traumatic brain injury and central tendencies marshall university cd 315 by: sara alvey
TRANSCRIPT
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Traumatic Brain Injuryand
Central Tendencies
Marshall University
CD 315
By: Sara Alvey
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What is a TBI?• Traumatic Brain Injury (TBI), may also be referred to as an
acquired brain injury or head injury (Centre for Neuro Skills, 2006).
• TBI occurs when the brain is damaged by a sudden blow to the head.
• Diffuse damage to the brain often occurs because the brain ricochets inside the skull during the impact.
• This diffuse damage causes general features, or central tendencies, to arise in most people who have TBIs.
• Brain damage following a traumatic brain injury is a result of the primary and secondary damage that occurs (Ferrand & Bloom, 1997).
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What is TBI?
• The initial impact is referred to as COUP.• The secondary impact after the brain is thrown
backward is called the CONTRACOUP (Ferrand & Bloom, 1997).
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What is TBI?
• PRIMARY DAMAGE- caused by the impact to the head, which can range from large brain lesions to microscopic brain lesions
• SECONDARY DAMAGE- caused by factors that include: – Infection
– Hypoxia (oxygen deprivation)
– Edema (swelling due to increased fluid around the brain)
– Elevated intracranial pressure (due to increased brain mass from excess fluid such as blood from hematoma, or cerebrospinal fluid within intracranial spaces.
– Infarction (death of brain tissue in a localized area)– Hematomas (localized areas of bleeding within the skull due to tearing of blood vessels (Centre
for Neuro Skills, 2006).
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Diffuse Axonal Injury
Stretching, shearing, and tearing of blood vessels and nerve fibers caused by rapid rotation of the brain in the skull resulting in widespread brain
dysfunction (Ferrand & Bloom, 1997)
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Classifications of TBI
• Closed head injury– In closed head injuries, the skull is not penetrated
and the three layers that cover the brain, or meninges, remain intact.
– Damage results from the inward compression of the skull at the point of impact and the subsequent rebound effects
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Classifications of TBI• Open head injury (Ferrand & Bloom, 1997)
– Open head injuries occur when the scalp or skull is penetrated.
– Damage results from the penetrating object along a localized path in the brain
– Common objects involved in open head injuries may include:• Bone fragments from skull fractures• Bullets• Shell fragments• Stones• Knives• Blunt instruments
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Causes
• Traumatic Brain Injury (TBI) have several causes including:– Motor vehicle accidents– Gun shot wounds – Falls– Sports related– Assault – Any trauma involving a blow to the head
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Central Tendencies
• Cognitive deficits
• Language deficits
• Speech and Swallowing deficits
• Emotional and Behavioral problems
• Sensory processing problems
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Cognitive Deficits
• Orientation- awareness of person, place, time and circumstance– Personal information learned before the
accident must only be retrieved, and not relearned
– Orientation after the accident requires the capability to store and recall new information.
– Orientation to circumstance returns first, followed by place and time.
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Cognitive Deficits• Attention
– This deficit may be mild or severe, and may go unnoticed.– The biggest problem for patients is concentration.– Types of attention include:
• Focused attention- ability to respond discretely to specific stimuli • Sustained attention- ability to maintain a consistent behavioral
response during continuous repetitive activities• Alternating attention- ability to shift the focus of attention and move
between tasks with different behavioral requirements.• Selective attention- ability to maintain a behavioral set in the
presence of distracting extraneous stimuli• Divided attention- the ability to respond simultaneously to multiple
task demands (Centre for Neuro Skills, 2006)
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Cognitive Deficits
• Memory– Encoding- coding of information to facilitate later recall
– Consolidation- integrating new memories with old ones
– “The most common cognitive impairment among severely head-injured patients is memory loss, characterized by some loss of specific memories and the partial inability to form or store new ones” (NINDS, 2002).
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Cognitive Deficits
• Problem-Solving and Reasoning– Considered to be aspects of high-level thought
processes– Problem-solving involves: strategy selection,
application of strategy for resolution of the problem, and evaluation of the outcome
– Deductive reasoning- drawing of conclusions based on premises or general principles in a step-by-step manner
– Inductive reasoning- involves the formulation of solutions given information that leads to, but may not support, a general solution
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Cognitive Deficits
• Executive Function– The frontal lobes are often damaged with a TBI. This
is the house for executive functioning.
– When executive functioning is impaired, all other cognitive systems may be effected.
– Executive functioning includes activities related to achievement/completion or a goal, goal formulation, planning, implementing, self-monitoring, and using feedback (Centre for Neuro Skills, 2006).
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Language Deficits
• Aphasia- is an impairment of language processes underlying receptive and expressive modalities caused by damage to areas of the brain that are primarily responsible for language function
• Non-fluent aphasia, or Broca’s aphasia, is a condition in which patients have trouble recalling words and speaking in complete sentences.
• Fluent aphasia, or Wernicke’s aphasia, is a condition in which patients display little meaning in their speech even though they speak in complete sentences.
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Language Deficits
• Pragmatics – Refers to a system of rules that structures the use of
language in terms of situational and social context
– Those with prefrontal injury demonstrate problems with pragmatics and may display disorganized discourse, inappropriate social interactions, and abstract forms of language (Ferrand & Bloom, 1997)
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Speech and Swallowing Deficits
• Dysarthria- is a speech disorder resulting from weakness or incoordination of the muscles that control respiration, phonation, resonation or articulation
• Speech is often slow and slurred.• Problems with intonation or
inflection may occur, which is known as prosodic dysfunction.
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Speech and Swallowing Deficits
• Dysphasia- a condition in which the action of swallowing is difficult or painful to perform
• Problems included: – Delayed triggering of the swallow response– Reduced tongue control– Reduced pharyngeal transit
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Emotional and Behavioral Problems
Personality changes and behavioral problems are often times the most difficult disabilities to handle for families.
Problems that may occur include: depression, apathy, anxiety, irritability, anger, paranoia, confusion, frustration, agitation, insomnia or other sleep problems, and mood swings.
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Emotional and Behavioral Problems
• Behavioral problems may include: – Aggression and
violence– Impulsivity– Disinhibition– Acting out– Noncompliance– Social
inappropriateness– Emotional outbursts
–Childish behavior–Impaired self-control–Impaired self-awareness–Inability to take responsibility –Egocentrism–Inappropriate sexual activity–Alcohol or drug abuse/addiction.
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Sensory-Processing Problems
• Difficulty with vision and recognizing objects can occur.
• Some may have problems with hand-eye coordination.
• May have problems with hearing, touch, smell and taste“Damage to the part of the brain that controls the sense of touch may cause a TBI patient to develop persistent skin tingling, itching, or pain (Centre for Neuro Skills, 2006).”
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References
Centre for Neuro Skills, TBI Resource Guide. (2006). Brain Injury. Retrieved October 30, 2006, from http://www.neuroskills.com
Ferrand, C. T., & Bloom, R. L. (1997). Introduction to organic and neurogenic disorders of communication: Current scope of practice. Needham Heights, MA: Allyn & Bacon.