Acquired Cognitive Communicative Impairments: Traumatic Brain Injury

Flashcards about Acquired Cognitive Communicative Impairments related to Traumatic Brain Injury (TBI).

What is a Traumatic Brain Injury (TBI)?

Caused by a blow to the head or a penetrating head injury with varying severity.

What is the scope of the TBI problem in the U.S.?

At least 5.3 million Americans have long-term or lifelong needs, and about 40% of those hospitalized with TBI have unmet needs.

What are the leading causes of TBI?

Falls, motor vehicle-traffic crashes, struck by/against events, assaults, and firearm use.

What are the estimated financial costs of TBI in the United States?

Estimated direct and indirect costs totaled $40.6 billion in the United States in 2016.

What functional changes can TBI cause?

Changes in cognition, sensation, language, and emotion.

What is the International Classification of Functioning, Disability and Health (ICF)?

Provides a framework for describing an individual’s health in relation to what they can do in a standard and actual environment.

What is Primary Neuropathology in TBI?

Brain injury caused directly by the initial impact or injury event.

What is Secondary Neuropathology in TBI?

Brain injury resulting from pathological processes that are triggered by the primary damage, exacerbating the initial injury.

What is an example of Focal Injuries?

Cerebral Contusions (bruises on the brain), often caused by acceleration-deceleration forces.

What parts of the brain are most susceptible to contusions and why?

orbitofrontal and ventromedial prefrontal structures, anterior and inferior temporal structures, medial temporal lobe (limbic) structures

What is a Blast Injury?

Result of a blast over-pressurization wave, or complex pressure wave of an explosion causing a rise in atmosphere pressure.

What are unique clinical considerations for concussion in the military?

Military are at greater risk of TBI than civilians and may have sustained a TBI prior to military service.

What is Diffuse Axonal Injury (DAI)?

In severe cases, it involves tearing of white matter/neuronal axons; in milder cases, disruptions in the cell membrane of the axon.

What does DAI include?

Axonal damage, rupture of capillaries/small hemorrhages, breakdown of the blood brain barrier, and surges of excitatory Neurotransmitters.

What are examples of Secondary Pathological Changes?

Cerebral Edema (accumulation of fluids), or Hemorrhage (bleeding in the brain).

What is Cerebral Edema?

Accumulation of fluids in meninges, ventricles, or brain tissues and causes increases in intracranial pressure.

What causes Hemorrhage?

Blood vessels break due to rotational forces, contusions, etc. causing bleeding in the brain

What is Hypoxia and Hypotension

Hypoxia (brain is deprived of oxygen) and Hypotension (Inadequate cerebral perfusion).

How can Seizures affect TBI?

Early onset (1 week) - common; Late onset (> 1 week) - associated with epilepsy.

What is the difference between primary and secondary injury?

Primary injury is caused directly by the injury, while secondary injury is caused by the processes that take place after the injury in response.

Name two possible consequences of an increase in intracranial pressure.

Loss of consciousness, impaired respiration, and impaired cardiac function.

What is the difference between subdural and epidural hematoma?

Subdural hematoma is bleeding between the brain and the dura mater, while epidural hematoma is bleeding outside the dura mater.

How do children with TBI differ?

More susceptible to severe TBI due to pliable skull, weak cervical musculature, and incomplete myelination; emergence of new deficits as they mature.

What is the Kennard Principle

Children’s brains are more plastic than adult brains so other areas can compensate but may not be as many preserved areas to compensate in diffuse damage

What are other types of Acquired Brain Injury?

Infectious Disorders (Viral or Bacterial) and Brain Tumors.

How is mTBI Diagnosis determined?

Diagnosis is based on the initial neurological signs and symptoms at the time of the event.

What are concussion phenotypes?

Cognitive, Headache/Migraine, Ocular-Motor, Vestibular and Anxiety Mood.

What are Cognitive Phenotypes?

Concentration and attention problems, processing speed, memory and learning, executive function, social cognition and social communication

What are Physical Phenotypes for mTBI?

Headache/Migraine, Ocular-Motor, Balance problems, Vision changes, Light sensitivity

What are the functional difficulties for concentration and attention deficits?

Problems maintaining attention and train of thought, and focusing with verbal and visual attention.

What is the impact of Processing Speed

Slow information processing, evident on timed tasks and verbal fluency measures.

How is memory impacted for mTBI?

Working memory (verbal and visual) affects language comprehension, and episodic memory impacts quality of life.

What are the Executive Function deficits for mTBI?

Initiation, planning/organization, task monitoring, emotional regulation, and decision making.

What are Cognitive Communication Deficits?

Word finding problems, impairments in speech-in-noise, decreased content units, mazing, abandoned utterances, vague language, and irrelevant/tangential content.

Written language concerns

Run-on sentences, fragments, grammatical errors, semantic errors, and agreement errors.

How does mTBI affect Reading?

Decreased reading comprehension, reduced oral reading fluency, challenges with paraphrasing, and decreased processing speed.

What are the gaps in Research in Effects of Multiple mTBIs?

Unknowns about genetic factors, the contribution of age, gender, stress, alcohol and substance abuse.

What are the variables Affecting Recovery

Injury variables, premorbid characteristics, environmental influences, and reaction to injury.

What Pre-Morbid Characteristics affect TBI

Age, intelligence & education level, premorbid or current substance abuse, motivation, and personality

How does Social & Environmental Influences affect TBI recovery?

Culture, family support, stage of life.

How can an individuals Reaction to Injury affect TBI recovery?

Coping abilities and depression.

How does Time affect TBI recovery?

Most rapid recovery in first 6 months, but individual needs vary.