Glossary of TBI Medical Terms
A-B-C Data
"A" stands for antecedents to the behavior. "B" is for the behavior. "C" is for consequences to the behavior. A-B-C data collects information, not only on unwanted behavior, but also on what immediately precedes and follows the behavior.
Absence Seizures
Formerly known as petit mal, there is transient loss of consciousness. Person may cease physical movement, have loss of attention or stare vacantly, neither speaking nor apparently hearing what is said. There may be excessive eye blinking, staring or chewing movements. Seizures so brief that may not be recognized.
Abstract Concept
A concept or idea not related to any specific instance or object and which potentially can be applied to many different situations or objects. Persons with cognitive deficits often have difficulty understanding abstract concepts.
Abstract Thinking
Being able to apply abstract concepts to new situations and surroundings.
Abulia
Absence or inability to exercise will-power or to make decisions. Also, slow reaction, lack of spontaneity, and brief spoken responses. Usually associated with damage to a cerebellar vessel. See also cerebellum.
Acalculia
The inability to perform simple problems of arithmetic. See also parietal lobe.
Active Treatment Interaction
Very broad concept that avoids caring for a person in a custodial sense or behaving in ways that are likely to increase dependency within the relationship. The term implies directed action, teaching and a certain degree of risk taking.
Acquired Brain Injury
An injury to the brain occurring after birth that is not hereditary, congenital or degenerative; does not refer to brain injuries induced by birth trauma.
Acute Care
The phase of managing health problems which is conducted in a hospital on patients needing medical attention.
Acute Rehabilitation Program
Primary emphasis is on the early phase of rehabilitation which usually begins as soon as the patient is medically stable. The program is designed to be comprehensive and based in a medical facility with a typical length of stay of 1-3 months. Treatment is provided by an identifiable team in a designated unit. See Program/Service Types.
ADA
Americans with Disabilities Act
Adaptive/Assistive Equipment
A special device which assists in the performance of self-care, work or play/leisure activities or physical exercise. See also adaptive equipment catalog.
ADL
Activities of daily living. Routine activities carried out for personal hygiene and health (including bathing, dressing, feeding) and for operating a household.
Affect
The observable emotional condition of an individual at any given time. See also frontal lobe.
Agnosia
Failure to recognize familiar objects although the sensory mechanism is intact. May occur for any sensory modality.
Agraphia
Inability to express thoughts in writing. See also parietal lobe.
Akathia
Inability to sit or stand still; motor restlessness.
Akinesia
Slowness and loss of movement.
Alexia
Inability to read. See also parietal lobe.
Ambulate
To walk.
Amnesia
Lack of memory about events occurring during a particular period of time. See also: anterograde amnesia, retrograde amnesia, post-traumatic amnesia.
Amygdala
Close to the hippocampus, the amygdala is a "fight - flight" structure closely tied with emotional memories and reactions.
Aneurysm
A balloon-like deformity in the wall of a blood vessel. The wall weakens as the balloon grows larger, and may eventually burst, causing a hemorrhage.
Anomia
Inability to recall names of objects. Persons with this problem often can speak fluently but have to use other words to describe familiar objects. See also parietal lobe.
Anosognosia
Lack of awareness of deficits.
Anosmia
Loss of the sense of smell.
Anoxia
A lack of oxygen. Cells of the brain need oxygen to stay alive. When blood flow to the brain is reduced or when oxygen in the blood is too low, brain cells are damaged.
Anterograde Amnesia
Inability to consolidate information about ongoing events. Difficulty with new learning.
Anticonvulsant
Medication used to decrease the possibility of a seizure (e.g., Dilantin, Phenobarbital, Mysoline, Tegretol). See also pharmacology guide.
Antidepressants
Medication used to treat depression. See also pharmacology guide.
Anxiolytoics
Anti-anxiety medication.
Aphasia
Loss of the ability to express oneself and/or to understand language. Caused by damage to brain cells rather than deficits in speech or hearing organs. See also frontal and temporal lobes.
Apraxia
Inability to carry out a complex or skilled movement; not due to paralysis, sensory changes, or deficiencies in understanding. See also parietal lobe.
Aprosodia
A condition in which there is a loss of production or comprehension of the meaning of different tones of voice.
Aspiration
Inhalation of foods, liquids or vomitus into the lungs.
Arachnoid
Like a spider web that bridges the brain's many wrinkles and folds.
Arousal
Being awake. Primitive state of alertness managed by the reticular activating system (extending from medulla to the thalamus in the core of the brain stem) activating the cortex. Cognition is not possible without some degree of arousal. See also brain stem.
Articulation
Movement of the lips, tongue, teeth and palate into specific patterns for purposes of speech. Also, a movable joint.
Aspiration
When fluid or food enters the lungs through the wind pipe. Can cause a lung infection or pneumonia.
Astereognosia
Inability to recognize things by touch. See also parietal lobe.
Ataxia
A problem of muscle coordination not due to apraxia, weakness, rigidity, spasticity or sensory loss. Caused by lesion of the cerebellum or basal ganglia. Can interfere with a person's ability to walk, talk, eat, and to perform other self care tasks. See also cerebellum.
Attendant Care
Provision of assistance in activities of daily living for a person with disability. Daily number of hours of required assistance, either physical or supervisory.
Atrophy
A wasting away or decrease in size of a cell, tissue, organ, or part of the body caused by lack of nourishment, inactivity or loss of nerve supply.
Attention/Concentration
The ability to focus on a given task or set of stimuli for an appropriate period of time.
Audiologist
One who evaluates hearing defects and who aids in the rehabilitation of those who have such defects.
Augmentative and Alternative Communication
Use of forms of communication other than speaking, such as: sign language, "yes, no" signals, gestures, picture board, and computerized speech systems to compensate (either temporarily or permanently) for severe expressive communication disorders.
Axon
A long, slim "wire" in the neuron that transmits signals from one cell body to another via junctions known as synapses.
Basal Ganglia
Four nerve cell clusters of the basal ganglia or "nerve knots" help handle physical movements by relaying information from the cerebral cortex to the brainstem and cerebellum.
Balance
The ability to use appropriate righting and equilibrium reactions to maintain an upright position. It is usually tested in sitting and standing positions.
Behavior
The total collection of actions and reactions exhibited by a person. See also Working with Behavior Disorders.
Bilateral
Pertaining to both right and left sides.
Brain Injury, Acquired
The implication of this term is that the individual experienced normal growth and development from conception through birth, until sustaining an insult to the brain at some later time which resulted in impairment of brain function.
Brain Injury, Closed
Occurs when the head accelerates and then rapidly decelerates or collides with another object (for example the windshield of a car) and brain tissue is damaged, not by the presence of a foreign object within the brain, but by violent smashing, stretching, and twisting, of brain tissue. Closed brain injuries typically cause diffuse tissue damage that results in disabilities which are generalized and highly variable.
Brain Injury, Mild
A patient with a mild traumatic brain injury is a person who has had a traumatically-induced physiological disruption of brain function, as manifested by at least one of the following: 1) any period of loss of consciousness, 2) any loss of memory for events immediately before or after the accident, 3) any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused), 4) focal neurological deficit(s) which may or may not be transient; but where the severity of the injury does not exceed the following: a) loss of consciousness of approximately 30 minutes or less; b) after 30 minutes, an initial Glasgow Coma Scale score of 13-15; c) Post Traumatic Amnesia not greater than 24 hours.
Brain Injury, Traumatic
Damage to living brain tissue caused by an external, mechanical force. It is usually characterized by a period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely). The specific disabling condition(s) may be orthopedic, visual, aural, neurologic, perceptive/cognitive, or mental/emotional in nature. The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congential disorders, birth trauma or degenerative processes.
Brain Plasticity
The ability of intact brain cells to take over functions of damaged cells; plasticity diminishes with maturation.
Brain Scan
An imaging technique in which a radioactive dye (radionucleide) is injected into the blood stream and then pictures of the brain are taken to detect tumors, hemorrhages, blood clots, abscesses or abnormal anatomy.
Brain Stem
The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brain stem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert).
Brocca’s Area
Located in the lower portion of the motor cortex in the left frontal– temporal lobe; controls muscles of the face and mouth and enables the production of speech.
Case Management
Facilitating the access of a patient to appropriate medical, rehabilitation and support programs, and coordination of the delivery of services. This role may involve liaison with various professionals and agencies, advocacy on behalf of the patient, and arranging for purchase of services where no appropriate programs are available.
Catheter
A flexible tube for withdrawing fluids from, or introducing fluids into, a cavity of the body. Frequently used to drain the urinary bladder (Foley catheter).
Cellulitis
Inflammation of the skin.
Cerebellum
Located in the lower back section of the brain, the cerebellum is the "movement" part of the brain that coordinates, modulates, and stores all body movement.
Cerebral Cortex
This is divided into two hemispheres dedicated to the highest levels of thinking, moving, and acting. The right and left hemispheres are further divided into four lobes – frontal, parietal, temporal and occipital.
Cerebral-spinal Fluid (CSF)
Liquid which fills the ventricles of the brain and surrounds the brain and spinal cord.
Chronic
Marked by long duration or frequent recurrence.
Circumlocution
Use of other words to describe a specific word or idea which cannot be remembered.
Client
A person under the protection of another; one who engages the professional advice or services of another. See Consumer and Patient.
Clonic
Alternating contraction and relaxation of muscles.
Clonus
A sustained series of rhythmic jerks following quick stretch of a muscle.
Closed Head Injury
Injury to the head in which the skull remains intact.
Cognition
Conscious process of knowing or being aware of thoughts or perceptions, including understanding and reasoning.
Cognitive Impairment
Difficulty with perception, memory, attention and reasoning skills.
Cognitive Rehabilitation
Therapy programs which aid persons in the management of specific problems in perception, memory, thinking and problem solving. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits. The interventions are based on an assessment and understanding of the person's brain-behavior deficits and services are provided by qualified practitioners.
Cogwheel Rigidity
Rigidity with little jerks when the muscles in the arms and legs are stretched by the examiner.
Coma
A state of unconsciousness from which the patient cannot be awakened or aroused, even by powerful stimulation; lack of any response to one's environment. Defined clinically as an inability to follow a one-step command consistently; Glasgow Coma Scale score of 8 or less.
Communicative Disorder
An impairment in the ability to 1) receive and/or process a symbol system, 2) represent concepts or symbol systems, and/or 3) transmit and use symbol systems. The impairment may be observed in disorders of hearing, language, and/or speech processes.
Community Skills
Those abilities needed to function independently in the community. They may include: telephone skills, money management, pedestrian skills, use of public transportation, meal planning and cooking.
Complex Partial Seizures
Formerly known as psychomotor or temporal lobe seizures, consciousness is impaired. May be a warning or aura. Seizures usually last one to three minutes and may be followed by some confusion.
Comprehension
Understanding of spoken, written, or gestural communication.
Concentration
Maintaining attention on a task over a period of time; remaining attentive and not easily diverted.
Concrete Thinking
A style of thinking in which the individual sees each situation as unique and is unable to generalize from the similarities between situations. Language and perceptions are interpreted literally so that a proverb such as "a stitch in time saves nine" cannot be readily grasped.
Concussion
The common result of a blow to the head or sudden deceleration usually causing an altered mental state, either temporary or prolonged. Physiologic and/or anatomic disruption of connections between some nerve cells in the brain may occur. Often used by the public to refer to a brief loss of consciousness.
Confusion
A state in which a person is bewildered, perplexed, or unable to self-orient.
Conjugate Movement
Both eyes move simultaneously in the same direction. Convergence of the eyes toward the midline (crossed eyes) is a disconjugate movement.
Contracture
Abnormal, usually permanent condition of a joint characterized by flexion and fixation due to wasting away and abnormal shortening of muscle fibers and loss of skin elasticity.
