Pediatric Brain Injury Program

Glossary

This glossary is written for health care professionals. As a result, some of the terms and phraseology used might seem confusing to those not familiar with brain injury management. If you have a question about any of the terms or definitions listed below, please consult your health care provider.

ABI

Acquired Brain Injury; an injury to the brain that has occurred since birth. An ABI can be caused by direct neurological insult or indirectly via metabolic/systemic illness.

 

ACCELERATION

The sudden movement of the brain inside the skull during an impact which causes the tearing of neurons and connections deep inside the brain

 

ACTIVITY REINFORCER

A type of secondary reinforcer which includes activity consequences such as bowling, a card game or walking

 

AGNOSIA

Partial or complete inability to recognize sensory stimuli; perception without meaning

 

AMNESIA

A loss of memory

1. Anterograde
   Inability to remember events subsequent to traumatic brain injury
2. Post-traumatic (PTA)
   Period of time following an accident when you have no memory. This period includes the coma at any time after awakening that you cannot remember anything. The length of the PTA is a partial predictor of the quality of the recovery.
3. Retrograde
   Inability to remember events that occurred prior to the onset of amnesia

ANGULAR GYRUS

A convolution in the parietal lobe, important language functions and intersensory processing

ANOMIA

Difficulty in finding words, especially in naming objects

 

ANOSOGNOSIA

A diminished self-awareness of problems, resulting from information processing difficulties

 

ANOXIA

An abnormal condition characterized by a relative or total lack of oxygen

 

ANTECEDENT

A stimulus or event which precedes a behavior

 

ANEURYSM

Circumscribed dilation of an artery formed by a stretching of its walls; suggestive of a condition in which the weakened blood vessel may burst

APHASIA

Inability to comprehend and/or use language skills

1. Global
2. Expressive
3. Receptive

APRAXIA

Impairment in the ability to perform purposeful acts or to manipulate objects without paralysis/paresis; can affect oral, verbal and upper/lower extremity functioning

AROUSAL

The ability to stay awake; one part of the attention stage of information processing. An early problem with many survivors is a constant feeling of drowsiness, sleepiness or inability to remain alert. This often improves with time.

ATAXIA

A disturbance in the coordination of the muscular movements

 

ATTENTION

1. Focused Attention
   The ability to demonstrate a discrete response to stimuli
2. Sustained Attention
   The ability to maintain a behavioral response for a continuous or repetitive activity
3. Selective Attention
   The ability to maintain a behavioral response which requires activation or inhibition of the response depending upon discrimination of stimuli
4. Alternating Attention
   The ability to perform tasks that require rapid switching from one response set to another
5. Divided AttentionThe ability to respond to two simultaneous selective attention tasks

AUGMENTATIVE & ALTERNATIVE COMMUNICATION

Use of forms of communication other than speaking, such as sign language, "yes/no" signals, gestures, pictureboard and computerized speech systems to compensate either temporarily or permanently for severe expressive communication disorder

 

AWARENESS/INSIGHT

1. Intellectual Awareness (IA)
   The ability to understand at some level that a function is impaired (low level awareness) or to understand the implications of that impairment (high level awareness). Lack of knowledge may be the basis of intellectual unawareness. On the other hand, brain damage itself may be responsible through impaired abstract reasoning and severe memory problems.

2. Emergent Awareness (EA)
   The ability to recognize a problem when it's happening (this requires that a person first have intellectual awareness). The person may have difficulty monitoring the relationship between their actions and their environment and may have to trust the feedback of others ("Did I really forget to close the cash register drawer?"). To make matters worse, the person may not trust others. They may be able to define their deficit, state why a particular comp. system is needed but can't apply it because they don't realize the problem is occurring.

3. Anticipatory Awareness (AA)
   The ability to anticipate that a problem will occur as a result of having some type of deficit. To anticipate a problem, a person must have both intellectual awareness (i.e., awareness they have a problem) and emergent awareness (i.e., a recognition when problems are actually occurring). The person with problems in this area is unable to realize in advance of their actions (i.e., anticipate) that a given problem will cause a particular problem in the future. Anticipation is one of the important executive functions of the brain.

