Traumatic Brain Injury: Rehabilitative Treatment and Case Management, Second Edition

Front cover......Page 1
Preface......Page 6
Acknowledgment......Page 8
Contributors......Page 10
Contents......Page 14
Medical Themes......Page 17
The Neurologic Examination of the Patient with Traumatic Brain Injury......Page 19
Introduction......Page 20
Evaluation of the Traumatic Brain Injury Patient in the Postacute Setting......Page 21
Examination of Mental Status......Page 22
Attention and Concentration......Page 23
Speech and Language......Page 24
Affect, Mood, and Behavior......Page 26
Cranial Nerve II......Page 27
Cranial Nerves III, IV, and VI......Page 28
Cranial Nerve VIII......Page 29
Muscle Bulk......Page 30
Muscle Tone......Page 31
Abnormal Movements......Page 32
Sensory Examination......Page 33
Coordination......Page 34
Posture and Gait......Page 35
Hydrocephalus......Page 36
Depression......Page 37
References......Page 38
Introduction......Page 43
Evaluation of Episodic Behavioral Changes......Page 44
Clinical Evaluation of Seizures......Page 45
Etiologic Considerations......Page 47
Diagnostic Investigations of Posttraumatic Seizures......Page 48
Potential Epileptogenesis Associated with Psychotropic Medications......Page 50
Therapy for Posttraumatic Epilepsy......Page 51
Mechanisms and Models of Posttraumatic Epilepsy......Page 55
Posttraumatic Seizures, Epilepsy, and Anticonvulsant Prophylaxis: Implications for Neurobehavioral Recovery......Page 58
References......Page 63
Neurotransmitters and Pharmacology......Page 73
Editor’s Note......Page 74
Introduction......Page 75
Chemical Neurotransmission......Page 76
Sites Where Drugs Act......Page 78
Synthesis, Storage, Release, and Inactivation of ACh......Page 79
Nicotinic Receptors......Page 82
Muscarinic Receptors......Page 83
Facilitators of Cholinergic Neurotransmission......Page 84
Inhibitors of Cholinergic Neurotransmission......Page 85
Norepinephrine......Page 86
Synthesis, Storage, Release, and Inactivation of NE......Page 87
Norepinephrine Receptors......Page 90
Facilitators of Noradrenergic Neurotransmission......Page 92
Inhibitors of Noradrenergic Neurotransmission......Page 93
Noradrenergic Drugs in the TBI Patient......Page 94
Synthesis, Storage, Release, and Inactivation of Dopamine......Page 95
Dopamine Receptors......Page 96
Facilitators of Dopaminergic Neurotransmission......Page 97
Inhibitors of Dopaminergic Neurotransmission......Page 98
Dopaminergic Drugs in the TBI Patient......Page 99
Synthesis, Storage, Release, and Inactivation of Serotonin......Page 100
Facilitators of Serotonergic Neurotransmission......Page 102
Inhibitors of Serotonergic Neurotransmission......Page 103
Gamma Aminobutyric Acid (GABA)......Page 104
Synthesis, Storage, Release, and Inactivation of GABA......Page 105
GABA Receptors......Page 107
Facilitators of GABAergic Neurotransmission......Page 108
GABAergic Drugs in the TBI Patient......Page 109
Synthesis, Storage, Release, and Inactivation of Glycine......Page 110
Glycine Receptors......Page 111
l-Glutamic Acid......Page 112
Synthesis, Storage, Release, and Inactivation of Glutamate......Page 113
Excitatory Amino Acid Neurotransmitter Receptors......Page 114
Glutamatergic Drugs in the TBI Patient......Page 116
Peptide Neurotransmitters......Page 117
Synthesis, Storage, Release, and Inactivation of Opioid Peptides......Page 118
Opioid Receptors......Page 119
Drugs That Enhance Opioideragic Neurotransmission......Page 120
Summary......Page 121
References......Page 122
Appendix 3A Summary of Relationship between Therapeutically Used Drugs and Various Neurotransmitters......Page 129
Heterotopic Ossification......Page 135
Prevalence and Onset......Page 136
Radionuclide Bone Imaging......Page 137
Bone Markers......Page 138
Hip......Page 139
Knee......Page 140
Natural History......Page 141
Treatment......Page 143
Ethylhydroxybisphosphonate (Ethidronate Disodium)......Page 145
Forceful Manipulation......Page 146