Convergence
Movement of two eyeballs inward to focus on an object moved closer. The nearer the object, the greater is the degree of convergence necessary to maintain single vision. See also vision after head injury.
Corpus Callosum
Complex band of nerve fibers that exchanges information between the two hemispheres.
Cortical Blindness
Loss of vision resulting from a lesion of the primary visual areas of the occipital lobe. Light reflex is preserved.
Cortex
“Thinking” part of the brain.
Corti
Organ where transmitted sound waves vibrate thousands of tiny sensitive hairs. Each hair is connected to thousands of nerve fibers, which send signals through the eighth cranial (acoustic) nerve to the brainstem. There, many of the nerve fibers cross over before taking signals up to the tops of the temporal lobes for analysis.
Coup-Contra-Coup
Effect when the back of the head is struck and the front of the brain is injured by the brain bouncing back and forth.
CT Scan/Computerized Axial Tomography
A series of X-rays taken at different levels of the brain that allows the direct visualization of the skull and intracranial structures. A scan is often taken soon after the injury to help decide if surgery is needed. The scan may be repeated later to see how the brain is recovering.
Decerebrate Posture (Decerebrate Rigidity)
Exaggerated posture of extension as a result of a lesion to the prepontine area of the brain stem, and is rarely seen fully developed in humans. In reporting, it is preferable to describe the posture seen.
Decorticate Posture (Decorticate Rigidity)
Exaggerated posture of upper extremity flexion and lower extremity extension as a result of a lesion to the mesencephalon or above. In reporting, it is preferable to describe the posture seen.
Decubitus
Pressure area, bed sore, skin opening, skin breakdown. A discolored or open area of skin damage caused by pressure. Common areas most prone to breakdown are buttocks or backside, hips, shoulder blades, heels, ankles and elbows.
Dendrites
Networks of short "wires" in the neuron that branch out from a cell body and synapse with the ends of axons from other neurons.
Diencephalon
Located centimeters above the midbrain, the diencephalon is made up of the thalamus, hypothalamus, and other structures. It is a master relay center for forwarding information, sensations, and movement.
Diffuse Axonal Injury (DAI)
A shearing injury of large nerve fibers (axons covered with myelin) in many areas of the brain. It appears to be one of the two primary lesions of brain injury, the other being stretching or shearing of blood vessels from the same forces, producing hemorrhage.
Diffuse Brain Injury
Injury to cells in many areas of the brain rather than in one specific location.
Diplopia
Seeing two images of a single object; double vision. See also vision after head injury.
Discipline
When referring to health care or education it means a particular field of study, such as medicine, occupational therapy, nursing, recreation therapy or others.
Disinhibition
Inability to suppress (inhibit) impulsive behavior and emotions.
Disorientation
Not knowing where you are, who you are, or the current date. Health professionals often speak of a normal person as being oriented "times three" which refers to person, place and time.
Dorsiflexion
When applied to the ankle, the ability to bend at the ankle, moving the front of the foot upward.
Dura Matter
Outer hard matter of the brain, which is like a heavy plastic covering.
Dysarthria
Difficulty in forming words or speaking them because of weakness of muscles used in speaking or because of disruption in the neuromotor stimulus patterns required for accuracy and velocity of speech.
Dysphagia
A swallowing disorder characterized by difficulty in oral preparation for the swallow, or in moving material from the mouth to the stomach. This also includes problems in positioning food in the mouth.
Edema
Collection of fluid in the tissue causing swelling.
Electroencephalogram (EEG)
A procedure that uses electrodes on the scalp to record electrical activity of the brain. Used for detection of epilepsy, coma, and brain death.
Electromyography (EMG)
An insertion of needle electrodes into muscles to study the electrical activity of muscle and nerve fibers. It may be somewhat painful to the patient. Helps diagnose damage to nerves or muscles.
Emotional Lability
Exhibiting rapid and drastic changes in emotional state (laughing, crying, anger) inappropriately without apparent reason.
Empathy
Ability to identify with and understand another person's feelings or difficulties.
Endotracheal Tube
A tube that serves as an artificial airway and is inserted through the patient's mouth or nose. It passes through the throat and into the air passages to help breathing. To do this it must also pass through the patient's vocal cords. The patient will be unable to speak as long as the endotracheal tube is in place. It is this tube that connects the respirator to the patient.
Executive Functioning
The ability to plan, initiate, direct, and monitor one's activities. Involves organizing, planning, creating, evaluating and initiating projects and activities.
Extinction
The ability to plan, initiate, direct and monitor one's activities. Involves organizing, planning, creating, evaluating and initiating projects and activities.
Evoked Potential
Registration of the electrical responses of active brain cells as detected by electrodes placed on the surface of the head at various places. The evoked potential, unlike the waves on an EEG, is elicited by a specific stimulus applied to the visual, auditory or other sensory receptors of the body. Evoked potentials are used to diagnose a wide variety of central nervous system disorders.
Extended Care Facility-Basic
Residential facility which supplies 24-hour nursing care and supervision and assistance with activities of daily life. See Program/Service Types.
Extended Care Facility-Skilled
A residential facility for the patient who requires 24-hour nursing care (IV, intramuscular injections, special feeding tubes, skin care, oxygen) and rehabilitative therapy, such as physical therapy, occupational therapy, or speech therapy on a less intensive basis than as an inpatient in a comprehensive rehabilitation center. An extended care facility can be a short-term alternative (a few months) prior to placement at home (with outpatient therapy) or in a nursing home. See Program/Service Types.
Extremity
Arm or leg.
Figure-Ground
The differentiation between the foreground and the background of a scene; this refers to all sensory systems, including vision, hearing, touch.
Flaccid
Lacking normal muscle tone; limp.
Flexion
Bending a joint.
Foley Catheter
This is a tube inserted into the urinary bladder for drainage of urine. The urine drains through the tube and collects into a plastic bag.
Frontal Lobes
Include everything in front of the central fissure. When injured or damaged, an individual's ability to synthesize signals from the environment, assign priorities, make decisions, initiate actions, control emotions, behave and interact socially, make plans and other executive like functions are severely compromised.
Frustration Tolerance
The ability to persist in completing a task despite apparent difficulty. Individuals with a poor frustration tolerance will often refuse to complete tasks which are the least bit difficult. Angry behavior, such as yelling or throwing things while attempting a task is also indicative of poor frustration tolerance.
Gainful Occupation
Includes employment in the competitive labor market, practice of a profession, farm or family work (including work for which payment is "in kind" rather than in cash), sheltered employment, work activity (to the extent that there is net pay), and home industries or other home-bound work.
Gait Training
Instruction in walking, with or without equipment; also called "ambulation training."
Generalized Seizures
Sudden burst of abnormal, generalized discharges that usually affect both hemispheres; sub-classified as tonic-clonic and absence seizure.
GI Tube
A tube inserted through a surgical opening into the stomach. It is used to introduce liquids, food, or medication into the stomach when the patient is unable to take these substances by mouth.
Glasgow Coma Scale
A standardized system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The system involves three determinants: eye opening, verbal responses and motor response all of which are evaluated independently according to a numerical value that indicates the level of consciousness and degree of dysfunction. Scores run from a high of 15 to a low of 3. Persons are considered to have experienced a `mild' brain injury when their score is 13 to 15. A score of 9 to 12 is considered to reflect a `moderate' brain injury and a score of 8 or less reflects a 'severe' brain injury.
Glial Cells
Non-communicating ("glue") cells that support and nourish the neurons.
Head Injury
Refers to an injury of the head and/or brain, including lacerations and contusions of the head, scalp and/or forehead. See also Brain Injury.
Hematoma
The collection of blood in tissues or a space following rupture of a blood vessel; types include:
Epidural--Outside the brain and its fibrous covering, the dura, but under the skull.
Subdural--Between the brain and its fibrous covering (dura).
Intracerebral--In the brain tissue.
Subarachnoid--Around the surfaces of the brain, between the dura and arachnoid membranes.
Hemianopsia Hemianopia
Visual field cut. Blindness for one half of the field of vision. This is not the right or left eye, but the right or left half of vision in each eye. See also vision after head injury.
Hemiparesis
Weakness of one side of the body.
Hemiplegia
Paralysis of one side of the body.
Heterotopic Ossification (HO)
Creation of abnormal growth of bone in soft tissues or around joints.
Hippocampus
A paired–organ, one on each side of the brain sitting within the temporal lobes, "between your ears" so to speak. Most commonly associated with memory functioning.
Household management
Includes meal preparation, housekeeping, money management and other activities related to managing one’s home.
Hydrocephalus
Enlargement of fluid-filled cavities in the brain, not due to brain atrophy.
Hypothalamus
Control center for hunger, thirst, sexual rhythms, endocrine levels and temperature regulation. Also involved in many complex responses like anger, fatigue, memory and calmness. Serves as the "conductor" of a person’s emotional orchestra.
Hypoxia
Insufficient oxygen reaching the tissues of the body.
IEP
An individualized education plan for a student found eligible for special education and/or related services that designates the kinds and extent of services that the student needs.
Impulse Control
Refers to the individual's ability to withhold inappropriate verbal or motor responses while completing a task. Persons who act or speak without first considering the consequences are viewed as having poor impulse control.
Inclusion
Incorporation and welcome of the individual into the community, regardless of a disability.
Incontinent
Inability to control bowel and bladder functions. Many people who are incontinent can become continent with training.
Initiation Problems
Difficulty engaging in activities unless prompted.
Initiative
Refers to the individual's ability to begin a series of behaviors directed toward a goal.
Integration
Based on the expectation that people fit in, be alike and reach for similar standards.
Integumentary System
This is the organ system that protects the body from the outside. The system comprises skin and all appendages including hair, nails, sweat and sebaceous glands.
Interdependence
An interconnection or an interrelationship between two or more entities that suggests a partnership between entities that maximizes potential for both groups.
Interdependent Paradigm
Refers to a blended framework where people are seen to have gifts and capacities to build supports to engage community. Interdependence focuses on finding the points of connection between people.
Interdisciplinary Approach
A method of diagnosis, evaluation, and individual program planning in which two or more specialists, such as medical doctors, psychologists, recreational therapists, social workers, etc., participate as a team, contributing their skills, competencies, insights, and perspectives to focus on identifying the developmental needs of the person with a disability and on devising ways to meet those needs.
Internal Occurrence
Cause of injury to the brain by stroke, infectious disease, tumor, or loss of oxygen.
Intracranial Pressure (ICP)
Cerebrospinal fluid (CSF) pressure measured from a needle or bolt introduced into the CSF space surrounding the brain. It reflects the pressure inside of the skull.
Jargon
Spoken language that has a normal rate and rhythm but is full of nonsense words.
JCAHO
Joint Commission on the Accreditation of Healthcare Organizations, a national accreditation agency with standards for rehabilitation programs.
Job Analysis
Involves the systematic study of an occupation in terms of what the worker does in relation to data, people, and things; the methods and techniques employed, the machines, tools, equipment, and work aids used; the materials, products, subject matter or services which result, and the traits required of the worker
Kinesthesia
The sensory awareness of body parts as they move (see Position Sense and Proprioception)
Lability
State of having notable shifts in emotional state (e.g., uncontrolled laughing or crying).
Latency
Length of time that it takes a person to initiate (or complete) a behavior.
Leg Bag
A small, thick plastic bag that can be tied to the leg and collects urine. It is connected by tubing to a catheter inserted into the urinary bladder. See also Bowel and Bladder Training manual.
Leisure skills
These skills relate to the ability to use free time in ways that are not harmful (i.e., substance abuse, or other dangerous activities). In addition, to the recreational activities listed under community skills, this category includes reading, television, music and other activities done at home.
Limbic System
Located in the middle section of the brain, the limbic system sits on top of the brain stem and is involved in emotions and basic elemental feelings.