   Problems in AA can frustrate loved ones because the person is able tell them about their problem (i.e., intellectual awareness) and can also tell them when they're having a problem (i.e., emergent awareness), but are unable to anticipate problems before they occur. As a result, loved ones often think, "They should have known that was going to happen!"

   Isolated deficits in AA are typically rarer than those in IA and EA because the frontal lobe lesions that cause difficulty in anticipation are frequently associated with lesions that reduce abstract reasoning, which in turn lead to deficits in IA. Intact IA is a prerequisite for AA to occur.
    

BACK-UP REINFORCER

A reinforcer for which tokens are traded

BASAL GANGLIA

Paired subcortical structures that are parts of the extrapyramidal motor system involved in maintaining motor tone and involuntary motor activity. These structures are interconnected with the frontal lobes and when damaged can lead to problems in various domains of executive functions
 

BEHAVIOR

Any action or response made by an individual. Behavior may be overt or covert. Overt behavior is observable and includes verbal behavior. Covert behavior is not observable; thoughts and feelings are covert behavior. Behavior is also classified as being either respondent or operant.
 

BILATERAL

Occurring on or applying to both sides of the body
 

BLUNT IMPACT

The cause of closed head injuries, from a collision between the skull and a blunt object. There is no penetration of the skull, but the skull is often bent inward from the blow.
 

BRAIN

A large, soft structure of nerve tissue, blood and cerebrospinal fluid contained within the skull. The brain, together with the spinal cord, makes up the central nervous system.
 

BRAIN STEM

Lower end of brain; the midbrain, pons and medulla; controls all automatic body functions, such as breathing, blood circulation, heartbeat, swallowing and level of consciousness. It also plays a role in governing movement.
 

BRAIN STEM EVOKED RESPONSE

A response provoked by stimulating the brain stem; may be auditory, visual, and/or somatosensory. A machine is used to test whether the brain stem has received the signals.
 

BRAIN SWELLING

A significant increase in the size of the brain due to an increase in the amount of blood going there; may occur after severe head injury
 

CAREGIVERS CONFERENCE

A PRN meeting to do more focused treatment planning and problem solving for individuals with acquired brain injury. Anyone on the treatment team can call for a caregiver conference. Sometimes problems and issues exist in only one therapy. However, that particular problem is not just that therapist's issue; it is a team issue which must be addressed accordingly.
 

CEREBELLUM

a portion of the brain that occupies a position in posterior (i.e. back) of the brainstem. It has a left and right hemisphere as well as median lobe called the vermis. It regulates motor coordination and has been implicated in cognitive functions such as complex attention and procedural learning.
 

CEREBROSPINAL FLUID (CSF)

A water cushion protecting the brain and spinal cord from shock
 

CEREBRUM

The largest part of the brain; controls voluntary or willed movement and the ability to create rational thought. Such capabilities are only possessed by human beings. The cerebrum is made up of frontal, temporal, parietal and occipital lobes divided into halves.
 

CLINICAL PATHWAY

An interdisciplinary tool that maps expected outcomes and associated interventions along a timeline, for patients with specific diagnoses or procedures
 

CLOSED HEAD INJURY

Traumatic head injury in which the skull is not broken and the dura is not pierced
 

COGNITION

The mental process or faculty of knowing; may be simple or complex, and includes psychological (past/present) cognitive and physiological medical/neurological factors
 

COGNITIVE RETRAINING REHAB

Therapeutic intervention aimed at facilitating the recovery of mental skills disrupted as a result of brain injury
 

COMA

Long periods of unconsciousness. The depth may vary from no response to stimulation to a slight awakening. Depth and length often affect the quality of recovery.
 

CONCEPT

Embracing all of the various models: perceiving, remembering, imagining, conceiving, judging, reasoning, visual spatial and problem solving
 

CONCUSSION

A mild form of head injury producing a temporary loss of consciousness, fatigue, headaches and brief memory loss
 

CONFABULATION

The fabrication of experiences recounted to fill in and cover up gaps in memory
 

CONFRONTATION NAMING

Ability to name objects when asked versus in the context of speech
 

CONSEQUENCE

A stimulus or event which follows a behavior
 

CONTINGENCY

A relationship between a behavior and consequence. "Eric can play catch (consequence) after he cleans his room (behavior)" is a statement of contingency.
 

