Connecticut Traumatic Brain Injury Attorneys If your potential claim involves a personal injury such as spinal cord injury or traumatic brain injury, it is essential that you contact our attorneys as soon as possible. Traumatic Brain Injury Glossary At the law offices of Casper & de Toledo, we continually strive to ensure the information our clients receive is insightful and relevant to their case. Below are some terms that can help you better understand traumatic brain injury. If you have questions or concerns about a case, please contact our personal injury lawyers. A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Abscess – a localized collection of pus in a cavity. Acalculia – the inability to perform simple problems of arithmetic. Acuity – sharpness or quality of a sensation. 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 that resulted in impairment of brain function. Adiadochokinesia – inability to stop one movement and follow it immediately with movement in the opposite direction. Adynamia – apathy, loss of drive. The individual is no longer dynamic or energetic and may appear to lack motivation. Responses to others or to situations are dull. There is slowed mental function, a marked decrease in ideas, activity is rarely self-initiated. Affect – The observable emotional condition of an individual at any given time. Affective disorders – Mental illnesses characterized mainly by abnormalities in mood. The two principal categories are mania and depression. 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. Amnesia – lack of memory about events occurring during a particular period of time. See also anterograde amnesia, retrograde amnesia, post-traumatic amnesia. Aneurysm – a blood-filled sac formed by disease related stretching of an artery or blood vessel. 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. Anosmia – loss of the sense of smell. Anoxia – an absence of oxygen supply to an organ’s tissues leading to cell death. Anterograde amnesia – inability to consolidate information about ongoing events. Difficulty with new learning. Anticonvulsant – medication use to decrease the possibility of a seizure (e.g., Dilantin, Phenobarbital, Mysoline, Tegretol). Aphasia – difficulty understanding and/or producing spoken and written language. (See also non-fluent aphasia). Aphasia, expressive – inability to find or formulate the words to express oneself event though knowing what one wants to say. Aphasia, fluent – characterized by spontaneous use of language at normal speed that conveys little meaning. Aphasia, non-fluent – Characterized by awkward articulation, limited vocabulary, hesitant, slow speech output, restricted use of grammatical forms and a relative preservation of auditory comprehension. Aphasia, receptive – problems in understanding what others attempt to communicate. Aphasia, subclinical – refers to evidence of impaired linguistic processing on testing, which is not obvious in casual interactions with the person. Apoptosis – cell death that occurs naturally as part of normal development, maintenance, and renewal of tissues within an organism. Apraxia – inability to carry out a complex or skilled movement; not due to paralysis, sensory characters, or deficiencies in understanding. Arachnoid membrane – one of the three membranes that cover the brain; it is between the pia mater and the dura. Collectively, these three membranes form the meninges. 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. Attention, concentration – The ability to focus on a given task or set of stimuli for an appropriate period of time. Attention, concentration, arousal – the ability to respond consistently to sensory stimulation by eye opening, localizing and tracking with head or eye movement. To assess a patient’s level of arousal one might determine if the patient brushes away pinching fingers; or, if the eyes or head turns to a variety of sensory stimuli’s. Attention, concentration, distractibility – refers to the patient’s inability to sustain attention because of competing internal or external stimuli. The person with a brain injury may have decreased ability to inhibit competing responses. For example, a restrained patient may focus more on his arm restraint than on a task presented by a therapist; a patient asked to complete arithmetic problems may focus more on construction work taking place outside. Attention, concentration, length – refers to the length of time a patient is able to focus on a given task. Complexity of task and patient fatigability will affect length of attention (attention span). Attention, sustained – refers to a person’s ability to work on a particular task or train of thought over an extended period of time. Auditory discrimination – the ability to differentiate and recognize sounds. This involves distinguishing between words, noises, and sounds that might be similar. A person with poor auditory discrimination might answer the phone in his room although the actual ringing came from an alarm clock. Balance – The ability to use appropriate righting and equilibrium reactions to maintain an upright position. It is usually tested in sitting and standing positions. Brain death – an irreversible cessation of measurable brain function. Brain injury – a more specific term than head injury. Damage to the brain that results in impairments in one or more functions, including: arousal, attention, language, memory, reasoning, abstract thinking, judgment, problem solving, sensory abilities, perceptual abilities, motor abilities, psychosocial behavior, information processing and speech. The damage may be caused by external physical force, insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congenital disorders, birth trauma or degenerative processes. 