Locked-in Syndrome
A condition resulting from interruption of motor pathways in the ventral pons, usually by infarction. This disconnection of the motor cells in the lower brain stem and spinal cord from controlling signals issued by the brain leaves the patient completely paralyzed and mute, but able to receive and understand sensory stimuli; communication may be possible by code using blinking, or movements of the jaw or eyes, which can be spared.
Magnetic Resonance Imaging (MRI)
A type of diagnostic radiography using electromagnetic energy to create an image of soft tissue, central nervous system and musculoskeletal systems.
Magnitude
Measurement of intensity, which is especially important for unwanted behaviors; seldom used because of difficulty in objectively measuring the intensity of an aggressive or self-injurious response.
Malingering
To pretend inability so as to avoid duty or work.
Medical Model
Framework for delivering services that views a disability as a form of illness or sickness; most effective as a treatment model when the goal is to address sickness or establish medical stability.
Medical Paradigm
Refers to the scientific framework that reduces the focus of attention to the deficits or dysfunction of the person. The medical paradigm is very narrow and looks to fix people's major problems.
Medulla
First area in the lower part of the brain stem which is involved in many basic living functions. It contains reflex centers, which control many involuntary functions such as breathing, heart rate, blood pressure, swallowing, vomiting and sneezing.
Memory, Episodic
Memory for ongoing events in a person's life. More easily impaired than semantic memory, perhaps because rehearsal or repetition tends to be minimal.
Memory, Immediate
The ability to recall numbers, pictures, or words immediately following presentation. Patients with immediate memory problems have difficulty learning new tasks because they cannot remember instructions. Relies upon concentration and attention.
Memory, Long Term
In neuropsychological testing, this refers to recall thirty minutes or longer after presentation. Requires storage and retrieval of information which exceeds the limit of short term memory.
Memory, Short Term
Primary or 'working' memory; its contents are in conscious awareness. A limited capacity system that holds up to seven chunks of information over periods of 30 seconds to several minutes, depending upon the person's attention to the task.
Money Management
Ability to distinguish the different denominations of money, count money, make change, budget.
Meninges
Three membranes that cover the brain.
Midbrain
Smallest part of the brainstem and responsible for alertness and arousal.
Mild Brain Injury
Characteristics include: loss of consciousness for less than 30 minutes (or no loss); Glasgow Coma Scale of 13-15; posttraumatic amnesia for less than 24 hours; temporary or permanently altered mental or neurological state; post concussion symptoms.
Mobility
The ability to move about, either by walking, or with the aid of some form of assistive device such as a wheelchair, walker, or cane. A second aspect of mobility refers to the ability to transfer from one position to another. For example, transferring from a car to a wheelchair, or from standing with a walker to lying on a bed.
Moderate Brain Injury
Characteristics include: coma more than 20-30 min., but less than 24 hours; Glasgow Coma Scale of 9-12; possible skull fractures with bruising & bleeding; signs on EEG, CAT or MRI scans; some long term problems in one or more areas.
Motor Control
Regulation of the timing and amount of contraction of muscles of the body to produce smooth and coordinated movement. The regulation is carried out by operation of the nervous system.
Motor Planning
Action formulated in the mind before attempting to perform.
Muscle Tone
Used in clinical practice to describe the resistance of a muscle to being stretched. When the peripheral nerve to a muscle is severed, the muscle becomes flaccid (limp). When nerve fibers in the brain or spinal cord are damaged, the balance between facilitation and inhibition of muscle tone is disturbed. The tone of some muscles may become increased and they resist being stretched--a condition called hypertonicity or spasticity.
Mutual Reinforcement
Exchange of reinforcers or desired events between two or more people.
Myclonic Seizures
Sudden brief contraction of muscle groups, producing rapid jerky movements in one or more extremities of the entire body.
Nasogastric Tube (NG Tube)
A tube that passes through the patient's nose and throat and ends in the patient's stomach. This tube allows for direct "tube feeding" to maintain the nutritional status of the patient or removal of stomach acids.
Negative Reciprocal Relationship:
Also called negative reciprocity, this refers to relationships that involve ongoing exchange of unwanted events between people.
Negative Reinforcement
The removal of something unpleasant following a behavior that makes the behavior more likely to occur again.
Neglect
Paying little or no attention to a part of the body.
Neurochemical transmitters
Leap the synaptic gaps between each neuron's axon and the other neurons with which an axon makes contact.
Neologism
Nonsense or made-up word used when speaking. The person often does not realize that the word makes no sense.
Neurogenic Bladder
A neurologic impairment that affects bladder function.
Neurologist
A physician who specializes in the nervous system and its disorders.
Neurons: Billions and billions of tiny brain cells making up the nervous system which are the "communicators". Each neuron has a cell body, axon and dendrites.
Neuropsychologist
A psychologist who specializes in evaluating (by tests) brain/behavior relationships, planning training programs to help the survivor of brain injury return to normal functioning and recommending alternative cognitive and behavioral strategies to minimize the effects of brain injury. Often works closely with schools and employers as well as with family members of the injured person.
No Blame: Concept that proposes that if people are predisposed to behave in certain ways in certain situations, then holding them at fault or blame for unwanted actions does not make good sense.
Non-ambulatory
Not able to walk.
Nystagmus
Involuntary horizontal, vertical, or rotary movement of the eyeballs. See also vision after head injury.
Occipital Lobe
Region in the back of the brain which processes visual information. Damage to this lobe can cause visual deficits.
Occupational Therapy
Occupational Therapy is the therapeutic use of self-care, work and play activities to increase independent function, enhance development and prevent disability; may include the adaptation of a task or the environment to achieve maximum independence and to enhance the quality of life. The term occupation, as used in occupational therapy, refers to any activity engaged in for evaluating, specifying and treating problems interfering with functional performance.
Open Head Injury
Skull is broken and the brain is exposed after an injury to the head.
Optic Chiasm: Located near the back of the eyes, the optic nerves carrying these signals meet at this "crossing" where optic fibers from the inner half of each retina cross to the opposite hemisphere of the brain.
Orientation
Awareness of one's environment and/or situation, along with the ability to use this information appropriately in a functional setting.
Orthopedics
The branch of medicine devoted to the study and treatment of the skeletal system, its joints, muscles and associated structures.
Orthosis
Splint or brace designed to improve function or provide stability.
Outcome-Oriented Model
Identifies areas of agreement between people that are related to the goals of their assistance. This model stresses the accomplishments and successes of the person in question.
Outpatient
The patient residing outside the hospital but returning on a regular basis for one or more therapeutic services.
Paraplegia
Paralysis of the legs (from the waist down).
Parietal Lobe
Caps the top of the brain behind the central fissure and merges into the occipital lobe. Responds to touch, heat, cold, pain, and body awareness; injury to the parietal lobe can cause a loss of these sensing abilities.
Partial Seizures: Arise from disturbances in specific, localized areas of one hemisphere of the brain; subclassified as simple partial or complex partial.
Perception
The ability to make sense of what one sees, hears, feels, tastes or smells. Perceptual losses are often very subtle, and the patient and/or family may be unaware of them.
Perseveration
The inappropriate persistence of a response in a current task which may have been appropriate for a former task. Perseverations may be verbal or motoric.
Persistent Vegetative State (PVS)
A long-standing condition in which the patient utters no words and does not follow commands or make any response that is meaningful.
Person-Centered Treatment Plan: Inclusion of the individual, whenever possible, in the development and design of the treatment plan as well as discussion of expected discharge site, outcome criteria, goals, objectives, and treatment methods.
Phonation
The production of sound by means of vocal cord vibration.
Physiatrist
Pronounced Fizz ee at' rist. A physician who specializes in physical medicine and rehabilitation. Some physiatrists are experts in neurologic rehabilitation, trained to diagnose and treat disabling conditions. The physiatrist examines the patient to assure that medical issues are addressed; provides appropriate medical information to the patient, family members and members of the treatment team. The physiatrist follows the patient closely throughout treatment and oversees the patient's rehabilitation program.
Physical Therapist
The physical therapist evaluates components of movement, including: muscle strength, muscle tone, posture, coordination, endurance, and general mobility. The physical therapist also evaluates the potential for functional movement, such as ability to move in the bed, transfers and walking and then proceeds to establish an individualized treatment program to help the patient achieve functional independence.
Pia Mater
Tender matter which molds around every tiny crook and crevice on the brain's surface.
Plasticity
The ability of cellular or tissue structures and their resultant function to be influenced by an ongoing activity.
Plateau
A temporary or permanent leveling off in the recovery process.
Pons
Bridge of nerve fibers just above the medulla that connect the cerebral cortex and the cerebellum.
Positive Reciprocal Relationship
Also called positive reciprocity, this occurs when an exchange of reinforcers develops into a consistent pattern.
Post-concussion Symptoms
May or may not persist and include: headache, dizziness, vomiting, sleep disturbance, memory problems, changes in personality, irritability, depression, changes in personality, difficulty in problem solving, diminished attention span.
Postictal State: Person awakens after seizure to a state of confusion, extreme fatigue and no memory of the seizure.
Post Traumatic Amnesia (PTA)
A period of hours, weeks, days or months after the injury when the patient exhibits a loss of day-to-day memory. The patient is unable to store new information and therefore has a decreased ability to learn. Memory of the PTA period is never stored, therefore things that happened during that period cannot be recalled. May also be called Anterograde Amnesia.
Posture
The attitude of the body. Posture is maintained by low-grade, continuous contraction of muscles which counteract the pull of gravity on body parts. Injury to the nervous system can impair the ability to maintain normal posture, for example holding up the head.
Pre-Morbid Condition
Characteristics of an individual present before the disease or injury occurred.
Prefrontal Cortex
Located at the very front part of the frontal lobes (right over one’s eyebrows), the prefrontal cortex is responsible for various emotional responses to circumstances.
Prolonged Coma or Minimally Conscious State
Individuals still can breathe and their hearts beat, even without life supporting equipment. For individuals with minimal levels of consciousness, there may also be some minimal level of awareness to basic stimulations, i.e., touch, light, temperature.
Problem-Solving Skill
Ability to consider the probable factors that can influence the outcome of each of various solutions to a problem, and to select the most advantageous solution. Individuals with deficits in this skill may become "immobilized" when faced with a problem. By being unable to think of possible solutions, they may respond by doing nothing.
Prognosis
The prospect as to recovery from a disease or injury as indicated by the nature and symptoms of the case.
Polydipsia: Excessive thirst
Program/Service Categories
The following program/service categories describe the array of organized services (not mutually exclusive). This is not an exhaustive list available for the rehabilitation of persons with brain injury:
Acute Rehabilitation
Based in a medical facility; accepts patient as soon as medically stable; focuses on intensive physical and cognitive restorative services in early months after injury; typical length of stay one week to several months (short term); identifiable team and program with specialized unit.
Behavior Disorders
For the patient exhibiting patterns of behavior preventing participation in active rehabilitation, including destructive patient behavior to self and others; continuum of controlled settings.
Community Integration Program
Provides services designed to accomplish functional outcomes focused on home and community integration, including productive activity. Services may be provided in residential facilities, day treatment programs, the consumer's home. They may be of short-term (several weeks) or long-term duration (several months).
Independent Living
Community-based to maximize a person's ability to be empowered and self-directed; allows an individual to live in one's own home with maximum personal control over how services are delivered, combined with the opportunity to work as appropriate.
Lifelong Living
For persons discharged from rehabilitation who need ongoing lifetime supports; located in residential or skilled nursing environment; structured activities available on individual and group basis.
Postacute Rehabilitation
Are programs designed to provide intensive, 24-hour rehabilitation to improve cognitive, physical, emotional, and psychosocial abilities, to facilitate better independent living skills. Facilities typically provide a full spectrum of clinical therapies, as well as life-skills training in a residential setting.