COUP-CONTRECOUP

When the brain is hit with sufficient force, it will "bounce" against the opposite side of the skull causing injury to both the site of impact (coup) and the part of the brain opposite the impact (contrecoup).
 

CONTRALATERAL

Pertaining to the side of the body opposite the reference point
 

CONTROLLING VARIABLE

An environmental variable which can affect a behavior
 

CONTUSION

A form of injury involving bruising of the tissue
 

CORPUS CALLOSUM

The band of commissural fibers which connects the two hemispheres of the brain and allows for rapid and effective interhemisphere communication
 

CORTEX

The outer convoluted surface of the brain that is composed of nerve cell bodies and their synaptic connections. It is the highest and most complexly organized center of the brain. The cortex is typically divided into four main lobes: frontal, temporal, parietal and occipital.
 

CORTICAL DYSPLASIA

An abnormality in the growth, size and/or shape of cells.
 

CRANIAL NERVES

12 pairs of nerves which have their origin in the brain stem. Each performs the following functions:

OLFACTORY	Smell		FACIAL	Face Movement
OPTIC	Vision		AUDITORY	Hearing
OCULOMOTOR	Pupils' Reaction to Light		VESTIBULOCOCHLEAR	Hearing & Balance
TROCHLEAR	Eye Movement		VAGUS	Involuntary Muscles
TRIGEMINAL	Facial; Chew Sensation		SPINAL ACCESSARY	Voluntary muscles of neck
ABDUCENS	Eye Movement		HYPOGLOSSAL	Tongue Movement

 

CRANIUM

The bones of the skull

 

CT SCAN

Computed tomography; an x-ray procedure that provides a three dimensional reconstruction of the brain architecture using a computer. By varying the angles of the x-ray beam, numerous "slices" of brain tissue can be visualized and distinguished according to the densities of their components.
 

DECELERATION

The sudden stop of the brain's forward motion when it hits the skull after an impact. This sudden stop tears the neuron connections and violently twists and jars the brain.
 

DEPENDENCY

A causal relationship between a behavior and a consequence. For example: Tom will receive a paycheck (consequence) ONLY if he works 30 hours this week (behavior).
 

DEPRESSED SKULL FX

Pressure against the brain from broken bones
 

DEPRIVATION

When the probability of a behavior is increased only because the individual has not come into contact with the positive consequence of that behavior for a sufficiently long period of time
 

DIFFUSE BRAIN INJURY

Widespread injury resulting from the brain forcefully hitting the inside of the skull bones in addition to being twisted
 

DIMINISHED BEHAVIORS

A class of behavior characterized by withdrawal, refusal to answer questions or talk and answering in monosyllables
 

DURA MATER

A tough, leathery membrane that encases the brain and provides the brain's last defense against intrusion
 

DIPLEGIA

bilateral paralysis of extremities (e.g. both arms, both legs)
 

DIPLOPIA

Double vision; perceiving two images from a single object
 

DISINHIBITION

The inability to control or inhibit impulses and emotions
 

DISORIENTATION

Not knowing where or who you are and/or the time; often referred to as "disoriented in all three spheres" or "disoriented times three," referring to person, place and time
 

DISTRIBUTED PARALLEL PROCESSING

A contemporary concept used to describe cognitive processing that is both parallel and distributed. Most cognitive tasks require the simultaneous consideration of many items of information. "Distributed" refers to the idea that complex behavioral/cognitive domains are mapped at the level of multifocal networks distributed throughout the brain. There are both local and large-scale networks, and processing occurs at many different levels (i.e., parallel), including the sensory, cognitive/cordical and metacognitive levels.
 

DORSAL

Toward the back
 

DURA

The outer layer of membranes enclosing the brain and spinal cord
 

DYSARTHRIA

Difficulty in speech production caused by a lack of coordination of speech apparatus and a lack of strength, ROM and coordination
 

DYSCALCULIA

An impairment in the ability to perform mathematical operations
 

DYSGRAPHIA

An impairment in the ability to write
 

DYSLEXIA

An impairment in the ability to read
 

DYSPHAGIA

An impairment in the ability to swallow, which may result from a brain injury
 

DYSPLASIA

Abnormal tissue development
 

DYSPRAXIA

A partial loss of the ability to perform skilled, coordinated movements without paralysis or paresis; can affect oral, verbal and upper extremity/lower extremity functioning.
 

