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Traumatic Brain Injury in the US - Epidemiology and Rehabilitation

Introduction

1. Traumatic Brain Injury (TBI) is an injury that disrupts the normal function of the brain, and it can be classified as mild, moderate, or severe on the basis of the presentation of a patient’s neurologic signs and symptoms.

A. True

B. False


TBI Health Efforts

2. A TBI can result in health effects that vary in intensity, length, and: ______________.

A. Overall Impact

B. Constancy

C. Presentation

D. Clinical Manifestation


Factors Influencing Outcomes

3. The degree to which individual characteristics such as age and pre-injury functioning can influence outcomes after TBI depends upon cognitive capacity and patient motivation.

A. True

B. False


Cognitive Rehabilitation

4. Empirical support for cognitive rehabilitation (CR) following TBI shows the strongest support for each of the following interventions EXCEPT:

A. Goal-oriented process training to promote development of compensatory strategies and generalization

B. Interventions to address functional communication deficits and memory strategies for mild memory impairments

C. Meta-cognitive strategies for executive function deficits

D. Comprehensive holistic neuropsychological rehabilitation


Conclusion

5. Since preventing all TBI’s is impractical, an imperative for those in public health practice, clinical practice, and research is to design and evaluate effective strategies to mitigate the health effects of TBI.

A. True

B. False


Background: Purpose

6. The goal of public health related to injury prevention is to reduce the burden of injury at the population level by preventing injuries and assuring care and rehabilitation that:

A. Is sensitive to the individual needs of patients

B. Maximizes the health and quality life of injured persons

C. Strengthens understanding of TBI continuum of care

D. Implements integrated systems of support, treatment, and follow up


Section 1 – Definition of TBI

7. The presentation of signs and symptoms of TBI immediately, shortly after, or even several days after the suspected event is sufficient to classify a person as having sustained a TBI.

A. True

B. False


Injury Severity Classification of TBI

8. TBI is classified as severe when an injured person loses consciousness for 30 minutes to 24 hours and has post traumatic amnesia for up to seven days.

A. True

B. False


Health and Others Effects of TBI

9. Somatic signs and symptoms of TBI include headache, fatigue, sleep disturbance, dizziness, and:

A. Agitation

B. Confusion

C. Chronic pain

D. Mood disturbance


Burden of TBI

10. In the United States, children ages 0-4 years, adolescents aged 15-19 years, and older adults aged 75 years or older are most likely to have a TBI related ED visit or hospitalization, with the older adults having the highest rates of TBI related deaths.

A. True

B. False


Unique Considerations for Specific Populations

11. Which of the following is NOT a correct statement about how TBI impacts children?

A. A TBI experienced by a child can contribute to physical impairments and lowered cognitive and academic skills relative to development expectations

B. Children with a TBI can experience specific impairments in language, memory, problem-solving, perceptual-motor skills, attention, and executive function

C. The delay of TBI effects can manifest themselves in later academic failure, chronic behavior problems, social isolation, difficulty with employment relationships, and in some cases, difficulty with the law

D. Approximately 85,000 children and adolescents aged 0-19 years are estimated to be living with substantial and long-lasting limitations in social behavior, physical, or cognitive functioning following a TBI


Incarcerated Populations

12. Incarcerated populations are affected by TBI, and experts suggest that in many cases the illegal acts leading to incarceration as well as non-compliant prison behaviors and subsequent recidivism may be at least partially influenced by the effects of a TBI.

A. True

B. False


Recommendations

13. In order to fill gaps in understanding the epidemiology and consequences of TBI, recommendations include:

A. Improve TBI incidence and prevalence estimates to include persons with TBIs who are treated in non-hospital settings and those with TBIs who are not receiving medical care

B. Examine trends in TBI incidence by injury mechanism and within population subgroups

C. Develop and implement a concussion surveillance system that captures the full range of sports and recreation-related concussions

D. All of the above


Section II – Table 5

14. Psychological issues that may have a substantial impact on long term TBI outcomes include personality changes, mood disturbances, and:

A. Adjustment problems

B. Social impairment

C. Functional communication

D. Reasoning and judgment issues


Table 6. Outcome Domains and Descriptions for TBI Common Data Elements Unique to Pediatrics

15. Children with TBI have been found to have significant academic difficulties characterized by school failure and deficits in academic achievement, such as reading, math and written language, as well as deficits in language comprehension and expression and in speech articulation.

A. True

B. False


16. Studies have shown that cognitive-behavioral, problem-solving therapy can improve several pediatric outcomes, including executive function skills, behavior, and caregiver distress.

A. True

B. False


Gaps in TBI Outcome Measurement

17. Recent research has clearly demonstrated the validity of using a proxy to assist with outcome measures for TBI patients with cognitive and communication deficits.

A. True

B. False


Important Recommendations

18. One important recommendation to address the gaps in TBI-related outcome measurement is to develop comprehensive outcome measures that enable measurement of treatment effectiveness specific to the TBI population, and that are sensitive to changes associated with treatment and rehabilitation regardless of TBI severity.

A. True

B. False


Section III - Goals and Purpose of TBI Rehabilitation

19. TBI rehabilitation is the medical and therapeutic services designed to improve and maintain cognitive, ________________, and psychosocial functioning in persons with TBI.

A. Neurobiological

B. Sensorimotor

C. Behavioral

D. Emotional


Cognitive Rehabilitation

20. Cognitive Rehabilitation (CR) for TBI uses restorative interventions to teach ways to adapt to impaired cognitive functioning, and compensatory skill development to improve functioning through practice.

A. True

B. False


Effectiveness of Cognitive Rehabilitation

21. Literature suggests that CR is effective in teaching skills to compensate for cognitive limitations, although there is currently an insufficient body of evidence that demonstrates the effectiveness of this method in treating the underlying cognitive deficits caused by TBI.

A. True

B. False


Effectiveness of Physical Rehabilitation

22. In recent years, approaches such as motor interventions, proprioceptive muscle training, and neurodevelopmental treatment have been used in clinical practice, with significant research demonstrating their effectiveness.

A. True

B. False


Vocational Rehabilitation Services

23. For persons affected by TBI, program-based vocational rehabilitation is an approach that offers intensive individualized cognitive and work skills, assistance with placement, and:

A. Job coaching

B. Continuity of care

C. Long-term support

D. Guided work trials


Gaps in Evaluating the Effectiveness of TBI Rehabilitation

24. Questions that must be answered regarding TBI rehabilitation include identifying the optimal dose or intensity of therapy, the ideal timing of therapy in the recovery process, or the necessary modifications for subpopulations.

A. True

B. False


Recommendations

25. In order to strengthen the TBI continuum of care, experts suggest examining the effectiveness of rehabilitation services following acute inpatient rehabilitation, such as community-based rehabilitation and vocational rehabilitation.

A. True

B. False


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