Residential Services
Assumes a 24-hour residential environment outside the home and includes 24-hour provision of or access to support personnel capable of meeting the client's needs. (Adopted by the PostAcute Committee of ISIG on Head Injury October 28, 1991.)
Subacute
May follow a period of acute rehabilitation; not necessarily hospital based; typical length of rehabilitation stay 6-24 months (short to intermediate term); stay based on demonstrated improvement; identifiable team and program with specialized unit.
Supervised Living
Setting is a home which is like other homes in the neighborhood in terms of size and number of residents. Consumers are provided individualized care, supervision, support and training services to maximize and/or maintain function and self-direction. Staff is present at night and other times when the consumer is present.
Supported Independent Living
Setting is a home chosen by the consumer who is primarily independent. Program offers support to assist the resident in maximizing and/or maintaining independence and self-direction. Staff is available as needed and at planned intervals to offer assistance and support but not to provide supervision.
Transitional Living
Non-medical residential program providing training for living in a setting of greater independence. The primary focus is on teaching functional skills and compensating for abilities that cannot be restored.
Vocational Evaluation
An organized and comprehensive service staffed by specialists who systematically and comprehensively utilize work activities (real or simulated) and/or educational services as the focal point for educational and vocational assessment and exploration. In addition, psychological testing, counseling, social summaries, occupational information, etc., are other evaluation tools that are used. It incorporates the medical, psychological, social, vocational, educational, cultural, and economic data for establishment and attainment of individual goals.
Prone
Lying on one's stomach.
Proprioception
The sensory awareness of the position of body parts with or without movement. Combination of kinesthesia and position sense.
Psychologist
A professional specializing in counselling, including adjustment to disability. Psychologists use tests to identify personality and cognitive functioning. This information is shared with team members to assure consistency in approaches. The psychologist may provide individual or group psychotherapy for the purpose of cognitive retraining, management of behavior and the development of coping skills by the patient/client and members of the family.
Range of Motion (ROM)
Refers to movement of a joint (important to prevent contractures).
Reasoning, Abstract
Mode of thinking in which the individual recognizes a phrase that has multiple meanings and selects the meaning most appropriate to a given situation. The term "abstract" typically refers to concepts not readily apparent from the physical attributes of an object or situation.
Reasoning, Concrete
The ability to understand the literal meaning of a phrase.
Reasoning, Problem-Solving
The ability to analyze information related to a given situation and generate appropriate response options. Problem-solving is a sequential process that typically proceeds as follows: identification of problem; generation of response options; evaluation of response option appropriateness; selection and testing of first option; analysis as to whether solution has been reached. A patient/client may discontinue making a cup of coffee because the sugar bowl is empty, even though sugar is readily available in a nearby cabinet. A patient/client may easily navigate his way into a room crowded with furniture, but request staff assistance to navigate his way out.
Reasoning, Sequencing
The ability to organize information or objects according to specified rules, or the ability to arrange information or objects in a logical, progressive manner. Nearly every activity, including work and leisure tasks, requires sequencing. For example, in cooking certain foods it is important that ingredients be added and mixed in a specified order; in dressing, undergarments must be put on prior to outer garments.
Receptive Communication
Ability to understand others through speech and language.
Recreation Therapist
Individual within the facility responsible for developing a program to assist persons with disabilities plan and manage their leisure activities; may also schedule specific activities and coordinate the program with existing community resources.
Rehabilitation
Comprehensive program to reduce/overcome deficits following injury or illness, and to assist the individual to attain the optimal level of mental and physical ability.
Rehabilitation Counselor
Also called Vocational Counselor. A specialist in social and vocational issues who helps the patient develop the skills and aptitudes necessary for return to productive activity and the community.
Rehabilitation Facility
Agency of multiple, coordinated services designed to minimize for the individual the disabling effects of one's physical, mental, social, and/or vocational difficulties and to help realize individual potential.
Rehabilitation Nurse
A nurse specializing in rehabilitation techniques as well as basic nursing care. Nurses assist the patient and family in acquiring new information, developing skills, achieving competence and exhibiting behaviors that contribute to the attainment of a healthy state.
Reticular Activating System (RAS)
Collection of nerve fibers and nuclei within the brainstem that modulates or changes arousal, alertness, concentration, and basic biological rhythms.
Retrograde Amnesia
Inability to recall events that occurred prior to the accident; may be a specific span of time or type of information.
Seizure
An uncontrolled discharge of nerve cells which may spread to other cells nearby or throughout the entire brain. It usually lasts only a few minutes. It may be associated with loss of consciousness, loss of bowel and bladder control and tremors. May also cause aggression or other behavioral change.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Antidepressant medications.
Self-Determination: Concept of saying individual freedom that builds on the principles of informed consent, right to refuse, and consumer empowerment.
Self-Help Skills
Include bathing, dressing, eating, grooming, and toileting. These are often referred to as activities of daily living (ADL skills). They are central to reaching a basic level of independence.
Sensation
Feeling stimuli which activate sensory organs of the body, such as touch, temperature, pressure and pain. Also seeing, hearing, smelling and tasting.
Sensorimotor
Refers to all aspects of movement and sensation and the interaction of the two.
Sensorimotor Impairments
Changes affecting muscles groups and sensory modalities. Depending on the location and extent of injury to the brain, sensorimotor impairments can be localized to one extremity or side of the body or generalized.
Sensory Integration
Interaction of two or more sensory processes in a manner that enhances the adaptiveness of the brain.
Sequencing
Reading, listening, expressing thoughts, describing events or contracting muscles in an orderly and meaningful manner.
Severe Brain Injury: Characteristics include: coma longer than 24 hours, often lasting days or weeks; Glasgow Coma Scale of 8 or less; bruising, bleeding in brain; signs on EEG, CAT or MRI scans; long term impairments
Sheltered Workshop
A work setting certified as such by the Wage & Hour Division. It provides transitional and/or long-term employment in a controlled and protected working environment for those who are unable either to compete or to function in the open job market due to their disabilities. May provide vocational evaluation and work adjustment services.
Shunt
A procedure to draw off excessive fluid in the brain. A surgically-placed tube running from the ventricles which deposits fluid into either the abdominal cavity, heart or large veins of the neck.
Simple Partial Seizures: Formerly known as focal motor or jacksonian seizures, person does not lose consciousness. Abnormal, localized electrical activity in the motor area of the brain may result in motor symptoms such as stiffening or jerking of muscles, eye movements, and unusual tongue movement, blinking and facial twitching.
Somatosensory
Sensory activity having its origin elsewhere than in the special sense organs (such as eyes and ears) and conveying information to the brain about the state of the body proper and its immediate environment.
Spasticity
An involuntary increase in muscle tone (tension) that occurs following injury to the brain or spinal cord, causing the muscles to resist being moved. Characteristics may include increase in deep tendon reflexes, resistance to passive stretch, clasp knife phenomenon, and clonus.
Spatial Ability
Ability to perceive the construction of an object in both two and three dimensions. Spatial ability has four components: the ability to perceive a static figure in different positions, the ability to interpret and duplicate the movements between various parts of a figure, the ability to perceive the relationship between an object and a person's own body sphere, and the ability to interpret the person's body as an object in space.
Speech-language Pathology Services
A continuum of services including prevention, identification, diagnosis, consultation, and treatment of patients regarding speech, language, oral and pharyngeal sensorimotor function.
Spontaneous Recovery
The recovery which occurs as damage to body tissues heals. This type of recovery occurs with or without rehabilitation and it is very difficult to know how much improvement is spontaneous and how much is due to rehabilitative interventions. However, when the recovery is guided by an experienced rehabilitation team, complications can be anticipated and minimized; the return of function can be channeled in useful directions and in progressive steps so that the eventual outcome is the best that is possible.
Status Epilepticus
Seizure that lasts longer than 5 minutes, or two or more seizures without time between for the person to recover consciousness.
Subdural
Beneath the dura (tough membrane) covering the brain and spinal cord.
Supine
Lying on one's back.
Suppository
Medicine contained in a capsule which is inserted into the rectum so that the medicine can be absorbed into the blood stream.
Surveillance: Ongoing and systematic collection, analysis and interpretation of data used to describe and monitor a health event.
Tactile Defensiveness
Being overly sensitive to touch; withdrawing, crying, yelling or striking when one is touched.
Tardive Dyskinesia: Side effect of antipsychotic medications resulting in involuntary movement disorder characterized by lip smacking, rhythmic darting of the tongue, chewing movements, aimless movements of the arms and legs and in severe cases, difficulty breathing and swallowing.
Task Analysis
Breakdown of a particular job into its component parts; information gained from task analysis can be utilized to develop training curricula or to price a product or service.
TBI Model Systems
Research centers involved in prospective, longitudinal multi-center efforts to examine the course of recovery and outcomes following TBI.
Temporal Lobes
There are two temporal lobes, one on each side of the brain located at about the level of the ears. These lobes allow a person to tell one smell from another and one sound from another. They also help in sorting new information and are believed to be responsible for short-term memory.
Right Lobe--Mainly involved in visual memory (i.e., memory for pictures and faces).
Left Lobe--Mainly involved in verbal memory (i.e., memory for words and names).
Thalamus: Sits on the very top of the brain stem just beneath the cortex. Acts as a major relay station for incoming and outgoing sensory information. Each sense (except smell) relays its impulses through the thalamus.
Tonic
Excessive muscle tension/contraction
Tonic-Clonic Seizures
Formerly known as grand mal, there is abrupt loss of consciousness. Body stiffens in tonic contraction at onset. Person may cry out, drop unconscious to the ground, roll up eyes or turn to the side, and bite tongue.
Tracheostomy
A temporary surgical opening at the front of the throat providing access to the trachea or windpipe to assist in breathing.
Tracking, Visual
Visually following an object as it moves through space. See also vision after head injury.
Traumatic Brain Injury: Defined under the Individuals with Disabilities Education Act as: "...an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; problem–solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma." (Section 300.7b[12] 1999)
Traumatic Brain Injury Act: Passed in 1996, this federal legislation expanded efforts for effective prevention, biomedical research and the improvement of services through state demonstration projects.
Tremor, Intention
Course, rhythmical movements of a body part that become intensified the harder one tries to control them.
Tremor, Resting
Rhythmical movements present at rest and may be diminished during voluntary movement.
Unilateral Neglect
Paying little or no attention to things on one side of the body. This usually occurs on the side opposite from the location of the injury to the brain because nerve fibers from the brain typically cross before innervating body structures. In extreme cases, the patient may not bathe, dress or acknowledge one side of the body.
Urinary Tract Infection
When bacteria have reproduced to a large number in the bladder. This can cause fever, chills, burning on urination, urgency, frequency, incontinence or foul smelling urine.
Verbal Apraxia
Impaired control of proper sequencing of muscles used in speech (tongue, lips, jaw muscles, vocal cords). These muscles are not weak but their control is defective. Speech is labored and characterized by sound reversals, additions and word approximations.
Vestibular
Pertaining to the vestibular system in the middle ear and the brain which senses movements of the head. Disorders of the vestibular system can lead to dizziness, poor regulation of postural muscle tone and inability to detect quick movements of the head.
Vocational Skills refer to behaviors needed to get and keep a job. This domain includes everything from simple on-task behavior in a structured workshop setting to higher-level cognitive functions in competitive employment.
Wernicke's Area: Located in the left temporal parietal lobe; governs a person’s understanding of speech and the ability to make sense of the thoughts that are spoken
Definitions Source:
Brain Injury Association of America
Training Manual for Certified Brain Injury Specialists, Third Edition 2004
HDI Publishers
PO Box 131401
Houston, TX 77219
Toll Free (800) 321-7037
Fax (713) 526-7787
Local (713) 526 6900
www.hdipub.com
"A" stands for antecedents to the behavior. "B" is for the behavior. "C" is for consequences to the behavior. A-B-C data collects information, not only on unwanted behavior, but also on what immediately precedes and follows the behavior.