DYSTONIA

slow, involuntary, dysrrhythmic muscle contractions. This often results in distorted body posture
 

ELECTROENCEPHALOGRAPHY (EEG)

The method studying electrical brain waves with electrodes attached to the scalp or inserted into the brain ("depth electrodes"). The EEG is used to help diagnosis epilepsy, encephalitis, toxic and metabolic conditions. It is also used to evaluate coma and brain death.
 

ELICIT

Causing a response to occur by presenting a particular antecedent
 

EMBOLISM

The sudden blocking of an artery or vein by a blood clot, bubble of air, deposit of oil or fat or small mass of cells deposited by the blood current
 

ENCEPHALITIS

Inflammation of the brain
 

EPIDURAL HEMORRHAGE

Bleeding between the skull and dura
 

EPILEPSY

A group of neurological disorders characterized by recurrent episodes of convulsive seizures, abnormal behavior, loss of consciousness, sensory disturbances, etc. An uncontrolled electrical discharge from the nerve cells of the cerebral cortex is common to all forms of epilepsy. A status epilepticus is a continual attack of convulsive seizures which occur without intervals of consciousness. Irreversible brain damage may result if seizures go unarrested. Status epilepticus is a medical emergency.
 

EXECUTIVE FUNCTIONS:

1. Goal Selection
   The ability to generate or choose, as defined by appropriate future objectives; requires anticipation (Sohlberg & Mateer) and a sense of intention

2. Planning/Sequencing
   The ability to develop a scheme to reach intended objectives; includes the ability to correctly order the steps involved in generating a plan and encompasses organizational skills

3. Initiation
   The ability to behaviorally begin an action

4. Execution
   The ability to carry out or follow through with intended actions; the behavioral correlate to planning. Execution comprises the skills involved in carrying out planning/organizational schemes.

5. Time Sense
   The ability to estimate the passage of time and monitor one's performance within time constraints; a specific application of planning and execution. The rationale for distinguishing time sense as a separate scale was based on the high frequency with which problems in time management were reported as a primary obstacle to community reentry. As such, time management was often an important treatment objective.

6. Awareness of Deficits
   An individual's level of awareness and understanding of existing impairments after injury, including knowledge of how impairments will impact daily functioning and acceptance of the need to compensate for and accommodate deficits

7. Self-Monitoring
   The ability to self-evaluate and modify one's own behavior in response to information gleaned from the environment, including the ability to detect and correct one's own errors
    

EXTERNAL MEMORY

Device aid used to give feedback and assist an individual with recall of information/events, things to do, steps in an activity, problem solving and self-monitoring. Examples would include a string on the finger, programmable watch, spell checker, memory log or notebook organizer.

 

EXTRAPYRAMIDAL SIDE EFFECTS

"Extrapyramidal" refers to motor control that originates in the basal ganglia and does not involve the pyramidal tracts. The term "Extrapyramidal Side Effects" is typically used to describe the side effects that affect the extrapyramidal system. Typical symptoms of an extrapyramidal disorder from medications include Brady Kinesia (slowness of movement), heightened muscle tone, pronounced rigidity and slow and shuffling gait. Some classes of neuroleptics (g. Haldol and Mellaril) can produce these side effects.
 

EXTINCTION

A process whereby a behavior eventually stops occurring because the positive consequence normally maintaining the behavior is eliminated
 

FEEDBACK

Information given by another person regarding behavior. Such information can be used constructively to improve behavior.
 

FIM SCALE

The Functional Independence Measurement Scale is a tool used for program evaluation. It measures how patients are doing when they are admitted to the Rehab Unit, again at discharge and 90 days following discharge. Data is collected on 18 items in the areas of self care, sphincter control, mobility, communication and social cognition.
 

FIXED REIMFORCEMENT SCHEDULE

A schedule whereby reinforcement occurs on a regular or consistent basis, such as after every five responses (fixed-ratio 5) or after the first response that occurs after 10 minutes have elapsed since the last reinforcement (fixed interval 10 minutes)
 

FLACCID

Loss of muscle tone; body part appears limp
 

FOCAL DEFICITS

Hematomas and lesions on the surface or interior of the brain located at the site of impact or at isolated points in the brain. Not as random as diffuse consequences, these problem areas of the brain can be pinpointed and many problems attributed to them.
 

