5070 Unit 2

Traumatic Brain Injury (TBI)

Acquired brain injury caused by an external force

1. penetrating head injury (gunshot, piercing skull)

2. Closed head Injury (blow to the head that doesn't fracture the skull)

Acquired Brain Injury (ABI)

An insult to the brain caused by one or more:

- TBI (motorcycle vehicle accidents, sport, ect.)

- Infection (meningitis)

- Anoxia/hypoxia (oxygen deprivation)

- Cerebral Vascular Accidents (stroke)

- Tumor

- Toxic/ metabolic exposure (substance abuse)

- Seizures

Does NOT include degenerative diseases (dementia)

Caused AFTER birth

Incidence

- rate of newly diagnosed cases of a particular condition

- number of new cases occurring within a period of time

- 2.8 million sustain a TBI every year

Prevalencce

actual number of cases alive within a disease during a particular time

- 5.3 individuals in the US live with a permanent brain injury related disabilities

Sports Related Brain Injury

- 71% sports related injury TBI were males 10-19

- highest injuries in football and girls soccer

- males get TBI 1.5x more than girls

Brain Injuries in Prison

25% to 87% of inmates report experiencing a TBI compared to non-inmates at 8.5%

Prevalence of Debilitating Conditions

1. Depression

2. ABI

3. TBI

TBI Facts

- adults 75+ have the highest rate of TBI hospitalization and death

- homeless 2-4x more likely to have a TBI and 10x more likely to have a moderate/severe TBI

- falls are the leading cause for TBI for 0-4 years old and 75+

Social Impact of TBI

- significant number of persons with moderate/ severe TBI secondary to frontal-parietal lobe injury develop behavior disorders that interfere with

- social success

- physical success

- occupational success

- all individuals with 3 week or more post traumatic amnesia develop permanent mental handicap

- re-marriage rate is 8% for those with TBI

Primary Injury (TBI)

Injury that occurs at the time of the trauma

- diffuse axonal shearing

- contusion

- abrasions

- coup

- contrecoup

Secondary Injury (TBI)

- brain swelling

- hematomas

- increased intracranial pressure

- hypovolemic shock

- anoxia

- seizure disorder

- hydrocephalus

Frontal Lobe Injury

- cause change in personality/ social skills

- cause disturbances in cognition and memory

- impaired ability to know when to suppress a drive in favor of a more socially appropriate behavior

- perseverations, rigid behavior, difficulty changing sets despite consequences

- failure to put breaks on limbic system (fight/flight)

- difficulty delaying gratification (waiting)

- reduced problem solving skills (decision making and safety awareness)

Occipital Lobe Injury

range from change in vision to blindess

Temporal Lobe Injury

rapid acceleration or deceleration can cause abrasions due to brain smashing to the bony ridges

Parietal Lobe Injury

- results in language or speech difficulties and sensory neglect or motor problems

- responsible for reception and processing of sensory stimuli

- body awareness

- construction of a mental map to represent the environment

Damage to left Parietal lobe

- right-left confusion

- difficulty writing

- difficulty with mathematics

- disorders of language

- inability to perceive object normally

Acute- Early Stage (TBI)

- agitation

- regression

- disorganized behavior

- impaired info processing

Middle Stage (TBI)

- intolerance to stimulation

- denial or underestimate of deficits

Final Stage (TBI)

- increase in awareness of impairment

- acceptance

- depression

- anxiety

- anger

- risk-taking behavior

Long Term Effects of TBI

- attentional deficits

- over-activity

- aggression

- impulsivity

- tantrums

- listlessness

- socially disinhibited behavior

Pediatric Neurobehavioral Sequelae

- obliteration of previously learned skills

- reduction in efficiency of skill performance

- change in child development trajectory

- deficits may not appear until a much later stage of development

Kennard Doctrine

- surplus of brain cells in first 2 years of life implies damage a that time might be less harmful due to ample time to re-grow last connection

- young brain plasticity might result in spearing of a function otherwise lost to an older person

- suggests a critical period when change must happen or the chance is lost forever

3 Patterns in Recovering in Children

1. Initial impairment following injury with a progressive pattern of recovery over time

2. Impairment of behavioral abilities with persistent impairment as the child grows up

3. No discernable impairments following initial brain injury; behavioral deficits appear as child grows

Fluency Training

- combination of accuracy and speed ensures client performs easily despite distractions

- SAFMEDS

Composite Skills

big 6+6

big 6:

- point

- reach

- touch

- grasp

- place

- release

+6

- pull

- shake

- squeeze

- tap

- twist

Fluency

ability to respond correctly to specific stimuli with little to no hesitation and at standardized rates within a given amount of time

- increase REAPS and resistance to distractions (retention, endurance, application, performance)

SAFMEDS

- say all fast minute each day shuffled

- set the goal as one better than the previous day

Disinhibition

- loss or reduction of an inhibition

- lack of inhibitory control (impulsivity)

Hypersexuality (TBI)

- rare but well-recognized condition following brain injury

- secondary to dysfunction in hypothalamus, the temporal and frontal lobes

- present a sanger to the person and others (legal)

behaviors include

- explicit verbalizations

- non-consensual touch/grope

- high frequency maturation

- over selectivity in intimate apparel

- arousal from mild content

Decision making

making a decision between 2 or more alternatives, calculate the value of one alternative compared to the other

factors that effect:

- delay until outcome

- value of outcome

- probability of receiving outcome

Self Control

- delay of reinforcer affects the value of the reinforcer (delay of gratification)