Absence Seizures
Formerly known as petit mal, there is transient loss of consciousness. Person may cease physical movement, have loss of attention or stare vacantly, neither speaking nor apparently hearing what is said. There may be excessive eye blinking, staring or chewing movements. Seizures so brief that may not be recognized.
Abstract Concept
A concept or idea not related to any specific instance or object and which potentially can be applied to many different situations or objects. Persons with cognitive deficits often have difficulty understanding abstract concepts.
Abstract Thinking
Being able to apply abstract concepts to new situations and surroundings.
Abulia
Absence or inability to exercise will-power or to make decisions. Also, slow reaction, lack of spontaneity, and brief spoken responses. Usually associated with damage to a cerebellar vessel. See also cerebellum.
Acalculia
The inability to perform simple problems of arithmetic. See also parietal lobe.
Active Treatment Interaction
Very broad concept that avoids caring for a person in a custodial sense or behaving in ways that are likely to increase dependency within the relationship. The term implies directed action, teaching and a certain degree of risk taking.
Acquired Brain Injury
An injury to the brain occurring after birth that is not hereditary, congenital or degenerative; does not refer to brain injuries induced by birth trauma.
Acute Care
The phase of managing health problems which is conducted in a hospital on patients needing medical attention.
Acute Rehabilitation Program
Primary emphasis is on the early phase of rehabilitation which usually begins as soon as the patient is medically stable. The program is designed to be comprehensive and based in a medical facility with a typical length of stay of 1-3 months. Treatment is provided by an identifiable team in a designated unit. See Program/Service Types.
ADA
Americans with Disabilities Act
Adaptive/Assistive Equipment
A special device which assists in the performance of self-care, work or play/leisure activities or physical exercise. See also adaptive equipment catalog.
ADL
Activities of daily living. Routine activities carried out for personal hygiene and health (including bathing, dressing, feeding) and for operating a household.
Affect
The observable emotional condition of an individual at any given time. See also frontal lobe.
Agnosia
Failure to recognize familiar objects although the sensory mechanism is intact. May occur for any sensory modality.
Agraphia
Inability to express thoughts in writing. See also parietal lobe.
Akathia
Inability to sit or stand still; motor restlessness.
Akinesia
Slowness and loss of movement.
Alexia
Inability to read. See also parietal lobe.
Ambulate
To walk.
Amnesia
Lack of memory about events occurring during a particular period of time. See also: anterograde amnesia, retrograde amnesia, post-traumatic amnesia.
Amygdala
Close to the hippocampus, the amygdala is a "fight - flight" structure closely tied with emotional memories and reactions.
Aneurysm
A balloon-like deformity in the wall of a blood vessel. The wall weakens as the balloon grows larger, and may eventually burst, causing a hemorrhage.
Anomia
Inability to recall names of objects. Persons with this problem often can speak fluently but have to use other words to describe familiar objects. See also parietal lobe.
Anosognosia
Lack of awareness of deficits.
Anosmia
Loss of the sense of smell.
Anoxia
A lack of oxygen. Cells of the brain need oxygen to stay alive. When blood flow to the brain is reduced or when oxygen in the blood is too low, brain cells are damaged.
Anterograde Amnesia
Inability to consolidate information about ongoing events. Difficulty with new learning.
Anticonvulsant
Medication used to decrease the possibility of a seizure (e.g., Dilantin, Phenobarbital, Mysoline, Tegretol). See also pharmacology guide.
Antidepressants
Medication used to treat depression. See also pharmacology guide.
Anxiolytoics
Anti-anxiety medication.
Aphasia
Loss of the ability to express oneself and/or to understand language. Caused by damage to brain cells rather than deficits in speech or hearing organs. See also frontal and temporal lobes.
Apraxia
Inability to carry out a complex or skilled movement; not due to paralysis, sensory changes, or deficiencies in understanding. See also parietal lobe.
Aprosodia
A condition in which there is a loss of production or comprehension of the meaning of different tones of voice.
Aspiration
Inhalation of foods, liquids or vomitus into the lungs.
Arachnoid
Like a spider web that bridges the brain's many wrinkles and folds.
Arousal
Being awake. Primitive state of alertness managed by the reticular activating system (extending from medulla to the thalamus in the core of the brain stem) activating the cortex. Cognition is not possible without some degree of arousal. See also brain stem.
Articulation
Movement of the lips, tongue, teeth and palate into specific patterns for purposes of speech. Also, a movable joint.
Aspiration
When fluid or food enters the lungs through the wind pipe. Can cause a lung infection or pneumonia.
Astereognosia
Inability to recognize things by touch. See also parietal lobe.
Ataxia
A problem of muscle coordination not due to apraxia, weakness, rigidity, spasticity or sensory loss. Caused by lesion of the cerebellum or basal ganglia. Can interfere with a person's ability to walk, talk, eat, and to perform other self care tasks. See also cerebellum.
Attendant Care
Provision of assistance in activities of daily living for a person with disability. Daily number of hours of required assistance, either physical or supervisory.
Atrophy
A wasting away or decrease in size of a cell, tissue, organ, or part of the body caused by lack of nourishment, inactivity or loss of nerve supply.
Attention/Concentration
The ability to focus on a given task or set of stimuli for an appropriate period of time.
Audiologist
One who evaluates hearing defects and who aids in the rehabilitation of those who have such defects.
Augmentative and Alternative Communication
Use of forms of communication other than speaking, such as: sign language, "yes, no" signals, gestures, picture board, and computerized speech systems to compensate (either temporarily or permanently) for severe expressive communication disorders.
Axon
A long, slim "wire" in the neuron that transmits signals from one cell body to another via junctions known as synapses.
Basal Ganglia
Four nerve cell clusters of the basal ganglia or "nerve knots" help handle physical movements by relaying information from the cerebral cortex to the brainstem and cerebellum.
Balance
The ability to use appropriate righting and equilibrium reactions to maintain an upright position. It is usually tested in sitting and standing positions.
Behavior
The total collection of actions and reactions exhibited by a person. See also Working with Behavior Disorders.
Bilateral
Pertaining to both right and left sides.
Brain Injury, Acquired
The implication of this term is that the individual experienced normal growth and development from conception through birth, until sustaining an insult to the brain at some later time which resulted in impairment of brain function.
Brain Injury, Closed
Occurs when the head accelerates and then rapidly decelerates or collides with another object (for example the windshield of a car) and brain tissue is damaged, not by the presence of a foreign object within the brain, but by violent smashing, stretching, and twisting, of brain tissue. Closed brain injuries typically cause diffuse tissue damage that results in disabilities which are generalized and highly variable.
Brain Injury, Mild
A patient with a mild traumatic brain injury is a person who has had a traumatically-induced physiological disruption of brain function, as manifested by at least one of the following: 1) any period of loss of consciousness, 2) any loss of memory for events immediately before or after the accident, 3) any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused), 4) focal neurological deficit(s) which may or may not be transient; but where the severity of the injury does not exceed the following: a) loss of consciousness of approximately 30 minutes or less; b) after 30 minutes, an initial Glasgow Coma Scale score of 13-15; c) Post Traumatic Amnesia not greater than 24 hours.
Brain Injury, Traumatic
Damage to living brain tissue caused by an external, mechanical force. It is usually characterized by a period of altered consciousness (amnesia or coma) that can be very brief (minutes) or very long (months/indefinitely). The specific disabling condition(s) may be orthopedic, visual, aural, neurologic, perceptive/cognitive, or mental/emotional in nature. The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congential disorders, birth trauma or degenerative processes.
Brain Plasticity
The ability of intact brain cells to take over functions of damaged cells; plasticity diminishes with maturation.
Brain Scan
An imaging technique in which a radioactive dye (radionucleide) is injected into the blood stream and then pictures of the brain are taken to detect tumors, hemorrhages, blood clots, abscesses or abnormal anatomy.
Brain Stem
The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brain stem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert).
Brocca’s Area
Located in the lower portion of the motor cortex in the left frontal– temporal lobe; controls muscles of the face and mouth and enables the production of speech.
Case Management
Facilitating the access of a patient to appropriate medical, rehabilitation and support programs, and coordination of the delivery of services. This role may involve liaison with various professionals and agencies, advocacy on behalf of the patient, and arranging for purchase of services where no appropriate programs are available.
Catheter
A flexible tube for withdrawing fluids from, or introducing fluids into, a cavity of the body. Frequently used to drain the urinary bladder (Foley catheter).
Cellulitis
Inflammation of the skin.
Cerebellum
Located in the lower back section of the brain, the cerebellum is the "movement" part of the brain that coordinates, modulates, and stores all body movement.
Cerebral Cortex
This is divided into two hemispheres dedicated to the highest levels of thinking, moving, and acting. The right and left hemispheres are further divided into four lobes – frontal, parietal, temporal and occipital.
Cerebral-spinal Fluid (CSF)
Liquid which fills the ventricles of the brain and surrounds the brain and spinal cord.
Chronic
Marked by long duration or frequent recurrence.
Circumlocution
Use of other words to describe a specific word or idea which cannot be remembered.
Client
A person under the protection of another; one who engages the professional advice or services of another. See Consumer and Patient.
Clonic
Alternating contraction and relaxation of muscles.
Clonus
A sustained series of rhythmic jerks following quick stretch of a muscle.
Closed Head Injury
Injury to the head in which the skull remains intact.
Cognition
Conscious process of knowing or being aware of thoughts or perceptions, including understanding and reasoning.
Cognitive Impairment
Difficulty with perception, memory, attention and reasoning skills.
Cognitive Rehabilitation
Therapy programs which aid persons in the management of specific problems in perception, memory, thinking and problem solving. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits. The interventions are based on an assessment and understanding of the person's brain-behavior deficits and services are provided by qualified practitioners.
Cogwheel Rigidity
Rigidity with little jerks when the muscles in the arms and legs are stretched by the examiner.
Coma
A state of unconsciousness from which the patient cannot be awakened or aroused, even by powerful stimulation; lack of any response to one's environment. Defined clinically as an inability to follow a one-step command consistently; Glasgow Coma Scale score of 8 or less.
Communicative Disorder
An impairment in the ability to 1) receive and/or process a symbol system, 2) represent concepts or symbol systems, and/or 3) transmit and use symbol systems. The impairment may be observed in disorders of hearing, language, and/or speech processes.
Community Skills
Those abilities needed to function independently in the community. They may include: telephone skills, money management, pedestrian skills, use of public transportation, meal planning and cooking.
Complex Partial Seizures
Formerly known as psychomotor or temporal lobe seizures, consciousness is impaired. May be a warning or aura. Seizures usually last one to three minutes and may be followed by some confusion.
Comprehension
Understanding of spoken, written, or gestural communication.
Concentration
Maintaining attention on a task over a period of time; remaining attentive and not easily diverted.
Concrete Thinking
A style of thinking in which the individual sees each situation as unique and is unable to generalize from the similarities between situations. Language and perceptions are interpreted literally so that a proverb such as "a stitch in time saves nine" cannot be readily grasped.
Concussion
The common result of a blow to the head or sudden deceleration usually causing an altered mental state, either temporary or prolonged. Physiologic and/or anatomic disruption of connections between some nerve cells in the brain may occur. Often used by the public to refer to a brief loss of consciousness.
Confusion
A state in which a person is bewildered, perplexed, or unable to self-orient.
Conjugate Movement
Both eyes move simultaneously in the same direction. Convergence of the eyes toward the midline (crossed eyes) is a disconjugate movement.
