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41 Cards in this Set

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What are the secondary FX following head injury due to blood (3) and brain (1)?
1. Hematoma: (blood flows and creates pressure on the brain)
2. Edema: swelling around damage tissue, results in a loss of consciousness
(3. ANOXIA?)
3. Increase ICP: (intracranial pressure) usually cause of death
H, E, ICP
Factors influencing the recovery of the patient following a head injury
1. time in coma
2. initial presentation after coma
3. recovery speed
4. premorbid ability
5. history of head trauma
6. social support - psychological factors
T, I, R, P, H, S
3 types of cognitive impairment in individuals with AIDS Dementia Complex
1. Impaired concentration
2. Memory Loss
3. Mental Slowing
I, M, M
3 types of motor problems in individuals with AIDS Dementia Complex
1. Unsteady gait
2. Leg Weakness
3. Postural Tremor
4. Decreased Coordination
U, L, P, D
4 tests used in a screen battery for ADC
1. finger tapping
2. verbal fluency
3. trails a/b
4. digit symbol
F, V, T, DS
DIFF BTWN OPEN AND CLOSED Head Injury
1. open-skull has been penatrated, dmg usually more focal, more likely to have seizures, high percent return to work, prognosis high
2. closed-static or high velocity, shearing effect of neurons, brain is rotated (results in loss of consciousness)
2 factors re: assessment of children with a head injury which would
1) influence choice of tests and 2) ability to interpret results
1. Developmental approach to assessment
2. Knowledge of developmental milestones
3. child's premorbid level of functioning
***Developmental appropriateness? Periodically re-evaluate them b/c they are growing
2 common diagnostic categories which tend to be correlated with child TBI. How do you determine how much of the disorders were premorbid vs. a result of recent brain injury?
1. ADHD and LD
2. ADHD, hard to tell premorbid. LD, examine child's reading level (if significantly below)
What 2 areas of the brain are the most affected by a head injury? Why? How does impairment affect initial recovery, work, or school reentry and personal relationships?
1. Frontal and Temporal, b/c these parts have more bony ridges so they get more damaged
2. Frontal ppl are initially confused, agitated, assaultive, more difficulty entering work force, or re-enter at a lower level. Also, diff. w/ judgement, low frustration tolerance, egocentric judgement, impulsivity.
4 general cognitive effects which are consistent with a diffuse head injury
1. slow thinking/reaction time
2. poor on concentration tests
3. distractable
4. fatigue easily
S, P, D, F
Why is Rancho Level III important in TBI recovery?
means they are coming out of their coma/ recovering/rehab potential
5 reasons children are more likely to be head injured?
1. more active
2. near drowning
3. Meningitis/Encephalitis
4. Car Accident
5. Child Abuse, shaken baby syndrome
A, D, M/E, C, C
3 main areas of cognitive dysfunction in persons with alcoholism?
1. Learning and memory-failure to use good strategies to encode, unable to retrieve
2. Abstract reasoning- problem concept formulation, use ineffective strategy, shift before testing adequately, persist with ineffective set
3. Perceptual organization-problem due to visuoperception-(DS) not learning new associations between symbols
5 factors which affect degree of cognitive impairment in people with alcohol problems
* Age
* Drinking hx
* Use of other drugs
* Education
* Background

Older, less educated and less intelligent more impairment
* SES
* Race
* Sex
How would a person with alcoholism appear on the WAIS in terms of effect on IQ, verbal and performance subtests? Which subtests appear to be most affected?
Block Design, Digit Symbol and Object Assembly decrease
Name 3 Halstead-Reitan tests which people with alcoholism show impairment on
Categories Test. Trails B, TPT (time and location), Speech Sounds Perception
What are the important factors in discriminating between delirium and dementia?
1. Delirium- transient or fluctuating, dev rapily
2. Dementia- cog. loss more permanent, gradual onset, stable or progressive
Name 4 factors which may cause delirium
* Overmedication
* Increase in Medical Problems
* Change in Living Situation
* See DSM-IV under Delirium
O, M, C, DSM-IV
When can you diagnose dementia?
* Clinical evaluations-MSE, interviews with family
* Neurodiagnostic procedures
* Neuropsychological assessment


When they have a memory problem +
apraxia
aphasia
exec functioning
agnosia
Why is it important to diagnose delirium?
1. Person could die
2. To prevent dementia
Name and describe 3 types of obstructive strokes.
* Arteriosclerotic plagues-build-up of fat deposits on walls
* Thrombus-growth of blood particles and tissues (gradual) on arteriosclerotic plagues
* Embolus-thrombic or other matter suddenly plug up artery
Discuss TIAs in terms of length, symtoms (cog. affects), cause and why individuals should be concerned?
Transient Ischemic Attacks