FRONTAL LOBE DYSFUNCTION

Behavioral symptoms resulting from damage to the frontal lobes of the brain, causing diminution in self-control, foresight and/or spontaneity
 

GLASGOW COMA SCALE (GCS)

A quick, practical and standardized system for assessing the degree of conscious impairment and predicting outcome following levels 1-15 traumatic brain injuries
 

GLASGOW OUTCOME SCALE (GOS)

A reliable scale for categorizing the outcomes of brain-injured survivors on the basis of overall social capability (or dependence). The four possible categories of survival are Vegetative state (VS), Moderate Disability (MD), Severe Disability (SD) and Good Recovery (GR).
 

HEMATOMA

A mass of blood caused by bleeding in a confined space
 

HEMIANOPSIA

A loss of half the visual field
 

HEMIPARESIS

Muscular weakness affecting one side of the body
 

HEMISPHERES

The two halves into which the cerebrum is divided down the middle
 

HEMIPLEGIA

Paralysis of one side of the body
 

HEMORRHAGE

Loss of a large quantity of blood in a short period of time
 

HIPPOCAMPUS

paired structures in the medial (i.e. middle) part of each temporal lobe. Part of the limbic system and heavily involved in the new learning of verbal and visual information. Often is the focus of seizure activity in complex partial seizures
 

HYDROCEPHALUS

An increased amount of cerebrospinal fluid (CSF) within the spaces of the brain
 

HYPOTHALAMUS

Part of the brain which regulates automatic body functions, such as thirst, appetite, body temperature and sex drive
 

HYPOXIA

An inadequate, reduced tension of arterial oxygen which results in increased heart and respiratory rates. Breathing failure and coma can ensue in severe cases. Treatment may include oxygen therapy, mechanical ventilation, frequent analysis of blood gasses or respiratory stimulant drugs.
 

INFORMATION PROCESSING

The primary purpose of the brain. Among its duties, the brain handles information, examines incoming information from the senses, pays attention to what is important, makes decisions and initiates response. This cycle applies to information from the environment and the body. Any break in the cycle can have profound consequences.
 

INITIATION

The ability to start or begin things
 

INPUT

The first stage of information processing. Information travels through the senses to the brain from the environment and internal organs of the body.
 

INTRACRANIAL PRESSURE (ICP)

The exertion of force within the brain by intracellular fluids capable of causing distortion or displacement of cerebral structures or a reduction of cerebral blood flow. Because the skull is a rigid container of brain tissue, blood and cerebrospinal fluid , an increased volume of one component without an equal decrease of another will result in ICP.
 

INTERMITTENT SCHEDULE OF REINFORCEMENT

A schedule or reinforcement whereby some occurrences are not reinforced. The four major intermittent schedules are Fixed-Ratio (FR), Variable-Ratio (VR), Fixed-Interval (FI) and Variable-Interval (VI).
 

INTRACEREBRAL HEMATOMA

Bleeding within brain tissue
 

JUDGEMENT

See Awareness .
 

LACERATION

A cut or tear of tissue
 

LESION

Any visible local abnormality of the tissues of the body or nervous system.
 

LOBES

The four sections into which the cerebrum is divided. While each has its own particular activities, it is important to remember that all the lobes interact with each other.

1. Frontal
   The forward portion of cerebrum; primary functions center around planning, organization, problem solving and self awareness

2. Parietal
   Complex lobe of the cerebrum; serves many functions; puts together verbal/visual information to make reading possible and plays a role in tactile sensation

3. Temporal
   The archral lobe plays a major role in language, as well as in coding information to memory. Though actual storage of info occurs throughout the brain, coding occurs in the temporal lobe.

4. Occipital
   Located on the backside of the cerebrum, this portion of the brain is primarily centered around vision. Information from the eyes is processed here.

 

MAGNETIC RESONANCE IMAGING (MRI)

A diagnostic technique that uses non-ionizing energy to produce sectional images of the human body. A strong magnetic field is used in conjunction with a radio frequency oscillating magnetic field to stimulate signals from atoms in living tissue. These signals are reconstructed by a computer into sectional images in any plane.
 