References......Page 147
Rehabilitation for Posttraumatic Vestibular Dysfunction......Page 151
Demographics......Page 152
Anatomy and Physiology of the Vestibular System......Page 154
Vestibular End Organ......Page 155
The Central Vestibular System......Page 159
Temporal Bone Fracture......Page 160
Perilymphatic Fistulas......Page 161
Posttraumatic Ménière’s Syndrome......Page 162
Benign Paroxysmal Positional Vertigo......Page 163
Posttraumatic Vascular Loop......Page 165
Central Vertigo......Page 166
Patient’s History......Page 167
Physical Examination......Page 168
Balance......Page 169
Clinical Vestibular Testing......Page 170
Auditory Testing......Page 173
The Electronystagmogram......Page 174
Computed Sinusoidal Harmonic Acceleration......Page 179
Symmetry......Page 181
Dynamic Platform Posturography......Page 183
Sensory Organization Testing......Page 184
Vestibular Rehabilitation......Page 187
Balance Retraining......Page 190
Cardiorespiratory Endurance Training or Conditioning......Page 192
References......Page 194
Introduction......Page 199
Retina......Page 200
Optic Tract Organization and Lesion Characteristics......Page 201
Oculomotor and Brainstem Organization......Page 203
Frontal Eye Fields......Page 207
Pupillary Responses......Page 208
Visual Fields......Page 209
Examination......Page 210
Ocular Examination......Page 211
Extraocular Motility: Peripheral and Central Dysfunction......Page 213
Nystagmus......Page 216
Learning and Therapy......Page 219
Summary......Page 222
References......Page 223
Rehabilitation and Management of Visual Dysfunction Following Traumatic Brain Injury......Page 225
Physical Substrates of Vision......Page 226
The Multidisciplinary Approach......Page 227
Prevalence and Impact of Visual Dysfunction in TBI Patients......Page 228
Remediation of Ocular-Motor and Binocular Disorders Following TBI......Page 230
When to Treat......Page 231
A Useful Model for Organizing Visual Rehabilitation......Page 232
Perception/Integration......Page 234
Eye Movements......Page 236
Binocular Dysfunction......Page 240
Decreased Visual Acuity......Page 243
Visual Field Loss......Page 244
Localization and Spatial Vision......Page 246
Unilateral Spatial Neglect......Page 248
Object Perception......Page 250
Assessment and Rehabilitation of Motor Output/Behavior......Page 252
The Hands......Page 253
The Body......Page 254
Assessment and Rehabilitation of Visual Thinking/Memory......Page 255
Summary......Page 256
Illustrative Visual Case Studies......Page 257
References......Page 260
Appendix 7A......Page 265
Auditory Function Assessment in Posttraumatic Brain Injury Rehabilitation......Page 267
Demographics......Page 268
External Ear......Page 269
Middle Ear......Page 270
Bony Labyrinth......Page 271
Membranous Labyrinth......Page 272
The Auditory Nerve......Page 273
Central Auditory Pathways......Page 274
Standard Audiologic Procedures......Page 275
Acoustic Immittance......Page 276
Acoustic Reflex Testing......Page 278
Mixed Hearing Loss......Page 279
Otoacoustic Emissions......Page 280
Auditory Evoked Responses......Page 281
BAER......Page 283
Auditory Late Response (ALR)......Page 284
Auditory P300 Event-Related Potential......Page 285
References......Page 286
Introduction......Page 289
Acute Medical Complications and Rehospitalization Rates in TBI......Page 290
Pathophysiology of Traumatic Brain Injury......Page 293
Dementia and Alzheimer’s Disease......Page 294
Other Neurological Disorders......Page 296
Seizures......Page 297
Normal Aging......Page 298
Traumatic Brain Injury......Page 299
Cerebral Atrophy, Ventricular Size, and Hydrocephalus......Page 301
Neuroendocrine Dysfunction......Page 302
Sleep......Page 304
Mortality and Life Expectancy......Page 305
Successful Aging......Page 308
References......Page 309
Introduction......Page 319
Habituation......Page 320
Sensitization......Page 321
Types of Learning......Page 323
Hierarchical Learning......Page 324