- people who choose the larger, more delayed reward

Discounting

- preference for small sooner than larger later

- belief that promised, delayed reward may never be delivered (devaluation of reward)

- embodies response suppression

Randomized Control Trials (RCT)

- each participant is randomly assigned to the treatment or the non-treatment group

- for TBI research it may inhibit the detection of meaningful changes

Single-Case Design

- uses a form of experiential reasoning called baseline logic

- demonstrates effectiveness of the IV on the behavior of individual subjects

Dementia

- technically called neurocognitive disorder

- decreased mental function due to medical disease or illness other than psychiatric illness or developmental or intellectual disability

- decline (acquired) in cognitive functioning

Geriatrics

- diagnoses and treatment

- branch of internal medicine

- prevent, treat diseases and disabilities

- medical aspects of aging

Gerontology

- focuses on biopsychosocial models of care

- studies age and the process of aging

- reviews impacts of biology, psychology and sociology factors on older adults

- BCBAs practice in this

Six Common types of Dementia

- Lewy body disease

- Vascular

- Alzheimer's

- Parkinson's

- Frontotemporal lobar degeneration

- Substance, medical use

Alzheimer's Disease

- amyloid plaques in spaces of brain cells

- cells cannot send messages and pathways die off

Vascular Disease

caused by problems in the supply of blood to the brain cells due to conditions like:

- coronary heart disease

- high blood pressure

- high cholesterol

- diabetes

- brain bleed

- stroke

- peripheral artery disease

progression of decline like a staircase

Mixed Dementia

combination of 2 or more types of dementia

- mixed progression of decline

Risk for Dementia

- starts around 4% at the age of 65

- every 5 years, the risk doubles

- risk starts earlier for: down syndrome (40) and profound intellectual or developmental disabilities

Primary Risk Factors (Dementia)

- age

- brain trauma

- family history

- down syndrome

Secondary Risk Factors (Dementia)

- social economic status

- education

- high cholesterol

- blood pressure

- diabetes

- smoking

- alcohol/drug

= poor sleep

- sedentary behavior

Loss of Instrumental Activities of Daily Living

IADLs

- pre-diagnosed dementia symptoms

- mild cognitive impairment

- driving

- manage finance

- grocery shopping

- medication management

- housekeeping

- telephone

Loss of Activities of Daily Living

ADL

- moderate cognitive impairment

- severe cognitive impairment

- late stage dementia

- dressing

- bathing/grooming

- bathroom

- feeding/eating

- ambulation

- transferring

Signs (Dementia)

objective

- rash/ irregular gait

Symptoms (Dementia)

subjective

- hallucination and symptoms

Dementia Signs and Symptoms

- memory loss

- impaired judgement

- loss of communication

- disorientation to time/place

- gait, moto, balance issues

- inappropriate/ challenging behavior

- neglect personal care/safety

Delirium

- sudden onset

- severe confusion

- dramatic changes in behavior

- temporary and reversible when treated

D iet

E lectrolyte

L ung, liver, kidney or heart failure

I nfections, UTI

R x prescription medication

I njury, pain, stress

U nfamiliar environment

M edical procedures

Cognitive Screenings

- generally these are questionnaires that are quick to complete

- test orientation, registration, attention, calculation, recall and language

Neuro-cognitive Testing

- completed by a licensed clinical psychologist/ neurologist

- 2-4 hour duration

- language, IADL, ADL assessments, behavior screening

Brain Imaging

- CT scan

- fMRI

- PitB

- Lumipulse

ID/DD Screening Tools (Dementia)

ABDQ: Adaptive behavior dementia questionnaire

- ask questions on how the person is acting now compared to many years ago

- compare skills now to skills before

National Task Group

- early detection for dementia

- compare a persons current skills to what they could do before

Dementia Interdisciplinary Team

- group of healthcare professionals treating patients condition

- primary care physician

- geriatrician

- neurologist, movement disorder specialist

- geriatric psychiatrist

- in home services

- senior living

- attorney

Target behaviors in crease (dementia)

- nutrition

- water intake

- socialization

- cognitive simulation

- movement

- decluttered environment

Dimensions of Wellness

- emotional

- occupational

- intellectual

- environment

- spiritual

- physical

- social

- financial

Challenging behavior in Dementia

- agitation

- aggression

- vocal disruption

- wandering

- uncooperative

- apathy

Basic Treatment Components (Dementia)

- quality of life and daily living skills

- increase activity engagement

- increase independence to decrease behaviors

- caregiver training

Behavior Assessment (Dementia)

1. pre assessment consent

2. select target behavior

3. measure target behavior

4. medical assessment

5. informal assessment (ask caregivers)

6. observation

7. preference assessment

8. other dementia assessment

9. plan and recommend

Functions of behavior

- sensory

- escape

- attention

- tangible reinforcers

Focuses of ABA services

children services: adult living skills

adult services: independent living skills

senior services: quality of life, manage decline process, plan what aging will look like

End of life options

Neurotypical:

- many options

- family home

- nursing home

- retirement community

ID/DD

- fewer choices

- nursing home or keep in current location

- best for you to keep a senior in living community

Hospice Care

- focuses on relief of terminally ill patients pain and symptoms

- attends to emotional and spiritual end of life needs

- prioritizes comfort and quality of life

- respite care

- medication

- home medical equipment

- continuous care

- routine home care

- inpatient care

4 areas of Gerontology

- research

- education

- clinical practice

- community collaboration

Elements of TBI in ABA

- optimizing treatment time

- facial recognition and fluency training

- discounting