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 that 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, moderate – A Glasgow Coma Scale score of 9 to 12 the first 24 hours post injury. Brain injury, penetrating – Occurs when an object (for example a bullet or an ice pick) fractures the skull, enters the brain and rips the soft brain tissue in its path. Penetrating injuries tend to damage relatively localized areas of the brain that result in fairly discrete and predictable disabilities. Brain injury, severe – severe injury is one that produces at least 6 hours of coma; Glasgow Coma Scale score of 8 or less within the first 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, neurological, 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, congenital 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). Broca’s aphasia – see non-fluent aphasia. Cerebellum – The portion of the brain (located at the back) which helps coordinate movement. Damage may result in ataxia. Cerebral infarct – When the blood supply is reduced below a critical level to a specific region of the brain and the brain tissue in that region dies. Cerebrospinal fluid (CSF) – the fluid that bathes and protects the brain and spinal cord. Circumlocution – use of other words to describe a specific word or idea that 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. Confabulation – verbalizations about people, places and events with no basis in reality. May be a detailed account delivered. Cognitive impairment – difficulty with one or more of the basic functions of the brain: perception, memory, attention abilities and reasoning skills. Cognitive rehabilitation – Therapy programs that 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 profound unconsciousness caused by disease, injury or poison. 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. See Glasglow coma scale and Glasglow outcome scale. 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 – maintaining attention on a task over a period of time; remaining attentive and not easily diverted. 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. Continent continence – The ability to control urination and bowel movements. Contra lateral – opposite sides Contrecoup damage – a contusion caused by the shaking of the brain back and forth within the confines of the skull. Coup damage – Damage to the brain at the point of impact. Contusion – distinct area of swollen brain tissue mixed with blood released from broken blood vessels. Coping skills – The ability to deal with problems and difficulties by attempting to overcome them or accept them. Cortical blindness – Loss of vision resulting from a lesion of the primary visual areas of the occipital lobe. Light reflex is preserved. Csf fistula – a tear between two of the three membranes – the dura and arachnoid membranes – that encase the brain. 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. It is common for a CT Scan to be interpreted as normal despite the existence of brain injury. The CT scan is most reliable for detecting bleeding in the brain. Day treatment program – non-residential program intended to increase the functional ability of the brain injured patient through therapeutic intervention and supervised activities. Day treatment seeks to facilitate successful community integration. Deep vein thrombosis (“DVT”) – formation of a blood clot deep within a vein. Dementia pugilistica – brain damage caused by cumulative and repetitive head trauma; common in career boxers. Depressed skull fracture – a fracture occurring when pieces of broken skull press into the tissues of the brain. Developmental disability – Any mental and/or physical disability that has an onset before age 22 and may continue indefinitely. It can limit major life activities. Term includes with mental retardation, cerebral palsy, autism, epilepsy (and other seizure disorders), sensory impairments, congenital disabilities, or conditions caused by disease (e.g., polio, muscular dystrophy). Diffuse axonal injury (“DAI”) – injury to large nerve fibers also known as the white matter as the nerve fibers are covered with white substance known as myelin. The axonal injury can take the form of stretching, twisting and/or severing or shearing. See also shearing. Diffuse brain injury – injury to cells in many areas of the brain rather than in one specific location. Discrimination, auditory – the ability to differentiate and recognize sounds. This involves distinguishing between words, noises and sounds that might be similar. A person with poor auditory discrimination might answer the phone in his room although the actual ringing came from an alarm clock. Discrimination, sensory – a process requiring differentiation of two or more stimuli. Discrimination, tactile – the ability to identify and distinguish between objects and stimuli solely through touch, this involves the ability to ascertain shape, size and