* Temporary obstruction of brain-less than 24 hours
* Same pattern of representation
* Associated with arteriosclerotic disease-typically thrombolic emboli that quickly passes
* May have several that lead to stroke
* Mild neuropsych problems-slowing, delayed recall
How does a hemorrhagic stroke generally develop? What areas of the brain does it usually occur in and how does this affect the individual functionally?
* Aneurysm-weak blood vessel wall balloons out
* Damage may be more widespread
* Associated with hypertension
* Usually subcortical (thalamus, basal ganglia, brain stem)
Name 5 risk factors for a CVA
* heart disease
* diabetes
* blood conditions affecting viscosity or clotting
* weight
* HBP
* smoking
* arteriosclerotic build-up
* Women-less effects Left-handers-less effects
Compare left versus right strokes in terms of the following areas: motor, cog. deficits, behavioral style, memory deficits.
Left sided effects

* Motor-paralyzed right side
* Cognitive-speech language deficits (aphasia)
* Behavioral style-slow cautious
* Memory deficits-language
Right brain damage

* Motor-paralyzed left side
* Cognitive-spatial-perceptual deficits
* Sensory-left-sided neglect
* Memory-nonverbal material
* Behavioral style-quick, impulsive overestimates abilities

Emotional lability-crying for no reason
What types of strategies would be useful in working with somone with a left CVA (5)?
1. Do not underestimate the patients ability to learn and communicate even if he cannot use speech
2. If he cannot use speech, Use pictures, pantomine, sketch
3. Do not overestimate his understanding of speech and overload him with "static"
* Speak in short phrases
4.Do not speak loudly or in unusual voice
5. Positive feedback
Describe Alzheimer's
* Neuritic plaques and neurofibrillary tangles, atrophy
* Neuronal loss in hippocampal area (disconnects from other areas)
* Plaques and tangles in cortex (temporal, parietal and frontal)
* Low in motor, sensory and cerebellar area
* 90% decrease in acetyocholine
Describe a multi-infact dementia
dementia caused by multiple strokes, decreases every time
Describe Parkinson's
Definition-movement disorders with cognitive and emotional problems, can lead to dementia

* Difficulty in initiating movement
* Slowness in movement
* Resting tremor
* Rigidity and postural changes
* Shuffling gait
* Ocular disturbance
* Autonomic disturbance
How do you make an English=developed neuropsychological test culture-fair?
Back Translation.
Describe 5 ways to assist elderly people with depression
1. Allow clt. to talk about feelings
2. encourage getting out of bed and following regular routine
3. engaged in mild exercise as allowed by doctor
4. involve in activities
5. assist in improving sense of control and problem-solving to resolve situations
Describe 6 ways to be more successful with a senior citizen in terms of behavior.
1. establish rapport
2. convey respect
3. convey sense of control
4. express self in calm, happy manner
5. use humor.
6. avoid arguing- try to compromise.
R, R, S, E, H, A
Describe the FX of normal aging in the area of learning and memory.
1. sensory memor (visual image, echo): require longer exposure
2. primary memory (rehearsal): stable
3. Secondary Memory (learning): decreased, problems with encoding and retrieving
4. Tertiary memory (remote): variable
Describe the FX of normal aging in the area of Problem-solving and executive functioning
1. statement of ability: increased
2. concept identification and logical analysis: decreases
3. Inquiry: decreases
4. Everyday problems: variable (may improve with some problems)
Name 4 variables (non-physiological) which may affect neuropsychological testing
1. culture
2. language
3. Education
4. age
Why would it be important to consider the individual's Latino background on neuropsychological testing?
1. no normative data, no cross-translations
2. Phonological and grammatical concerns
3 considerations in using a translator
1. he should not be a family member
2. many concepts and words not common to a nonpsychologist translator
3. tests cannot simply be translated (many phonological and cultural variables)
Strategies in working with a right CVA?
1. Don't overestimate abilties (spatial-perceptual deficits easy to miss)
2. use verbal cues if he has difficulty with demonstration
3. break tasks into small steps, give much feedback
4. watch to see what he can do safely rather than take his word
5. minimize clutter around him
6. avoid rapid movements around the patient
7. highlight visual reference points
What are some strategies you can use to help someone with one-sided neglect?
1. keep the unimpaired side toward the action unless specifically working with neglected side
2. avoid trapping the patient in an unnecessarily confined environment
3. avoid nagging but give frequent cues to aid orientation
4. Provide reminders of the neglected side.
5. arrange the environment to maximize performance.
Describe TBI deficit in
1. motor
2. perceptual
3. speech and language
4. cognitive
5. personality
1. motor: may exp. paralysis, poor blaance, ataxia, spasticity
2. perceptual: tactile defensiveness, visual field deficit, unilateral neglect, double vision
3. speech and language: difficult understand what is said (aphasia), anomia, dysarthria (diff. pronouncing words)
4. cognitive-disorientation, attention deficits, concentration deficits, memory deficits, poor judgement, perseveration
5. personality: apathy, emotional lability, disinhibition, low frustration tolerance.
Describe role of:
1. Phys. therapist
2. occupational therapist
3. speech therapist
4. educational/vocational specialist
1. Phys. therapist- return patient to highest level of motor functioning possible
2. occupational therapist-focuses on the physical, cognitive and percetual disabilites which influence the pt.s ability to perform functional tasks, fine motor skills,
3. speech therapist-evaluates motor-speech skills, language, reading and writing skills
4. educational/vocational specialist- reintegration into education/work, re-education to academic skills via IEP, or for adult, functional skills such as balancing a checkbook, etc.