A

acquired brain injury — 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.

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.

adaptive equipment — a special device which assists in the performance of self-care, work or play/leisure activities or physical exercise.

ADL (activities of daily living) — routine activities carried out for personal hygiene and health (including bathing, dressing, feeding) and for operating a household.

agitation - uncontrolled restlessness, upset or excitement in response to internal or external factors.

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.

alexia — inability to read.

alternative communication — see "augmentative and alternative communication"

ambulate — to walk.

amnesia — lack of memory about events occurring during a particular period of time.

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.

anosmia — loss of the sense of smell

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).

antidepressants — medication used to treat depression.

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 non-fluent aphasia.

apraxia — inability to carry out a complex or skilled movement; not due to paralysis, sensory changes, or deficiencies in understanding.

articulation — movement of the lips, tongue, teeth and palate into specific patterns for purposes of speech. Also, a movable joint.

assistive equipment — a special device which assists in the performance of self-care, work or play/leisure activities or physical exercise.

astereognosia — inability to recognize things by touch.

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.

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 — 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.

B

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.

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.

bilateral — pertaining to both right and left sides.

brain plasticitya — 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).

C

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

cerebellum — the portion of the brain (located at the back) which helps coordinate movement. Damage may result in ataxia.

chronic — marked by long duration or frequent recurrence.

circumlocution — use of other words to describe a specific word or idea which cannot be remembered.

closed head injury - an injury that occurs when the head suddenly and violently hits an object but the object does not break through the skull. 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.

cognition — the conscious process of knowing or being aware of thoughts or perceptions, including understanding and reasoning.

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.

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 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).

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.

comprehension — understanding of spoken, written, or gestural communication.

compressive cranial neuropathies - degeneration of nerves in the brain caused by pressure on those nerves.

computed tomography (CT) - a scan that creates a series of cross-sectional X-rays of the head and brain; also called computerized axial tomography or CAT scan.

concentration — the ability to focus on a given task or set of stimuli for an appropriate period of time.

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 - injury to the brain caused by a hard blow or violent shaking, causing a sudden and temporary impairment of brain function, such as a short loss of consciousness or disturbance of vision and equilibrium.

confabulation — verbalizations about people, places, and events with no basis in reality. May be a detailed account delivered.

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 — loss of range of motion in a joint due to abnormal shortening of soft tissues.

contrecoup - a contusion caused by the shaking of the brain back and forth within the confines of the skull. A bruising of brain tissue on the side opposite where the blow was struck.

contusion - distinct area of swollen brain tissue mixed with blood released from broken blood vessels.

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.

CT Scan — 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.

D

dementia pugilistica - brain damage caused by cumulative and repetitive head trauma; common in career boxers.

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. (See also: Shearing)

diffuse brain injury — injury to cells in many areas of the brain rather than in one specific location.

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.

distractability - the inability to hold attention on an activity.

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.

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.

E

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.

emotional lability — exhibiting rapid and drastic changes in emotional state (laughing, crying, anger) inappropriately without apparent reason.

episodic memory — memory for ongoing events in a person's life. More easily impaired than semantic memory, perhaps because rehearsal or repetition tends to be minimal.

F

fluent aphasia - a condition in which patients display little meaning in their speech even though they speak in complete sentences. Also called Wernicke's or motor aphasia.

frontal lobe — Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of "higher cognitive functions."

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.

G

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."

Glasgow Coma Scale (GCS) — 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. More information on the Glasgow Coma Scale.

global aphasia - a condition in which patients suffer severe communication disabilities as a result of extensive damage to portions of the brain responsible for language.

H

head injury — refers to an injury of the head and/or brain, including lacerations and contusions of the head, scalp and/or forehead.

hypermetabolism - a condition in which the body produces too much heat energy.

hypothyroidism - decreased production of thyroid hormone leading to low metabolic rate, weight gain, chronic drowsiness, dry skin and hair, and/or fluid accumulation and retention in connective tissues.

I

immediate memory — 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.