texture. For example, persons with impaired tactile discrimination might not be able to distinguish between a quarter and a dime in their pocket. Discrimination, visual – involves the differentiation of items using sight. An individual with impaired visual discrimination may not be able to distinguish between a red and green light while driving or may have difficulty distinguishing between the letter “E” and the letter “F”. Disinhibition – inability to suppress (inhibit) impulsive behavior and emotions. Dysarthria – inability or difficulty articulating words due to emotional stress, brain injury, paralysis, or spasticity of the muscles needed for 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. Dura – a tough, fibrous membrane lining the brain; the outermost of the three membranes collectively called the meninges. Early seizures – seizures that occur within 1 week after a traumatic brain injury. Electroencephalogram (“EEG”) – the recording made by electrodes on the scalp to record electrical activity of the brain. Used for detection of epilepsy, coma, and brain death. Epidural hematoma – bleeding into the area between the skull and the dura. Epilepsy – Epilepsy is a common neurological disorder caused by disturbances in the normal electrical functions of the brain. In normal brain function millions of tiny electrical charges pass from nerve cells in the brain to all parts of the body. In patients with epilepsy, this normal pattern is interrupted by sudden and unusually intense bursts of electrical energy, which may briefly affect a person’s consciousness, bodily movements, or sensations. These physical changes are called epileptic seizures. There are 2 categories of seizures: partial seizures, which occur in one area of the brain, and generalized seizures, which affect nerve cells throughout the brain. Epilepsy may result from a brain injury before, during, or after birth; head trauma; poor nutrition; some infectious diseases; brain tumors; and some poisons. However, in many cases the cause is unknown. Attacks of epilepsy may be preceded by a feeling of unease or sensory discomfort called an aura, which indicates the beginning of the seizure. Signs of an impending epileptic seizure, which vary among patients, may include visual phenomena such as flickering lights or “sunbursts.” 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 EEF, 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. Evoked responses – brain stem – auditory brain stem responses provoked by discreet sounds delivered to the ears through headphones. These sound waves are converted to nerve impulses by receptors in the ear. A machine is used to test whether the brain stem has received the signals. The quality of the brain stem’s response in a comatose patient is thought to be an important indicator of the degree and site of brain injury. Because this test requires very specialized and expensive equipment, it is not available in all hospitals. A more common test is the EEG. Executive functions – planning, prioritizing, sequencing, self-monitoring, self-correcting, inhibiting, initiating, controlling or altering behavior. The ability to organize thoughts and work, to create plans and successfully execute them, to manage the administrative functions of one’s life. Individuals with impaired executive function may appear to live moment-to-moment, fail to monitor their activities or social interactions to make sure plans are carried out (or even made). With diminished ability to create strategies, to handle more than one task at a time, to be effective, reliable, and productive, the simplest job may be too challenging. 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.” Gait training – Instruction in walking, with or without equipment; also called ambulation training. 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. Glasgow Outcome Scale – a system for classifying the outcome of persons who survive. The categories range from “Good Recovery” in which the patient appears to regain the pre-injury level of social and career activity (even if there are some minor residual abnormal neurological signs”; “Moderate Disability” in which the patient does not regain the former level of activity but is completely independent with respect to the activities of daily life; “Severe Disability” is defined as a state wherein the conscious, communicating patient is still dependent on the help of others. The original scale has eight outcome categories. This scale relates to functional independence and not residual deficits. 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. Hematoma – the collection of blood in tissues or a space following rupture of a blood vessel. Regarding Brain: 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. Hemiparesis – Weakness of one side of the body. Hemiplegia – paralysis of one side of the body as a result of injury to neurons carrying signals to muscles from the motor areas of the brain. Hemorrhage – bleeding that occurs following damage to blood vessels. Bleeding may occur within the brain when blood vessels in the brain are damaged. See Hematoma. Hemorrhagic stroke – stroke caused by bleeding out of one of the major arteries leading to the brain. Hydrocephalus – enlargement of fluid-filled cavities in the brain, not due to brain atrophy. 