal and temporal lobes involved in memory and concentration. 3.more synapses among neurons
neuroplasticity the brains ability to reorganize itself based on experience; "adaptability" or "flexibility"
open brain injury results from direct trauma to the head by an object that penetrates the skull and brain; bullets and fragments
closed brain injury occurs when acceleration, deceleration, and rotational forces are applied to the head and cause brain tissue to shear or tear apart; falls
primary injury occurs at the time of the trauma and is caused by localized contusions often resulting in diffuse axonal injury
contusions bruising; often occur in the temporal and frontal lobes
secondary injury results from a series of chemical reactionsin the brain that occur immediately after injury , hours and days later, and can worsen the first injury
what are some examples of secondary effects intracranial hematomas, cerebral edema, raised intracranial pressure, hydrocephalus, intracranial infections and seizures
retrograde amnesia decreased ability to recall information occurring before brain injury
anterograde amnesia decreased ability to recall new information
decoticate posturing sustained contraction and posturing of both UE in flexion and the trunk and both LE in extension
decerebrate posturing sustained contraction and posturing of the truck and extremities in extension
Why is it important to prevent brain swelling? increases pressure that can prevent blood from flowing to your brain, which deprives it of the oxygen it needs to function.
consciousness The state of being awake and aware of one's surroundings
role of OT for pt in comatose state
persistent vegetative state A coma,is a profound or deep state of unconsciousness; is not brain-death; is alive but unable to move or respond to his or her environment
permanent vegetative state
role of OT for a pt in minimally conscious state
What is best predictor of functional outcome from TBI? high score on GCS
Range of scores on the GSC 3-15
What are the three behavioral areas assessed on the GCS? eyes, motor, verbal
Where is motor cortex located? in the frontal lobe
Where is sensory cortex located? in the parietal lobe
Where is auditory cortex located? in the temporal lobe
Where is the visual cortex located? in the occipital lobe
Where is the associative cortex? located on all lobes; link regions together
basil ganglia structures at the base of the cerebrum..regulates posture and muscle tone. Collections of cell bodies
cerebellum movement or coordnation
lesion area where there is injury; could be a scar or tumor
focal one specific place
brain stem pons, mid-brain,
limbic system emotional part of brain
apraxia impaired motor planning
dyspraxia without motor planning
perserveration "over and over"; asking and doing something repeatedly
two-point discrimination fine perception; 2 points
aphasia without language (expressive and receptive; they may be able to understand but not respond
cortical blindness nothing wrong with the eyeball but brain damage causes block; not being received in occipital lobe
global aphasia cannot understand or express communication
visual agonosia lack of recognition visually
multi-focal more than one place; several different spots
diffuse ripping axons; spreads all over; such as shaken baby syndrome
non-traumatic chemicals, drugs, diseases, genetic, AIDS, epilepsy, toxicity
decorticate rigidity UE's in spastic flexed position, LEs in spastic extended position, internally rotated and adducted
decerebrate rigidity UE's and LE's in spastic extension, adduction, and internal rotation
What is the best possible score on the GCS? 15
What is the worst score on GSC? 3
When is a pt assessed with the GSC? time of injury
What would be the corresponding level on the Ranchos scale for a pt with a GCS score of 3? level one
What would be the corresponding level on the Ranchos scale for a pt with a GCS score of 15? level eight
Level one Ranchos Scale no response to stimuli such as touch, music or speech
Level TWO Ranchos Scale responds to stimuli; generalized; may make a sound or open eyes after touch
Level three Ranchos Scale responds to stimuli;localized; example: squeeze or withdrawal hand
Level four Ranchos Scale agitated; confused; cursing, swinging, hitting. Needs behavioral modification
Level five Ranchos Scale inappropriate; confused; such as pouring milk in wrong place
Level six Ranchos Scale appropriate; confused; can do some when presented with task
Level seven Ranchos Scale appropriate; automatic; dressing and ADL's
Level eight Ranchos Scale appropriate; purposeful. Can plan and problem solve
voluntary motor control of contralateral side of the body frontal
sequencing of movement temporal
anticipatory postural adjustment parietal
oral movements needed to produce speech frontal
nonverbal communication frontal
executive functions frontal
processing of sensory information from the environment parietal
attachment of meaning to sensory information parietal
processing of somatosensory information parietal
auditory discrimination temporal
hearing and comprehension of spoken language temporal
long term memory temporal
visual perceptual processing occuipital
processing of primary visual information occipital
Which hemisphere is language associated with? left
Which hemisphere is perception associated with? right
What level of the Ranchos scale indicates that the patient is no longer agitated? No longer confused? Purposeful? level 8
Self awareness self directing and initiating; self-inhibiting; self monitoring; self evaluating and self correcting
Metacognition includes the ability to evaluate the level of difficulty of a task in relationship to strengths and weaknesses and the ability to predict success; to think about thinking
Flexible problem solving integration of several cognitive skills; active process that involves awareness/ analysis of problems. goal formulation; ABILITY TO PLAN STRATEGY; SEQUENCE STEPS; IMPLEMENT AND EXECUTE; evaulate outcome
abstract reasoning