Multimodal Rehabilitation......Page 327
Constraint-Induced Therapy......Page 328
References......Page 329
Allied Health Themes......Page 331
Abstract......Page 333
Language as a Cognitive Domain......Page 334
Memory: Specific to a Task......Page 335
Philosophical Views and Theoretical Perspectives......Page 336
Functions Have Priority over Structure......Page 340
Cognition, Codification, Communication, Expression......Page 343
Cognitive Social Bases of Language: A Model......Page 344
Possible Worlds or Situated Minds (Level I)......Page 345
Centrality of Intent (Level II)......Page 346
Metalinguistic Capacities (Level IV)......Page 347
Conclusions......Page 348
References......Page 349
Principles of Cognitive Rehabilitation: An Integrative Approach......Page 353
Introduction......Page 354
Effects of Brain Injury on Neuronal Function......Page 355
Diffuse Axonal Injury (DAI)......Page 356
Brain Reorganization and Sprouting Following Injury......Page 357
General Principles of Cognitive Systems......Page 359
Attention......Page 360
Memory Processes......Page 363
Verbal Language......Page 368
Categorization......Page 369
Directions for Rehabilitation......Page 371
Efficacy Research......Page 372
References......Page 373
Level 5: Abstract Word Categorization......Page 380
Level 3: Progressive Rule Learning 3......Page 381
Introduction......Page 383
Cognition......Page 384
Neuroanatomical Review......Page 385
Hypothalamus, Thalamus, and Basal Ganglia......Page 388
Hippocampus......Page 390
Principles of Neurophysiology and Cognition......Page 391
Information Processing, Neurotransmission, and Learning......Page 392
Attention......Page 395
Perceptual Features......Page 397
Categorization......Page 399
Cognitive Distance......Page 401
Intervention Techniques and Strategies......Page 402
Conditions for Cognitive Rehabilitation......Page 403
Attention......Page 404
Feature Identification......Page 408
Categorization......Page 410
References......Page 411
The Use of Applied Behavior Analysis in Traumatic Brain Injury Rehabilitation......Page 419
Introduction......Page 420
The Brain-Behavior Relationship......Page 421
Medication......Page 422
Ethics......Page 423
General Management Guidelines......Page 425
Antecedent......Page 426
Behavior......Page 427
Consequence......Page 428
Prompting and Fading......Page 429
Historical Survey......Page 430
Current Status......Page 431
Functional Assessment......Page 432
Behavior Plan Format......Page 433
Target Behavior......Page 435
Behavior Plan Procedures......Page 436
Positive Programming......Page 437
Chaining......Page 438
Differential Reinforcement of Incompatible Behaviors (DRI)......Page 439
Differential Reinforcement of Other Behaviors (DRO)......Page 440
Overcorrection......Page 441
Stimulus Change......Page 442
Time-Out......Page 443
Contracting......Page 444
Stimulus Control......Page 445
Noncontingent Reinforcement (NCR)......Page 446
Data Collection and Graphing......Page 447
Data Collection......Page 448
Interval Recording......Page 449
Computer Management of Data......Page 451
Graphing......Page 452
Crisis Prevention and Intervention......Page 454
Models of Assault......Page 455
Stress Model......Page 456
Legal Model......Page 457
General Techniques and Methods......Page 458
Staff and Family Training......Page 460
Putting It All Together......Page 461
References......Page 463
Management of Residual Physical Deficits......Page 471
An Historical Perspective......Page 472
The Evaluative Process......Page 475
Range of Motion and Dexterity......Page 478
Sensation and Proprioception......Page 479
Cerebellar Tests......Page 480
The Manual Muscle Test, Tone, and Muscle Endurance......Page 481
Mobility, Posture, and Gait Evaluations......Page 483
Sensorimotor Integration and Dynamic Balance Evaluations......Page 487
Quick Reciprocal Movement Evaluation......Page 492
Reciprocal Jumping......Page 494
Four-Point......Page 495