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. Hypoxia – decreased oxygen levels in an organ, such as the brain; less severe than anoxia. Immediate seizures – seizures that occur within 24 hours of a traumatic brain injury. 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. Independent living program – 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. Intracerebral hematoma – bleeding within the brain caused by damage to a major blood vessel. Intracranial pressure cp – 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. Intracranial Pressure Monitor – an ICP monitor. A monitoring device to determine the pressure within the brain. It consists of a small tube (catheter) attached to the patient at the skull by either a ventriculostomy, subarachnoid bolt, or screw and is then connected to a transducer, which register the pressure. Ipsilateral – Same side of the body. Ischemia – a severe reduction in the supply of blood to body tissues. Ischemic stroke – stroke caused by the formation of a clot that blocks blood flow through an artery to the brain. Locked-in syndrome – a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of the body. Magnetic resonance imaging (MRI) – a noninvasive diagnostic technique that uses magnetic fields to detect subtle changes in brain tissue. Memory – the process of organizing and storing representations of events and recalling these representations to consciousness at a later time. Memory, audio visual – auditory memory is the ability to recall a series of numbers, lists of words, sentences, or paragraphs presented orally. Visual memory requires input of information through visuo-perceptual channels. It refers to the ability to recall text, geometric figures, maps and photographs. A brain-injured survivor with impaired visual memory may have to refer to a road map numerous times to reach a nearby destination. A brain-injured inpatient may need frequent assistance from staff to locate his room. A patient with impaired auditory memory will likely require frequent reminders of orally presented task instructions from staff. Notably, information may be encoded in memory using words or visual images independent of the mode of presentation. Memory, delayed – recall of information after a delay, often with other information presented to prevent active rehearsal. There is no particular specification of the required time interval; typically it is ten minutes or more. 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, learning – change in a person’s understanding or behavior due to experience or practice. Often thought of as acquisition of new information. For example, a person who learns quickly will likely remember an entire set of instructions after hearing them a single time. A patient with severely impaired learning ability will show little gain in recall after numerous repetitions. Learning and memory are interdependent. If immediate memory is poor, learning will be poor because only a portion of the information will be available for rehearsal/repetition. It is important to not that patients may have intact learning ability, but poor delayed memory. For example, a brain-injured patient may learn a set of instructions after several repetitions, but forget them the next day. Memory, long – term – in neuropsychological testing, this refers to recall thirty minutes or longer after presentation. Requires storage and retrieval of information that exceeds the limit of short-term memory. Memory, recall – ability to retrieve information without renewed exposure to the stimulus. Memory, recognition – ability to retrieve information when a stimulus cue is presented. Free recall of the information is often deficient if cues must be provided. Memory, remote – information an individual correctly recalls from the past, stored before the onset of brain injury. There is no specific requirement for the amount of elapsed time, but it is typically more than six months to a year. Preserved information from delayed memory becomes part of remote 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. Meningitis – inflammation of the three membranes that envelop the brain and spinal cord, collectively known as the meninges; the meninges include the dura, pia mater, and arachnoid. Motor aphasia – see non-fluent aphasia. Neural stem cells – cells found only in adult neural tissue that can develop into several different cell types in the central nervous system. Neurochemical changes – The force of blunt trauma to the head or sudden shaking of the head can produce damage to brain tissue from direct contact or when the brain bounces within the hard skull including damage to the axons (wire like structures) and the neurons that are connected to each other by the axons. In addition, there may be gross bleeding or subtle microscopic bleeding in the brain from damage to blood vessels. Like other parts of the body that can be injured, there is a chemical response to the brain injury. Much of the science behind the chemical reaction to brain injury is not yet understood. Some of the research in this area has been performed on rats and pigs. But it is becoming increasingly evident that the release of chemicals, enzymes, immunoregulattorney proteins and amino acids within the brain can cause a cascade of changes in the brain creating an imbalance and causing cellular damage and destruction that progresses over time. In turn, the enhanced damage can cause increasing cognitive deficits that make a patient’s condition worse. 