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Neuro-TBI
Exam 2
| Question | Answer |
|---|---|
| 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
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