planning and organizing determines needs, estimate degree of difficulty, relate to environments, identify alternatives, make choices, develop plan, select methods and materials
categorization involves multiple cortical pathways; perception and memory; involves chunking; classifying- be cautious of assumptions
decision making will involve more than one option
neuronal plasticity with repetition, physical changes occur in neuronal pathways- new pathways are created, old pathways are strengthened
cognition ability to think, plan, reflect and solve problems
What are the neurological areas of the brain responsible for executive functions frontal lobes, prefrontal cortex, limbic system (subcortical)
emergent awareness ability to recognize a problem when it is actually occuring
anticipatory awareness ability to recognize that a problem is going to happen
Impairment in executive function can be a __________________ of functional dependence post-discharge. predictor
Impairment in executive function can be a related to level of social and vocational ___________________. recovery
Impairment in executive function may result in __________________ efficiency of task performance. decreased
orientation ongoing attentiveness to situation; passage of time and situation
attention fluctuating process that directs focus to sensations/experience that are relevant and alerting. "zoned in"
0x1 oriented to person
0x2 oriented to person and place
0x3 oriented to person, place and time
0x4 oriented to person, place, time and situation
What are the 2 types of attention? generalized or focused
alerting response flucuating condition of the CNS. Prepares individual to attend
5 components of attention consciousness, awareness, arousal, affect and motivation
focused attention mind is free of competing thoughts; efforts to keep sensory channels open
sustained attention vigilance; maintaining attention over a period of time
selective attention ability to discriminate between multiple inputs and suppress non-relevant
alternating attention shifting; shifting back and forth between mental tasks
divided attention allocate "attention resources" while multi-tasking
concentration actively encoding in memory while attending; moving things to long term memory
memory the process, by which information is received, encoded and retrieved; perception which have been stored at an earlier time and can be brought forward into consciousness..involves permanent change
Are cognitive deficits always obvious? no
Executive dysfunction is related to the damage in the ___cortex and ____ prefontal cortex and limbic system
In order to form new memories, we need ?? sensory input, motor input
What are two primary treatment approaches OT practitioners use when working with an individual with cognitive dysfunction? remedial and adaptive
Sensory memory brief processing of large amounts of sensory information, esp. sight/sound
Working memory temporary storage and manipulation of information; can hold about 7 chunks of information such as social security number
Long-term memory new memories are integrated within individual's existing cognitive framework
Effectiveness of memory storage is influenced by type of _____ rehearsal
Maintenance strategy information is repeated, kept passively in the mind; such as rehearsing phone number over and over to make a phone call
Elaborative strategy information is related in a meaningful way to other information
Retrieval bringing stored memories into consciousness
implicit automatic; have been internalized, no conscious thought required; also known as procedural-includes motor, perceptual and cognitive
explicit facts, scenes from past; information that is recalled or recognized; also known as declaraive
What type of approach has been found to be helpful when working with a pt with severe unawareness? remediation
Which pt do you think is more likely to have a "better outcome" - one with intact cognition and motor dysfunction or one with cognitive dysfunction and intact motor skills? one with intact cognition and motor dysfunction
Prospective remembering to complete task or activity in the future
What does "compensation intervention" mean in reference to persons with executive dysfunction? makes pt aware of the perceptual problem and teaching the pt to take compensatory measures to improve performance
What is the capacity of working memory? Short term memory such as recalling a phone number
What factors influence an individual's ability to regain cognitive functioning after an injury?
thought function includes recognition, categorization, and being able to generalize ideas
higher level cognitive functions such as insight/judgement, awareness, concept formation, metacognition, and mental flexibility
remedial approach focuses on restoring cognition to it's former level(or as close as feasible)
adaptive approach focuses on adapting the task or environment to enhance occupational performance
transfer of training doing brain exercises to promote cognitive performance in task that require certain cognitive skills; the assumption is that the brain will reorganize itself and new learning will take place.
domain specific training task specific training, may be used for the pt who has global memory deficits; cannot transfer skills in a new environment
executive functions higher level cognitive functions include insight and judgement, awareness, concept formation, time management, organization, problem solving, and decision making
hemianopsia damage to the optic tract, or to primary visual cortex on one side of the brain; common after CVA
cortical blindness when the primary visual cortex is injured on both sides; cannot perceive anything even though their eyes and optic nerves are intact
Autopagnosia inability to recognize or correctly orient the parts of one’s own body
Color agnosia inability to recognize/identify colors by sight
Prosopagnosia inability to recognize faces of famous/familiar people
figure-ground discrimination ability to distinguish an object from its background
Spatial relations ability to understand and interpret relationship between self and others/objects.