Contracture
Abnormal, usually permanent condition of a joint characterized by flexion and fixation due to wasting away and abnormal shortening of muscle fibers and loss of skin elasticity.
Convergence
Movement of two eyeballs inward to focus on an object moved closer. The nearer the object, the greater is the degree of convergence necessary to maintain single vision. See also vision after head injury.
Corpus Callosum
Complex band of nerve fibers that exchanges information between the two hemispheres.
Cortical Blindness
Loss of vision resulting from a lesion of the primary visual areas of the occipital lobe. Light reflex is preserved.
Cortex
“Thinking” part of the brain.
Corti
Organ where transmitted sound waves vibrate thousands of tiny sensitive hairs. Each hair is connected to thousands of nerve fibers, which send signals through the eighth cranial (acoustic) nerve to the brainstem. There, many of the nerve fibers cross over before taking signals up to the tops of the temporal lobes for analysis.
Coup-Contra-Coup
Effect when the back of the head is struck and the front of the brain is injured by the brain bouncing back and forth.
CT Scan/Computerized Axial Tomography
A series of X-rays taken at different levels of the brain that allows the direct visualization of the skull and intracranial structures. A scan is often taken soon after the injury to help decide if surgery is needed. The scan may be repeated later to see how the brain is recovering.
Decerebrate Posture (Decerebrate Rigidity)
Exaggerated posture of extension as a result of a lesion to the prepontine area of the brain stem, and is rarely seen fully developed in humans. In reporting, it is preferable to describe the posture seen.
Decorticate Posture (Decorticate Rigidity)
Exaggerated posture of upper extremity flexion and lower extremity extension as a result of a lesion to the mesencephalon or above. In reporting, it is preferable to describe the posture seen.
Decubitus
Pressure area, bed sore, skin opening, skin breakdown. A discolored or open area of skin damage caused by pressure. Common areas most prone to breakdown are buttocks or backside, hips, shoulder blades, heels, ankles and elbows.
Dendrites
Networks of short "wires" in the neuron that branch out from a cell body and synapse with the ends of axons from other neurons.
Diencephalon
Located centimeters above the midbrain, the diencephalon is made up of the thalamus, hypothalamus, and other structures. It is a master relay center for forwarding information, sensations, and movement.
Diffuse Axonal Injury (DAI)
A shearing injury of large nerve fibers (axons covered with myelin) in many areas of the brain. It appears to be one of the two primary lesions of brain injury, the other being stretching or shearing of blood vessels from the same forces, producing hemorrhage.
Diffuse Brain Injury
Injury to cells in many areas of the brain rather than in one specific location.
Diplopia
Seeing two images of a single object; double vision. See also vision after head injury.
Discipline
When referring to health care or education it means a particular field of study, such as medicine, occupational therapy, nursing, recreation therapy or others.
Disinhibition
Inability to suppress (inhibit) impulsive behavior and emotions.
Disorientation
Not knowing where you are, who you are, or the current date. Health professionals often speak of a normal person as being oriented "times three" which refers to person, place and time.
Dorsiflexion
When applied to the ankle, the ability to bend at the ankle, moving the front of the foot upward.
Dura Matter
Outer hard matter of the brain, which is like a heavy plastic covering.
Dysarthria
Difficulty in forming words or speaking them because of weakness of muscles used in speaking or because of disruption in the neuromotor stimulus patterns required for accuracy and velocity of speech.
Dysphagia
A swallowing disorder characterized by difficulty in oral preparation for the swallow, or in moving material from the mouth to the stomach. This also includes problems in positioning food in the mouth.
Edema
Collection of fluid in the tissue causing swelling.
Electroencephalogram (EEG)
A procedure that uses electrodes on the scalp to record electrical activity of the brain. Used for detection of epilepsy, coma, and brain death.
Electromyography (EMG)
An insertion of needle electrodes into muscles to study the electrical activity of muscle and nerve fibers. It may be somewhat painful to the patient. Helps diagnose damage to nerves or muscles.
Emotional Lability
Exhibiting rapid and drastic changes in emotional state (laughing, crying, anger) inappropriately without apparent reason.
Empathy
Ability to identify with and understand another person's feelings or difficulties.
Endotracheal Tube
A tube that serves as an artificial airway and is inserted through the patient's mouth or nose. It passes through the throat and into the air passages to help breathing. To do this it must also pass through the patient's vocal cords. The patient will be unable to speak as long as the endotracheal tube is in place. It is this tube that connects the respirator to the patient.
Executive Functioning
The ability to plan, initiate, direct, and monitor one's activities. Involves organizing, planning, creating, evaluating and initiating projects and activities.
Extinction
The ability to plan, initiate, direct and monitor one's activities. Involves organizing, planning, creating, evaluating and initiating projects and activities.
Evoked Potential
Registration of the electrical responses of active brain cells as detected by electrodes placed on the surface of the head at various places. The evoked potential, unlike the waves on an EEG, is elicited by a specific stimulus applied to the visual, auditory or other sensory receptors of the body. Evoked potentials are used to diagnose a wide variety of central nervous system disorders.
Extended Care Facility-Basic
Residential facility which supplies 24-hour nursing care and supervision and assistance with activities of daily life. See Program/Service Types.
Extended Care Facility-Skilled
A residential facility for the patient who requires 24-hour nursing care (IV, intramuscular injections, special feeding tubes, skin care, oxygen) and rehabilitative therapy, such as physical therapy, occupational therapy, or speech therapy on a less intensive basis than as an inpatient in a comprehensive rehabilitation center. An extended care facility can be a short-term alternative (a few months) prior to placement at home (with outpatient therapy) or in a nursing home. See Program/Service Types.
Extremity
Arm or leg.
Figure-Ground
The differentiation between the foreground and the background of a scene; this refers to all sensory systems, including vision, hearing, touch.
Flaccid
Lacking normal muscle tone; limp.
Flexion
Bending a joint.
Foley Catheter
This is a tube inserted into the urinary bladder for drainage of urine. The urine drains through the tube and collects into a plastic bag.
Frontal Lobes
Include everything in front of the central fissure. When injured or damaged, an individual's ability to synthesize signals from the environment, assign priorities, make decisions, initiate actions, control emotions, behave and interact socially, make plans and other executive like functions are severely compromised.
Frustration Tolerance
The ability to persist in completing a task despite apparent difficulty. Individuals with a poor frustration tolerance will often refuse to complete tasks which are the least bit difficult. Angry behavior, such as yelling or throwing things while attempting a task is also indicative of poor frustration tolerance.
Gainful Occupation
Includes employment in the competitive labor market, practice of a profession, farm or family work (including work for which payment is "in kind" rather than in cash), sheltered employment, work activity (to the extent that there is net pay), and home industries or other home-bound work.
Gait Training
Instruction in walking, with or without equipment; also called "ambulation training."
Generalized Seizures
Sudden burst of abnormal, generalized discharges that usually affect both hemispheres; sub-classified as tonic-clonic and absence seizure.
GI Tube
A tube inserted through a surgical opening into the stomach. It is used to introduce liquids, food, or medication into the stomach when the patient is unable to take these substances by mouth.
Glasgow Coma Scale
A standardized system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The system involves three determinants: eye opening, verbal responses and motor response all of which are evaluated independently according to a numerical value that indicates the level of consciousness and degree of dysfunction. Scores run from a high of 15 to a low of 3. Persons are considered to have experienced a `mild' brain injury when their score is 13 to 15. A score of 9 to 12 is considered to reflect a `moderate' brain injury and a score of 8 or less reflects a 'severe' brain injury.
Glial Cells
Non-communicating ("glue") cells that support and nourish the neurons.
Head Injury
Refers to an injury of the head and/or brain, including lacerations and contusions of the head, scalp and/or forehead. See also Brain Injury.
Hematoma
The collection of blood in tissues or a space following rupture of a blood vessel; types include:
Epidural--Outside the brain and its fibrous covering, the dura, but under the skull.
Subdural--Between the brain and its fibrous covering (dura).
Intracerebral--In the brain tissue.
Subarachnoid--Around the surfaces of the brain, between the dura and arachnoid membranes.
Hemianopsia Hemianopia
Visual field cut. Blindness for one half of the field of vision. This is not the right or left eye, but the right or left half of vision in each eye. See also vision after head injury.
Hemiparesis
Weakness of one side of the body.
Hemiplegia
Paralysis of one side of the body.
Heterotopic Ossification (HO)
Creation of abnormal growth of bone in soft tissues or around joints.
Hippocampus
A paired–organ, one on each side of the brain sitting within the temporal lobes, "between your ears" so to speak. Most commonly associated with memory functioning.
Household management
Includes meal preparation, housekeeping, money management and other activities related to managing one’s home.
Hydrocephalus
Enlargement of fluid-filled cavities in the brain, not due to brain atrophy.
Hypothalamus
Control center for hunger, thirst, sexual rhythms, endocrine levels and temperature regulation. Also involved in many complex responses like anger, fatigue, memory and calmness. Serves as the "conductor" of a person’s emotional orchestra.
Hypoxia
Insufficient oxygen reaching the tissues of the body.
IEP
An individualized education plan for a student found eligible for special education and/or related services that designates the kinds and extent of services that the student needs.
Impulse Control
Refers to the individual's ability to withhold inappropriate verbal or motor responses while completing a task. Persons who act or speak without first considering the consequences are viewed as having poor impulse control.
Inclusion
Incorporation and welcome of the individual into the community, regardless of a disability.
Incontinent
Inability to control bowel and bladder functions. Many people who are incontinent can become continent with training.
Initiation Problems
Difficulty engaging in activities unless prompted.
Initiative
Refers to the individual's ability to begin a series of behaviors directed toward a goal.
Integration
Based on the expectation that people fit in, be alike and reach for similar standards.
Integumentary System
This is the organ system that protects the body from the outside. The system comprises skin and all appendages including hair, nails, sweat and sebaceous glands.
Interdependence
An interconnection or an interrelationship between two or more entities that suggests a partnership between entities that maximizes potential for both groups.
Interdependent Paradigm
Refers to a blended framework where people are seen to have gifts and capacities to build supports to engage community. Interdependence focuses on finding the points of connection between people.
Interdisciplinary Approach
A method of diagnosis, evaluation, and individual program planning in which two or more specialists, such as medical doctors, psychologists, recreational therapists, social workers, etc., participate as a team, contributing their skills, competencies, insights, and perspectives to focus on identifying the developmental needs of the person with a disability and on devising ways to meet those needs.
Internal Occurrence
Cause of injury to the brain by stroke, infectious disease, tumor, or loss of oxygen.
Intracranial Pressure (ICP)
Cerebrospinal fluid (CSF) pressure measured from a needle or bolt introduced into the CSF space surrounding the brain. It reflects the pressure inside of the skull.
Jargon
Spoken language that has a normal rate and rhythm but is full of nonsense words.
JCAHO
Joint Commission on the Accreditation of Healthcare Organizations, a national accreditation agency with standards for rehabilitation programs.
Job Analysis
Involves the systematic study of an occupation in terms of what the worker does in relation to data, people, and things; the methods and techniques employed, the machines, tools, equipment, and work aids used; the materials, products, subject matter or services which result, and the traits required of the worker
Kinesthesia
The sensory awareness of body parts as they move (see Position Sense and Proprioception)
Lability
State of having notable shifts in emotional state (e.g., uncontrolled laughing or crying).
Latency
Length of time that it takes a person to initiate (or complete) a behavior.
Leg Bag
A small, thick plastic bag that can be tied to the leg and collects urine. It is connected by tubing to a catheter inserted into the urinary bladder. See also Bowel and Bladder Training manual.
Leisure skills
These skills relate to the ability to use free time in ways that are not harmful (i.e., substance abuse, or other dangerous activities). In addition, to the recreational activities listed under community skills, this category includes reading, television, music and other activities done at home.