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. Neuropsychology – the study of (and the assessment, understanding, and modification of) brain-behavior relationships. Neuropsychology seeks to understand how the brain, through structure and neural networks, produces and controls behavior and mental processes, including emotions, personality, thinking, learning and remembering, problem solving, and consciousness. The field is also concerned with how behavior may influence the brain and related physiological processes, as in the emerging field of psychoneuroimmunology (the study that seeks to understand the complex interactions between brain and immune systems, and the implications for physical health). Neuropsychology seeks to gain knowledge about brain and behavior relationships through the study of both healthy and damaged brain systems. It seeks to identify the underlying biological causes of behaviors, from creative genius to mental illness, that account for intellectual processes and personality. Clinical neuropsychology seeks such understanding, particularly, in the case of how damaged or diseased brain structures alter behaviors and interfere with mental and cognitive functions. 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. 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, cognitive – using selective attention skills, the individual correctly perceives stimulus attributes or task elements, selects a strategy, monitors use of the strategy and reaches a correct solution. Low Level: Those individuals who can sustain attention and appropriately switch sets. Persons with low-level organization ability usually “fall apart” in high stress situations. High Level: Those individuals who can deal with multiple pieces of information and integrate them for accomplishing relatively complex tasks. Some persons demonstrating high-level cognitive organization may still “fall apart” in high stress situations. Orientation – awareness of one’s environment and/or situation, along with the ability to use this information appropriately in a functional setting. See Disorientation. Orientation to environment – knowledge regarding the present environment including where one is at the time of the evaluation. Accurate awareness of place. Orientation left – right – the ability to discriminate between left and right body parts on oneself and on others, as well as the ability to discriminate between left and right within the environment. Orientation personal – general knowledge related to oneself includes information regarding date of birth, age, name, and location of home. Orientation temporal – knowledge of the current date, day, month and year. Includes knowledge of facts related to time of day. For example, a disoriented patient asked to name the next meal at 4PM might say, “breakfast.” Oligodendrocytes – a type of support cell in the brain that produces myelin, the fatty sheath that surrounds and insulates axons. Paraparesis – weakness of the lower limbs. Paraphasic error – substitution of an incorrect sound (e.g., tree for free) or related word (e.g., chair for bed). Paraplegia – paralysis of the legs (from the waist down). Parapnasias – use of incorrect words or word combinations. Parietal lobe – one of the two parietal lobes of the brain located behind the frontal lobe at the top of the brain. Parietal lobe, right – damage to this area can cause visuo-spatial deficits (e.g., the patient may have difficulty finding their way around new, or even familiar places. Parietal Lobe, left – damage to this area may disrupt a patient’s ability to understand spoken and/or written language. Penetrating head injury – a brain injury in which an object pierces the skull and enters the brain tissue. Penetrating skull fracture – a brain injury in which an object pierces the skull and injures brain tissue. 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) – an ongoing state of severely impaired consciousness Phonation – The production of sound by means of vocal cord vibration. Plasticity – ability of the brain to adapt to deficits and injury. Pneumocephalus – a condition in which air or gas is trapped within the intracranial cavity. Position Sense – The sensory awareness of the location and orientation of body parts without moving them. See Kinesthesia and Proprioception. 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 (PTA) – 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. Post-traumatic dementia – a condition marked by mental deterioration and emotional apathy following trauma. Post-traumatic epilepsy – recurrent seizures occurring more than 1 week after a traumatic brain injury. Pre-morbid condition – Characteristics of an individual present before the disease or injury occurred. Problem solving – ability of the individual to bring cognitive processes to the consideration of how to accomplish a task. Problem solving skills – 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. 