Reciprocal Marching......Page 498
Rapid Alternating Movement Evaluation......Page 499
Evaluation of Vision......Page 500
Visual Perception and Perceptual Motor Evaluation......Page 502
Orthopedic and Spinal Cord......Page 503
Pain......Page 506
Functioning at Heights......Page 507
Therapeutic Measurement......Page 508
Mobility......Page 509
Pain......Page 511
Cerebellar Dysfunction......Page 512
Sensory Function......Page 514
Smell and Taste......Page 515
Driving......Page 516
Pool/Aquatic Therapy......Page 517
References......Page 518
Introduction......Page 525
Employment Trends Following TBI......Page 527
Prognosticating Return to Work......Page 528
Industry-Related Factors Influencing Return to Work......Page 530
Vocational Rehabilitation Prerequisites......Page 532
Physical Deficits......Page 533
Psychological and Behavioral Issues......Page 534
Cognitive Deficits......Page 536
Communicative Deficits......Page 537
Return to Work Models......Page 538
Vocational Rehabilitation Plan Development......Page 540
Vocational Counseling......Page 543
Vocational Testing/Work Evaluation/Work Hardening......Page 544
Follow-Up......Page 545
References......Page 546
Brief History of Therapeutic Recreation......Page 555
Effectiveness of Therapeutic Recreation for Persons with Disabilities......Page 557
Physical Health......Page 558
Mental Health......Page 559
Psychosocial Health......Page 560
Personal Satisfaction and Satisfaction with Life......Page 561
Models of Service Delivery......Page 562
Assessment......Page 563
Treatment......Page 564
Co-Treatment with Other Members of the Rehabilitation Team......Page 565
Translating Therapeutic Recreation to the Real World: Community Integration......Page 566
Conclusion......Page 568
The Future of Therapeutic Recreation and TBI......Page 569
References......Page 570
Appendix 17A: Leisure Interest Survey......Page 573
Children and Adolescents: Practical Strategies for School Participation and Transition......Page 575
Introduction......Page 576
Cognitive-Communicative Challenges after Traumatic Brain Injury......Page 578
The Case of John......Page 580
Challenges to Language, Executive Functioning, and Self-Regulation for a Child with Cognitive-Communicative Problems......Page 581
The Case of John (Continued)......Page 582
Treatment of Cognitive-Communicative Strengths and Needs: An Integrative Approach for School......Page 584
Strategies for Addressing Underlying Cognitive Processes......Page 585
Decreased Speed of Processing......Page 586
Writing......Page 587
The Case of John (Continued)......Page 588
Section 504......Page 589
Transitioning Students with Traumatic Brain Injury......Page 590
Step One: Plan in a Timely Manner......Page 591
Resources......Page 592
The Case of John (Continued)......Page 593
References......Page 595
The Contribution of the Neuropsychological Evaluation to Traumatic Brain Injury Rehabilitation......Page 597
Introduction......Page 598
Neuroimaging and the Neuropsychology of TBI......Page 599
Pathophysiology and Neuropsychological Functioning in TBI......Page 600
Neuropsychological Recovery after Traumatic Brain Injury......Page 601
Neuropsychological Assessment vs. Neuropsychological Testing......Page 602
Fixed Battery Approach......Page 604
Process Orientation Approach......Page 605
Cognitive Screening and Mental Status Examinations......Page 606
Ecological Implications......Page 607
Ecological Implications......Page 608
Ecological Implications......Page 609
Ecological Implications......Page 611
Working Memory and Complex Attention Processing......Page 612
Ecological Implications......Page 613
Speed of Information Processing......Page 614
Recent Memory Functioning......Page 615
Ecological Implications......Page 616
Visuospatial Analysis and Visuoconstruction Ability......Page 617
Executive Functioning Capacity......Page 618
Ecological Implications......Page 620
Ecological Implications......Page 621
Directions for the Future......Page 622