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.

impulsiveness - doing or saying something too quickly, often leading to errors and difficulties.

initiation - the ability to begin an activity.

initiative — refers to the individual's ability to begin a series of behaviors directed toward a goal.

intracranial pressure — Cerebrospinal fluid (CSF) pressure measured from a needle or bolt introduced into the CSF space surrounding the brain. It reflects the pressure buildup of pressure in the skull as a result of injury.

J

jargon — spoken language that has a normal rate and rhythm but is full of nonsense words.

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.

judgment - the ability to know the dangers of certain activities and to make the right decisions.

K

kinaesthesia — The sensory awareness of body parts as they move (see Position Sense and Proprioception).

L

lability — state of having notable shifts in emotional state (e.g., uncontrolled laughing or crying).

long term memory — 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.

M

magnetic resonance imaging (MRI) — a noninvasive diagnostic technique that uses magnetic fields to create an image of soft tissue, central nervous system and musculoskeletal systems. Used todetect subtle changes in brain tissue.

malingering — to pretend inability so as to avoid duty or work.

memory - remembering and learning new things. This includes remembering what you do; remembering what others say to you; and remembering what you see or read.

mild brain injury — 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.

money management — ability to distinguish the different denominations of money, count money, make change, budget.

motor aphasia - see non-fluent aphasia

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.

N

neuroexcitation - the electrical activation of cells in the brain; neuroexcitation is part of the normal functioning of the brain or can also be the result of abnormal activity related to an injury.

neuron - a nerve cell that is one of the main functional cells of the brain and nervous system.

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.

neurotransmitters -chemicals that transmit nerve signals from one neuron to another.

non-fluent aphasia - a condition in which patients have trouble recalling words and speaking in complete sentences. Also called Broca's or motor aphasia.

nystagmus — involuntary horizontal, vertical, or rotary movement of the eyeballs. See also vision after head injury.

O

occipital lobe — region in the back of the brain which processes visual information. Damage to this lobe can cause visual deficits.

occupational therapy (OT) — 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.

organization - the ability to arrange your thoughts to make them sound sensible and orderly.

orientation — a sense of what is going on around you. This includes knowing the day, date, month and year; knowing things about yourself; knowing where you are and how to get around; and knowing what happened to you; 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.

outpatient — the patient residing outside the hospital but returning on a regular basis for one or more therapeutic services.

P

paraplegia — paralysis of the legs (from the waist down).

parietal lobe — one of the two parietal lobes of the brain located behind the frontal lobe at the top of the brain.

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.

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.

plasticity — the ability of the brain to adapt to deficits and injury.

plateau — a temporary or permanent leveling off in the recovery process.

post-concussion syndrome (PCS) - a complex, poorly understood problem that may cause headache after head injury; in most cases, patients cannot remember the event that caused the concussion and a variable period of time prior to the injury.

post-traumatic amnesia — a state of acute confusion due to a traumatic brain injury, marked by difficulty with perception, thinking, remembering, and concentration; during this acute stage, patients often cannot form new memories. May also be called Anterograde Amnesia.

pre-morbid condition — characteristics of an individual present before the disease or injury occurred.

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.

proprioception — the sensory awareness of the position of body parts with or without movement. Combination of kinesthesia and position sense.

prosodic dysfunction - problems with speech intonation or inflection.

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.

R

range of motion (ROM) — refers to movement of a joint (important to prevent contractures).

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 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 behavior that contribute to the attainment of a healthy state.

retrograde amnesia — inability to recall events that occurred prior to the accident; may be a specific span of time or type of information.

S

seizure — abnormal activity of nerve cells in the brain causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and loss of consciousness.

sensation — feeling stimuli which activate sensory organs of the body, such as touch, temperature, pressure and pain

sensorimotor — refers to all aspects of movement and sensation and the interaction of the two.

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.

short term memory — 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.

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.

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.

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.

T

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).

traumatic brain injury (TBI) — 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.

U

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.

V

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.

visual tracking — visually following an object as it moves through space. See also vision after head injury.

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.