Limbic System
Located in the middle section of the brain, the limbic system sits on top of the brain stem and is involved in emotions and basic elemental feelings.
Locked-in Syndrome
A condition resulting from interruption of motor pathways in the ventral pons, usually by infarction. This disconnection of the motor cells in the lower brain stem and spinal cord from controlling signals issued by the brain leaves the patient completely paralyzed and mute, but able to receive and understand sensory stimuli; communication may be possible by code using blinking, or movements of the jaw or eyes, which can be spared.
Magnetic Resonance Imaging (MRI)
A type of diagnostic radiography using electromagnetic energy to create an image of soft tissue, central nervous system and musculoskeletal systems.
Magnitude
Measurement of intensity, which is especially important for unwanted behaviors; seldom used because of difficulty in objectively measuring the intensity of an aggressive or self-injurious response.
Malingering
To pretend inability so as to avoid duty or work.
Medical Model
Framework for delivering services that views a disability as a form of illness or sickness; most effective as a treatment model when the goal is to address sickness or establish medical stability.
Medical Paradigm
Refers to the scientific framework that reduces the focus of attention to the deficits or dysfunction of the person. The medical paradigm is very narrow and looks to fix people's major problems.
Medulla
First area in the lower part of the brain stem which is involved in many basic living functions. It contains reflex centers, which control many involuntary functions such as breathing, heart rate, blood pressure, swallowing, vomiting and sneezing.
Memory, Episodic
Memory for ongoing events in a person's life. More easily impaired than semantic memory, perhaps because rehearsal or repetition tends to be minimal.
Memory, Immediate
The ability to recall numbers, pictures, or words immediately following presentation. Patients with immediate memory problems have difficulty learning new tasks because they cannot remember instructions. Relies upon concentration and attention.
Memory, Long Term
In neuropsychological testing, this refers to recall thirty minutes or longer after presentation. Requires storage and retrieval of information which exceeds the limit of short term memory.
Memory, Short Term
Primary or 'working' memory; its contents are in conscious awareness. A limited capacity system that holds up to seven chunks of information over periods of 30 seconds to several minutes, depending upon the person's attention to the task.
Money Management
Ability to distinguish the different denominations of money, count money, make change, budget.
Meninges
Three membranes that cover the brain.
Midbrain
Smallest part of the brainstem and responsible for alertness and arousal.
Mild Brain Injury
Characteristics include: loss of consciousness for less than 30 minutes (or no loss); Glasgow Coma Scale of 13-15; posttraumatic amnesia for less than 24 hours; temporary or permanently altered mental or neurological state; post concussion symptoms.
Mobility
The ability to move about, either by walking, or with the aid of some form of assistive device such as a wheelchair, walker, or cane. A second aspect of mobility refers to the ability to transfer from one position to another. For example, transferring from a car to a wheelchair, or from standing with a walker to lying on a bed.
Moderate Brain Injury
Characteristics include: coma more than 20-30 min., but less than 24 hours; Glasgow Coma Scale of 9-12; possible skull fractures with bruising & bleeding; signs on EEG, CAT or MRI scans; some long term problems in one or more areas.
Motor Control
Regulation of the timing and amount of contraction of muscles of the body to produce smooth and coordinated movement. The regulation is carried out by operation of the nervous system.
Motor Planning
Action formulated in the mind before attempting to perform.
Muscle Tone
Used in clinical practice to describe the resistance of a muscle to being stretched. When the peripheral nerve to a muscle is severed, the muscle becomes flaccid (limp). When nerve fibers in the brain or spinal cord are damaged, the balance between facilitation and inhibition of muscle tone is disturbed. The tone of some muscles may become increased and they resist being stretched--a condition called hypertonicity or spasticity.
Mutual Reinforcement
Exchange of reinforcers or desired events between two or more people.
Myclonic Seizures
Sudden brief contraction of muscle groups, producing rapid jerky movements in one or more extremities of the entire body.
Nasogastric Tube (NG Tube)
A tube that passes through the patient's nose and throat and ends in the patient's stomach. This tube allows for direct "tube feeding" to maintain the nutritional status of the patient or removal of stomach acids.
Negative Reciprocal Relationship:
Also called negative reciprocity, this refers to relationships that involve ongoing exchange of unwanted events between people.
Negative Reinforcement
The removal of something unpleasant following a behavior that makes the behavior more likely to occur again.
Neglect
Paying little or no attention to a part of the body.
Neurochemical transmitters
Leap the synaptic gaps between each neuron's axon and the other neurons with which an axon makes contact.
Neologism
Nonsense or made-up word used when speaking. The person often does not realize that the word makes no sense.
Neurogenic Bladder
A neurologic impairment that affects bladder function.
Neurologist
A physician who specializes in the nervous system and its disorders.
Neurons: Billions and billions of tiny brain cells making up the nervous system which are the "communicators". Each neuron has a cell body, axon and dendrites.
Neuropsychologist
A psychologist who specializes in evaluating (by tests) brain/behavior relationships, planning training programs to help the survivor of brain injury return to normal functioning and recommending alternative cognitive and behavioral strategies to minimize the effects of brain injury. Often works closely with schools and employers as well as with family members of the injured person.
No Blame: Concept that proposes that if people are predisposed to behave in certain ways in certain situations, then holding them at fault or blame for unwanted actions does not make good sense.
Non-ambulatory
Not able to walk.
Nystagmus
Involuntary horizontal, vertical, or rotary movement of the eyeballs. See also vision after head injury.
Occipital Lobe
Region in the back of the brain which processes visual information. Damage to this lobe can cause visual deficits.
Occupational Therapy
Occupational Therapy is the therapeutic use of self-care, work and play activities to increase independent function, enhance development and prevent disability; may include the adaptation of a task or the environment to achieve maximum independence and to enhance the quality of life. The term occupation, as used in occupational therapy, refers to any activity engaged in for evaluating, specifying and treating problems interfering with functional performance.
Open Head Injury
Skull is broken and the brain is exposed after an injury to the head.
Optic Chiasm: Located near the back of the eyes, the optic nerves carrying these signals meet at this "crossing" where optic fibers from the inner half of each retina cross to the opposite hemisphere of the brain.
Orientation
Awareness of one's environment and/or situation, along with the ability to use this information appropriately in a functional setting.
Orthopedics
The branch of medicine devoted to the study and treatment of the skeletal system, its joints, muscles and associated structures.
Orthosis
Splint or brace designed to improve function or provide stability.
Outcome-Oriented Model
Identifies areas of agreement between people that are related to the goals of their assistance. This model stresses the accomplishments and successes of the person in question.
Outpatient
The patient residing outside the hospital but returning on a regular basis for one or more therapeutic services.
Paraplegia
Paralysis of the legs (from the waist down).
Parietal Lobe
Caps the top of the brain behind the central fissure and merges into the occipital lobe. Responds to touch, heat, cold, pain, and body awareness; injury to the parietal lobe can cause a loss of these sensing abilities.
Partial Seizures: Arise from disturbances in specific, localized areas of one hemisphere of the brain; subclassified as simple partial or complex partial.
Perception
The ability to make sense of what one sees, hears, feels, tastes or smells. Perceptual losses are often very subtle, and the patient and/or family may be unaware of them.
Perseveration
The inappropriate persistence of a response in a current task which may have been appropriate for a former task. Perseverations may be verbal or motoric.
Persistent Vegetative State (PVS)
A long-standing condition in which the patient utters no words and does not follow commands or make any response that is meaningful.
Person-Centered Treatment Plan: Inclusion of the individual, whenever possible, in the development and design of the treatment plan as well as discussion of expected discharge site, outcome criteria, goals, objectives, and treatment methods.
Phonation
The production of sound by means of vocal cord vibration.
Physiatrist
Pronounced Fizz ee at' rist. A physician who specializes in physical medicine and rehabilitation. Some physiatrists are experts in neurologic rehabilitation, trained to diagnose and treat disabling conditions. The physiatrist examines the patient to assure that medical issues are addressed; provides appropriate medical information to the patient, family members and members of the treatment team. The physiatrist follows the patient closely throughout treatment and oversees the patient's rehabilitation program.
Physical Therapist
The physical therapist evaluates components of movement, including: muscle strength, muscle tone, posture, coordination, endurance, and general mobility. The physical therapist also evaluates the potential for functional movement, such as ability to move in the bed, transfers and walking and then proceeds to establish an individualized treatment program to help the patient achieve functional independence.
Pia Mater
Tender matter which molds around every tiny crook and crevice on the brain's surface.
Plasticity
The ability of cellular or tissue structures and their resultant function to be influenced by an ongoing activity.
Plateau
A temporary or permanent leveling off in the recovery process.
Pons
Bridge of nerve fibers just above the medulla that connect the cerebral cortex and the cerebellum.
Positive Reciprocal Relationship
Also called positive reciprocity, this occurs when an exchange of reinforcers develops into a consistent pattern.
Post-concussion Symptoms
May or may not persist and include: headache, dizziness, vomiting, sleep disturbance, memory problems, changes in personality, irritability, depression, changes in personality, difficulty in problem solving, diminished attention span.
Postictal State: Person awakens after seizure to a state of confusion, extreme fatigue and no memory of the seizure.
Post Traumatic Amnesia (PTA)
A period of hours, weeks, days or months after the injury when the patient exhibits a loss of day-to-day memory. The patient is unable to store new information and therefore has a decreased ability to learn. Memory of the PTA period is never stored, therefore things that happened during that period cannot be recalled. May also be called Anterograde Amnesia.
Posture
The attitude of the body. Posture is maintained by low-grade, continuous contraction of muscles which counteract the pull of gravity on body parts. Injury to the nervous system can impair the ability to maintain normal posture, for example holding up the head.
Pre-Morbid Condition
Characteristics of an individual present before the disease or injury occurred.
Prefrontal Cortex
Located at the very front part of the frontal lobes (right over one’s eyebrows), the prefrontal cortex is responsible for various emotional responses to circumstances.
Prolonged Coma or Minimally Conscious State
Individuals still can breathe and their hearts beat, even without life supporting equipment. For individuals with minimal levels of consciousness, there may also be some minimal level of awareness to basic stimulations, i.e., touch, light, temperature.
Problem-Solving Skill
Ability to consider the probable factors that can influence the outcome of each of various solutions to a problem, and to select the most advantageous solution. Individuals with deficits in this skill may become "immobilized" when faced with a problem. By being unable to think of possible solutions, they may respond by doing nothing.
Prognosis
The prospect as to recovery from a disease or injury as indicated by the nature and symptoms of the case.
Polydipsia: Excessive thirst
Program/Service Categories
The following program/service categories describe the array of organized services (not mutually exclusive). This is not an exhaustive list available for the rehabilitation of persons with brain injury:
Acute Rehabilitation
Based in a medical facility; accepts patient as soon as medically stable; focuses on intensive physical and cognitive restorative services in early months after injury; typical length of stay one week to several months (short term); identifiable team and program with specialized unit.
Behavior Disorders
For the patient exhibiting patterns of behavior preventing participation in active rehabilitation, including destructive patient behavior to self and others; continuum of controlled settings.
Community Integration Program
Provides services designed to accomplish functional outcomes focused on home and community integration, including productive activity. Services may be provided in residential facilities, day treatment programs, the consumer's home. They may be of short-term (several weeks) or long-term duration (several months).
Independent Living
Community-based to maximize a person's ability to be empowered and self-directed; allows an individual to live in one's own home with maximum personal control over how services are delivered, combined with the opportunity to work as appropriate.
Lifelong Living
For persons discharged from rehabilitation who need ongoing lifetime supports; located in residential or skilled nursing environment; structured activities available on individual and group basis.