Body scheme a mental representation of one’s own body or bodies of others
Ideational apraxia inability to comprehend concept of the required movement or to execute the act in response to command, or automatically. Person doesn’t know what to do.
Ideomotor apraxia inability to plan and perform a motor skill. Person understands but can’t translate into movement.
Constructional apraxia deficit in the ability to copy, draw, or construct a design, either 2 or 3 dimensional, whether on command or spontaneous.
Right-left discrimination distinguishing between L/R
Form Discrimination ability to group & differentiate various forms of the same type of item. Objects are recognized mainly by shape, although color, orientation, edge, & motion cues are also used.
______ & ___ lobe damage is associated with disturbances in form perception. Parietal & temporal
Depth perception the ability to recognize and understand differences in distances between objects. Perception of distance of 3-dimensional qualities of objects.
_____ and ____alignment are necessary for depth perception. Visual acuity and ocular
Figure-ground ability to distinguish an object from its background
Spatial relations – capacity to localize objects in relation to self
Topographical orientation – ability to follow familiar route or new route once it has become familiar. Components include: understanding “where I am,” “where do I want to go,” and “how do I get there.”
Visual object agnosia unable to recognize common everyday objects
Prosopagnosia unable to recognize faces of familiar people
Color agnosia unable to recognize colors
Metamorphosia unable to recognize distorted images
Simultagnosia unable to recognize more than 1 object at a time
Visual spatial agnosia unable to recognize spatial relationships, or perform simple constructional task under visual control
Topographagnosia inability to interpret/draw maps/plans
Tactile agnosia inability to recognize geometric shapes/familiar objects through touch, proprioception, and cognition w/o aid of vision. Loss of ability to identify objects through touch. May be related to difficulty w/ discrimination of materials, forms.
retina region at the back of the eyeball that contains photoreceptors (rods and cones)
photoreceptors rods and cones; sensory receptors located at the back of the retina
rods photoreceptors located in retina that provide white and black vision
optic nerve cranial nerve II; innervates visual receptors of the eye
cones sensory receptors for color vision
extraocular muscles muscles that move the eyeball
optic chiasm place where optic nerve crosses
primary visual cortex site of visual perception; located in occipital lobe
hemisnopsia loss of vision in the visual field
cortical blindness loss of vision caused by damage to primary visual cortex
auditory ossicles small bones in the middle ear that transmits vibration through middle ear cavity to the oval window
vestibulocochlear nerve cranial nerve VII; conveys sensation of hearing and balance to the brain
primary auditory cortex region in the temporal lobe for perception of hearing
otolithic organs utricle and saccule; contain sensory receptors for head movement
semicircular canals 3 small regions of the inner ear that detect rotaional head movement
vestibular nuclei small brainstem structures that receive input from the vestibular apparatus in the inner ear and connect the cerebellum, motor cortex and spinal cord
proprioceptors sensory receptors located in the muscles, tendons and joint capsules that detect body position and movement
olfactory receptors receptors for smell located in the top of the nose
olfactory tract (nerve) cranial nerve I; neurons that convey sense of smell to the brain
primary olfactory cortex region of temporal lobe for perception of smell
anosmia loss of sense of smell
Agnosia - disorders of recognition, specific to one sensory channel that affects the perceptual analysis of the stimulus OR the recognition of it's meaning.
myopia nearsighted
hyperopia far sighted
presbyopia farsightedness associated with age related changes of the lens
astigmatism inability to focus light due to irregular shape of cornea
cataracts corneal opacity
macular degeneration loss of central vision
glaucoma increased intraocular pressure affects optic nerve loss of peripheral vision
diabetic retinopathy retinal damage from blood leakage
diplopia double vision
dysmetric eye movements undershoots or overshoots a target
visual cognition ability to mentally manipulate visual information and integrate it to solve problems, formulate plans and make decisions. Bases/foundation on academic activities
visual memory The ability to remember the forms of letters and other written symbols, which then feeds into the ability to remember sight words and the spelling pattern of irregular words based on the way they appear on the page.
pattern recognition identify important features of objects and environments, distinguish objects from each other and their surrounding area
scanning shifting attention from one visual target to another in smooth succession
visual functions acuity, oculomotor control and visual fields
visual attention
What are three environmental modifications that would help a client with a severe deficit in visual acuity brush her teeth?
What techniques could help a client with age-related macular degeneration to play cards?How would you expect his performance to differ from a client with advanced glaucoma?
Describe the scanning patterns used to train clients with right-sided brain injury to compensate for left inattention.
What strategies might you teach to an individual with new and severe vision loss of both eyes to shop for groceries?
Created by: kcjesusaves