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. Pruning – process whereby an injury destroys an important neural network in children, and another less useful neural network that would have eventually died takes over the responsibilities of the damaged network. Psychometric instruments – standardized tests (utilizing paper and pencil), which measure mental functioning. Psychomotor skills – skills that involve both mental and muscular ability such as playing sports or other activities where practice or concentration is involved. Psychosocial skills -refers to the individual’s adjustment to the injury (and resulting disability) and one’s ability to relate to others. Includes feelings about self, sexuality and the resulting behaviors. Quadriparesis – weakness of all four limbs. Quadriplegia – paralysis of all four limbs (from the neck down). British authors often use the prefix “tetra” to mean four, so they may describe a patient as having tetraplegia. Reasoning, abstract – mode of thinking in which the individual recognizes a phrase that has multiple meaning 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, association – a skill dependent on a person’s ability to determine the relationship between objects and concepts. A patient with impairment may touch a hot stove, failing to realize that pain is associated with touching a heated burner. Similarly, a patient give a knife, spoon, fork and baseball may not be able to discriminate which of the objects “does not belong.” Reasoning, categorization – the ability to sort or group objects and concepts based on the shared attribute(s) and apply a label depicting the attribute(s). Task difficulty is greater in circumstances requiring formulation of new categories. Impaired patients may have difficulty sorting clothes or choosing items for a balanced meal. Categorization is similar to association in that patients must understand the relationship between objects or concepts. However, categorization requires an extra step; the ability to provide a label describing the group of objects or concepts. Reasoning, cause and effect – the ability to perceive and anticipate the consequences of a given action or statement. For example, a patient may sit for a long period in a darkened room without realizing that flipping a light switch will cause the light to turn on. A patient may turn the oven up to make a coke cook faster, not realizing that the increased heat will simply cause the food to burn. Reasoning, concrete – the ability to understand the literal meaning of a phrase. Reasoning, deductive – drawing conclusions based upon premises or general principles in a step-by-step manner. Reasoning, generalization – the ability to take information, rules and strategies learned about one situation and apply them appropriately to other, similar situations. For example, a patient who leans to lock his wheelchair brakes in physical therapy may not lock the brakes while sitting in his room. Reasoning, inductive – awareness of one’s behavior and the accuracy or appropriateness of one’s performance. Usually automatic and on going. Reasoning, organization – the ability to arrange or group information in a manner that improves task efficiency. Persons who lack organizational skills often demonstrate a sense of purposelessness and have difficulty effectively utilizing nonstructured time. They have difficulty completing a puzzle or arranging materials to cook or shower. 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. 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. 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. Retrograde amnesia – inability to recall events that occurred prior to the accident; may be a specific span of time or type of information. Secondary insult – secondary or delayed brain injury; for traumatic brain injury, includes all events other than the mechanical injury sustained at the time of impact. Secondary phenomena may be divided into systemic and intracranial insults. Systemic insults include hypoxemia, anemia, hypotension, hypercarbia, hyperthermia, and electrolyte imbalance. Selective attention – ability to focus on the most important aspect of a situation without becoming distracted. Seizures – abnormal activity of nerve cells in the brain causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and loss of consciousness. See also epilepsy. Sensorimotor – refers to all aspects of movement and sensation and the interaction of the two. Sensory aphasia – see fluent aphasia. Sensory discrimination – a process requiring differentiation of two or more stimuli. Sensory integration – interaction of two or more sensory processes in a manner that enhances the adaptiveness of the brain. Sensory stimulation – arousing the brain through any of the senses. Sequencing – reading, listening, expressing thoughts, describing events or contracting muscles in an orderly and meaningful manner. Shaken baby syndrome – a severe form of head injury that occurs when an infant or small child is shaken forcibly enough to cause the brain to bounce against the skull; the degree of brain damage depends on the extent and duration of the shaking. Minor symptoms include irritability, lethargy, tremors, or vomiting; major symptoms include seizures, coma, stupor, or death. Shearing (or diffuse axonal injury) – damage to individual neurons or gray matter resulting in disruption of neural networks and the breakdown of overall communication among neurons in the brain. Shunt – a procedure to draw off excessive fluid in the brain. A surgically-placed tube running from the ventricles which deposits fluid into the abdominal cavity, heart or large veins of the neck. Skull fracture – the breaking of the bones surrounding the brain. A depressed skull fracture is one in which the broken bone exerts pressure on the brain. 