Postacute Rehabilitation
Are programs designed to provide intensive, 24-hour rehabilitation to improve cognitive, physical, emotional, and psychosocial abilities, to facilitate better independent living skills. Facilities typically provide a full spectrum of clinical therapies, as well as life-skills training in a residential setting.
Residential Services
Assumes a 24-hour residential environment outside the home and includes 24-hour provision of or access to support personnel capable of meeting the client's needs. (Adopted by the PostAcute Committee of ISIG on Head Injury October 28, 1991.)
Subacute
May follow a period of acute rehabilitation; not necessarily hospital based; typical length of rehabilitation stay 6-24 months (short to intermediate term); stay based on demonstrated improvement; identifiable team and program with specialized unit.
Supervised Living
Setting is a home which is like other homes in the neighborhood in terms of size and number of residents. Consumers are provided individualized care, supervision, support and training services to maximize and/or maintain function and self-direction. Staff is present at night and other times when the consumer is present.
Supported Independent Living
Setting is a home chosen by the consumer who is primarily independent. Program offers support to assist the resident in maximizing and/or maintaining independence and self-direction. Staff is available as needed and at planned intervals to offer assistance and support but not to provide supervision.
Transitional Living
Non-medical residential program providing training for living in a setting of greater independence. The primary focus is on teaching functional skills and compensating for abilities that cannot be restored.
Vocational Evaluation
An organized and comprehensive service staffed by specialists who systematically and comprehensively utilize work activities (real or simulated) and/or educational services as the focal point for educational and vocational assessment and exploration. In addition, psychological testing, counseling, social summaries, occupational information, etc., are other evaluation tools that are used. It incorporates the medical, psychological, social, vocational, educational, cultural, and economic data for establishment and attainment of individual goals.
Prone
Lying on one's stomach.
Proprioception
The sensory awareness of the position of body parts with or without movement. Combination of kinesthesia and position sense.
Psychologist
A professional specializing in counselling, including adjustment to disability. Psychologists use tests to identify personality and cognitive functioning. This information is shared with team members to assure consistency in approaches. The psychologist may provide individual or group psychotherapy for the purpose of cognitive retraining, management of behavior and the development of coping skills by the patient/client and members of the family.
Range of Motion (ROM)
Refers to movement of a joint (important to prevent contractures).
Reasoning, Abstract
Mode of thinking in which the individual recognizes a phrase that has multiple meanings and selects the meaning most appropriate to a given situation. The term "abstract" typically refers to concepts not readily apparent from the physical attributes of an object or situation.
Reasoning, Concrete
The ability to understand the literal meaning of a phrase.
Reasoning, Problem-Solving
The ability to analyze information related to a given situation and generate appropriate response options. Problem-solving is a sequential process that typically proceeds as follows: identification of problem; generation of response options; evaluation of response option appropriateness; selection and testing of first option; analysis as to whether solution has been reached. A patient/client may discontinue making a cup of coffee because the sugar bowl is empty, even though sugar is readily available in a nearby cabinet. A patient/client may easily navigate his way into a room crowded with furniture, but request staff assistance to navigate his way out.
Reasoning, Sequencing
The ability to organize information or objects according to specified rules, or the ability to arrange information or objects in a logical, progressive manner. Nearly every activity, including work and leisure tasks, requires sequencing. For example, in cooking certain foods it is important that ingredients be added and mixed in a specified order; in dressing, undergarments must be put on prior to outer garments.
Receptive Communication
Ability to understand others through speech and language.
Recreation Therapist
Individual within the facility responsible for developing a program to assist persons with disabilities plan and manage their leisure activities; may also schedule specific activities and coordinate the program with existing community resources.
Rehabilitation
Comprehensive program to reduce/overcome deficits following injury or illness, and to assist the individual to attain the optimal level of mental and physical ability.
Rehabilitation Counselor
Also called Vocational Counselor. A specialist in social and vocational issues who helps the patient develop the skills and aptitudes necessary for return to productive activity and the community.
Rehabilitation Facility
Agency of multiple, coordinated services designed to minimize for the individual the disabling effects of one's physical, mental, social, and/or vocational difficulties and to help realize individual potential.
Rehabilitation Nurse
A nurse specializing in rehabilitation techniques as well as basic nursing care. Nurses assist the patient and family in acquiring new information, developing skills, achieving competence and exhibiting behaviors that contribute to the attainment of a healthy state.
Reticular Activating System (RAS)
Collection of nerve fibers and nuclei within the brainstem that modulates or changes arousal, alertness, concentration, and basic biological rhythms.
Retrograde Amnesia
Inability to recall events that occurred prior to the accident; may be a specific span of time or type of information.
Seizure
An uncontrolled discharge of nerve cells which may spread to other cells nearby or throughout the entire brain. It usually lasts only a few minutes. It may be associated with loss of consciousness, loss of bowel and bladder control and tremors. May also cause aggression or other behavioral change.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Antidepressant medications.
Self-Determination: Concept of saying individual freedom that builds on the principles of informed consent, right to refuse, and consumer empowerment.
Self-Help Skills
Include bathing, dressing, eating, grooming, and toileting. These are often referred to as activities of daily living (ADL skills). They are central to reaching a basic level of independence.
Sensation
Feeling stimuli which activate sensory organs of the body, such as touch, temperature, pressure and pain. Also seeing, hearing, smelling and tasting.
Sensorimotor
Refers to all aspects of movement and sensation and the interaction of the two.
Sensorimotor Impairments
Changes affecting muscles groups and sensory modalities. Depending on the location and extent of injury to the brain, sensorimotor impairments can be localized to one extremity or side of the body or generalized.
Sensory Integration
Interaction of two or more sensory processes in a manner that enhances the adaptiveness of the brain.
Sequencing
Reading, listening, expressing thoughts, describing events or contracting muscles in an orderly and meaningful manner.
Severe Brain Injury: Characteristics include: coma longer than 24 hours, often lasting days or weeks; Glasgow Coma Scale of 8 or less; bruising, bleeding in brain; signs on EEG, CAT or MRI scans; long term impairments
Sheltered Workshop
A work setting certified as such by the Wage & Hour Division. It provides transitional and/or long-term employment in a controlled and protected working environment for those who are unable either to compete or to function in the open job market due to their disabilities. May provide vocational evaluation and work adjustment services.
Shunt
A procedure to draw off excessive fluid in the brain. A surgically-placed tube running from the ventricles which deposits fluid into either the abdominal cavity, heart or large veins of the neck.
Simple Partial Seizures: Formerly known as focal motor or jacksonian seizures, person does not lose consciousness. Abnormal, localized electrical activity in the motor area of the brain may result in motor symptoms such as stiffening or jerking of muscles, eye movements, and unusual tongue movement, blinking and facial twitching.
Somatosensory
Sensory activity having its origin elsewhere than in the special sense organs (such as eyes and ears) and conveying information to the brain about the state of the body proper and its immediate environment.
Spasticity
An involuntary increase in muscle tone (tension) that occurs following injury to the brain or spinal cord, causing the muscles to resist being moved. Characteristics may include increase in deep tendon reflexes, resistance to passive stretch, clasp knife phenomenon, and clonus.
Spatial Ability
Ability to perceive the construction of an object in both two and three dimensions. Spatial ability has four components: the ability to perceive a static figure in different positions, the ability to interpret and duplicate the movements between various parts of a figure, the ability to perceive the relationship between an object and a person's own body sphere, and the ability to interpret the person's body as an object in space.
Speech-language Pathology Services
A continuum of services including prevention, identification, diagnosis, consultation, and treatment of patients regarding speech, language, oral and pharyngeal sensorimotor function.
Spontaneous Recovery
The recovery which occurs as damage to body tissues heals. This type of recovery occurs with or without rehabilitation and it is very difficult to know how much improvement is spontaneous and how much is due to rehabilitative interventions. However, when the recovery is guided by an experienced rehabilitation team, complications can be anticipated and minimized; the return of function can be channeled in useful directions and in progressive steps so that the eventual outcome is the best that is possible.
Status Epilepticus
Seizure that lasts longer than 5 minutes, or two or more seizures without time between for the person to recover consciousness.
Subdural
Beneath the dura (tough membrane) covering the brain and spinal cord.
Supine
Lying on one's back.
Suppository
Medicine contained in a capsule which is inserted into the rectum so that the medicine can be absorbed into the blood stream.
Surveillance: Ongoing and systematic collection, analysis and interpretation of data used to describe and monitor a health event.
Tactile Defensiveness
Being overly sensitive to touch; withdrawing, crying, yelling or striking when one is touched.
Tardive Dyskinesia: Side effect of antipsychotic medications resulting in involuntary movement disorder characterized by lip smacking, rhythmic darting of the tongue, chewing movements, aimless movements of the arms and legs and in severe cases, difficulty breathing and swallowing.
Task Analysis
Breakdown of a particular job into its component parts; information gained from task analysis can be utilized to develop training curricula or to price a product or service.
TBI Model Systems
Research centers involved in prospective, longitudinal multi-center efforts to examine the course of recovery and outcomes following TBI.
Temporal Lobes
There are two temporal lobes, one on each side of the brain located at about the level of the ears. These lobes allow a person to tell one smell from another and one sound from another. They also help in sorting new information and are believed to be responsible for short-term memory.
Right Lobe--Mainly involved in visual memory (i.e., memory for pictures and faces).
Left Lobe--Mainly involved in verbal memory (i.e., memory for words and names).
Thalamus: Sits on the very top of the brain stem just beneath the cortex. Acts as a major relay station for incoming and outgoing sensory information. Each sense (except smell) relays its impulses through the thalamus.
Tonic
Excessive muscle tension/contraction
Tonic-Clonic Seizures
Formerly known as grand mal, there is abrupt loss of consciousness. Body stiffens in tonic contraction at onset. Person may cry out, drop unconscious to the ground, roll up eyes or turn to the side, and bite tongue.
Tracheostomy
A temporary surgical opening at the front of the throat providing access to the trachea or windpipe to assist in breathing.
Tracking, Visual
Visually following an object as it moves through space. See also vision after head injury.
Traumatic Brain Injury: Defined under the Individuals with Disabilities Education Act as: "...an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child's educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; problem–solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma." (Section 300.7b[12] 1999)
Traumatic Brain Injury Act: Passed in 1996, this federal legislation expanded efforts for effective prevention, biomedical research and the improvement of services through state demonstration projects.
Tremor, Intention
Course, rhythmical movements of a body part that become intensified the harder one tries to control them.
Tremor, Resting
Rhythmical movements present at rest and may be diminished during voluntary movement.
Unilateral Neglect
Paying little or no attention to things on one side of the body. This usually occurs on the side opposite from the location of the injury to the brain because nerve fibers from the brain typically cross before innervating body structures. In extreme cases, the patient may not bathe, dress or acknowledge one side of the body.
Urinary Tract Infection
When bacteria have reproduced to a large number in the bladder. This can cause fever, chills, burning on urination, urgency, frequency, incontinence or foul smelling urine.
Verbal Apraxia
Impaired control of proper sequencing of muscles used in speech (tongue, lips, jaw muscles, vocal cords). These muscles are not weak but their control is defective. Speech is labored and characterized by sound reversals, additions and word approximations.
Vestibular
Pertaining to the vestibular system in the middle ear and the brain which senses movements of the head. Disorders of the vestibular system can lead to dizziness, poor regulation of postural muscle tone and inability to detect quick movements of the head.
Vocational Skills refer to behaviors needed to get and keep a job. This domain includes everything from simple on-task behavior in a structured workshop setting to higher-level cognitive functions in competitive employment.
Wernicke's Area: Located in the left temporal parietal lobe; governs a person’s understanding of speech and the ability to make sense of the thoughts that are spoken
Definitions Source:
Brain Injury Association of America
Training Manual for Certified Brain Injury Specialists, Third Edition 2004
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