References......Page 623
Introduction......Page 629
Preparation......Page 631
Current Medical Status......Page 634
Cognition......Page 635
Education......Page 638
Occupational/Physical Therapy......Page 639
Psychosocial......Page 641
Speech/Language Pathology......Page 642
Vision......Page 643
Report Preparation......Page 644
References......Page 645
Appendix 20A: Patient Examination Report......Page 648
Appendix 20B: Iconic Store Cards......Page 649
Appendix 20C: Oral Peripheral Evaluation......Page 655
Case Management Themes......Page 657
Introduction......Page 659
Case Management: Roles and Responsibilities......Page 660
The Role of the Family......Page 662
Public Funding......Page 663
Workers’ Compensation......Page 664
Managed Care......Page 665
Life Care Planning......Page 666
Cost Analysis......Page 667
Continuum of Care......Page 668
Facility Assessment......Page 669
Working with the Person with TBI......Page 671
Summary......Page 672
References......Page 673
Appendix 21A......Page 674
Litigation and Settlement Options for the Brain-Injured Survivor......Page 677
Public Collateral Source Benefit Analysis......Page 678
Social Security Benefits (SSA) - Title II, 42 U.S.C. §402 to 431......Page 679
Medicare - Title XVIII......Page 680
Medicaid - Title XIX......Page 681
Structured Settlement Annuities......Page 687
Institutional Trustees......Page 688
Broker Advisor/Trustee Affiliations......Page 689
Primary and Secondary Guardianship/Conservatorship Selection......Page 690
Disclosed and Undisclosed Fees......Page 691
Experience with Type of Settlement Device......Page 692
Power of Attorney......Page 693
Wills......Page 694
Living Trusts......Page 695
Special-Needs Trust Provisions......Page 696
Summary......Page 699
42 U.S.C. §1396p(d)(4)(A) 01/02/01......Page 700
The Implications of Bioethical Principles in Traumatic Brain Injury Rehabilitation......Page 701
Introduction......Page 702
Brief Historical Perspective......Page 703
Respect for Autonomy......Page 704
Standards for Competence......Page 705
Memory......Page 707
Executive Function......Page 708
Informed Consent......Page 709
Components of Informed Consent......Page 710
The Application of Informed Consent to Rehabilitation......Page 715
Soliciting Patient Consent......Page 716
Beneficence......Page 717
Our Moral Obligation to Assist Others......Page 718
Justifiable Paternalism......Page 719
Family Involvement......Page 720
Prevention of Driving......Page 721
Use of Restraints......Page 722
The Concept of Harm and the Right to Refuse Treatment......Page 724
Surrogate Decision Making......Page 725
Minimally Responsive State (MRS)......Page 726
Introduction to the Concept of Justice......Page 727
Theories of Justice......Page 728
Resource Allocation......Page 730
Justice Applied to Rehabilitation......Page 731
The Level of the Organization/Facility......Page 733
The Level of the Rehabilitation Team......Page 734
The Level of the Individual Rehabilitation Professional......Page 735
Conclusions......Page 736
References......Page 737
Introduction......Page 743
Early Problem Identification during Follow-Up......Page 745
Avoiding Reinjury......Page 746
Activities and Activity Levels......Page 747
Family Systems......Page 748
Caregiver Concerns......Page 752
Seizure Hygiene......Page 753
Depression......Page 754
Sleep......Page 755
Crisis Management......Page 756
Home Adaptations......Page 757
Financial Planning......Page 758
Additional Rehabilitation Timing......Page 760
References......Page 761
Appendix 24A: Family Manual Outline......Page 765
Appendix 24B: Discharge Planning Checklist......Page 767
A......Page 773
B......Page 777
C......Page 779
D......Page 784
E......Page 786
F......Page 788
G......Page 789
H......Page 790
I......Page 792
L......Page 793
M......Page 795
N......Page 798
O......Page 801
P......Page 802
Q......Page 805
R......Page 806
S......Page 807
T......Page 811
V......Page 813
W......Page 815
Z......Page 816