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. Strabismus, external – outward turning of the eye which may be due to a lesion of the oculomotor nerve (III) causing paralysis of the medial rectus muscle. Strabismus, internal – inward turning of the eye which may be due to a lesion of the abducens nerve (VI) causing paralysis of the lateral rectus muscle. Stupor – a state of impaired consciousness in which the patient is unresponsive but can be aroused briefly by a strong stimulus. Subacute – the prefix “sub” means under, below, near or less than complete; “acute” means sharp, severe; having a sudden onset, sharp rise and short course. Thus, a subacute condition is one which has not reached, or has already passed through, the acute phase. Subdural – beneath the dura (touch membrane) covering the brain and spinal cord. Subdural hematoma – bleeding confined to the area between the dura and the arachnoid membranes. Subdural hygroma – a buildup of protein rich fluid in the area between the dura and the arachnoid membranes, usually caused by a tear in the arachnoid membrane. Supported employment – competitive work in integrated work settings for individuals with severe disabilities for whom competitive employment has not traditionally occurred, or for whom competitive employment has been interrupted as a result of severe disability, and who, because of the disability, need ongoing support services to perform that work. 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. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) – a condition in which excessive secretion of antidiuretic hormone leads to a sodium deficiency in the blood and abnormally concentrated urine; symptoms include weakness, lethargy, confusion, co ma, seizures, or death if left untreated. Tactile discrimination – the ability to identify and distinguish between objects and stimuli solely through touch, this involves the ability to ascertain shape, size, and texture. For example, persons with impaired tactile discrimination might not be able to distinguish between a quarter and a dime in their pocket. 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). 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 compensationg for abilities that cannot be restored. Thrombosis or thrombus – the formation of a blood clot at the site of an injury. Vasospasm – exaggerated, persistent contraction of the walls of a blood vessel. Vegetative state – a condition in which patients are unconscious and unaware of their surroundings, but continue to have a sleep/wake cycle and can have periods of alertness. Ventricles, brain – four natural cavities in the brain which are filled with cerebrospinal fluid. The outline of one or more of these cavities may change when a space-occupying lesion (hemorrhage, tumor) has developed in a lobe of the brain. Ventriculostomy – a surgical procedure that drains cerebrospinal fluid from the brain by creating an opening in one of the small cavities called ventricles. Verbal ability – composed of verbal understanding and verbal fluency. Verbal understanding is the ability of an individual to understand the subtleties and meaning of words. Verbal fluency is the ability to imagine, process and say words without associating them with any particular object. Also the ability to communicate by talking, writing, listening and reading. 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. Verbal fluency – the ability to produce words. 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 discrimination – involves the differentiation of items using sight. An individual with impaired visual discrimination may not be able to distinguish between a red and green light while driving or may have difficulty distinguishing between the letter “E” and the letter “F”. Visual imagery – the use of mental pictures to aid in recall. Visual perception – the ability to recognize and discriminate between visual stimuli and to interpret these stimuli through association with earlier experiences. For example, to separate a figure from a background, to synthesize the contents of a picture and to interpret the invariability of an object which is seen from different directions. Visual tracking – visually following an object as it moves through space. Vocational counseling – process of assisting a person to understand vocational liabilities and assets, provide occupational information to assist one in choosing an occupation suitable to one’s interests and liabilities. Vocational evaluation – those services provided to accomplish vocational evaluation according to established standards. Vocational rehabilitation process – providing, in a coordinated manner, those services deemed appropriate to the needs of a person with a disability, and designed to achieve objectives directed toward the realization of the individual’s maximum physical, social, mental and vocational potential. Wernicke’s aphasia – see fluent aphasia. Word retrieval deficit – difficulty recalling a specific word or words. Contact Casper & de Toledo to discuss a traumatic brain injury case with one of our experienced medical malpractice attorneys.