MEDULLA

Part of the hindbrain, the medulla controls automatic body activities. For example, your heart rate, breathing rate and blood pressure would be very hard to control if you had to do it consciously.
 

MEMORY

1. Procedural
   The ability to learn rule-based or automatic behavioral sequences, such as motor skills, conditioned responses, certain kinds of rule-based puzzles and perceptual motor tasks, and to carry out sequences for running/operating things (e.g., riding a bike; using a VCR, computer or microwave oven; playing tennis; etc.)

2. Declarative
   A type of memory that implies conscious awareness and the ability to report something (e.g., the ability to recall a conversation with someone last week or to remember information from a book). If someone were to ask about that conversation or the information in the book, you would use your declarative memory system to recall it.

3. Prospective
   The ability to remember what needs to be done (e.g., remembering an upcoming appointment). The ability to "remember into the future" places heavy demands on the executive control and "working memory" systems of the brain.

4. Retrograde
   Memory of events prior to insult or injury. In clinical practice, we often refer to "retrograde amnesia" as loss of memory for a period of time before an acquired brain injury.

5. Short Term
   Information you only need to remember for a short time (e.g., a phone number from an operator)

6. Long Term/Remote
   The ability to learn and remember new things over a long period of time; involves association with previous information or experiences
    

MENINGES

Three-layered membranes enclosing the brain and spinal cord; composed of the dura (outer layer), arachnoid (middle layer) and pia (inner layer)
 

MIDBRAIN

The first major division of the brain. Primary activities center around wakefulness and alertness. People with injury here are often drowsy and hard to arouse.
 

MOTOR PLANNING

The ability to organize voluntary movements
 

MYOCLONUS

Can be seen in a variety of normal (e.g. early stages of sleep) or abnormal situations (e.g. epilepsy)
 

NEGATIVE CONSEQUENCE

A stimulus or event which decreases the probability of the behavior it follows
 

NEUROPSYCHOLOGY

A branch of psychology that attempts to test different specific components of cognition by examining cognitive elements such as memory, visuoperceptual function and reaction time. The neuropsychologist is interested in determining the site and mechanism of damage to specific functions.
 

NEUROPSYCHOLOGICAL EVALUATION:

a comprehensive assessment of cognitive, motor and behavioral functions utilizing a set of standard tests and procedures. Various brain related functions are evaluated including: intelligence, memory, new learning ability, attention, language, planning, organization, problem solving & reasoning abilities, perceptual and motor abilities as well as various tests of behavior, personality and emotional function. A neuropsychological evaluation is utilized for assessing progress after a brain injury, identifying the consequences of neurological illness (e.g. epilepsy, tumor, anoxia, TBI) and assisting in developing educational and/or vocational plan.
 

NUCHAL RIGIDITY

Stiffness and pain in the neck upon movement
 

OPERANT

Behavior which is caused mainly by its past consequence rather than simply by its antecedents (e.g., mailing letters to friends because letters have been received in return in the past) (See Respondent .)
 

OPTIC CHIASM

The point at which the optic nerve from one eye crosses to join the other
 

ORIENTATION

Identifying person, place, time and situation
 

OUTPUT

The final stage of information processing, usually consisting of behaviors and/or feelings
 

PARALYSIS

Neurologic muscular weakness or dysfunction to the point of immobility. With lack of movement, muscles begin to contract and become smaller or atrophic. Paralysis of the extremities on one side of the body is called hemiplegia. Paralysis of all four extremities is called quadriplegia.
 

PATH FINDING SKILLS

The ability to utilize executive functions to safely travel from one destination to another at various levels of difficulty
 

PENETRATING INJURIES

Injuries which occur when the skull becomes broken and an object such as a skull fragment or bullet penetrates the dura mater and brain tissue
 

PERINATAL

Occurring during the period shortly before or after birth.
 

PERSEVERATION

The tendency to continue an activity, motor or mental, once it has been started and to be unable to modify or stop the activity even though it is acknowledged to have become inappropriate. In speech, automatic and often involuntary repetition of words
 

PLANNING

Two varieties: deciding what activities and things must be done, and deciding how to respond or behave to a given situation
 

PONS

The part of the hindbrain that acts as the information link between the forebrain and cerebellum
 

POSITIVE CONSEQUENCE

A stimulus or event which increases the probability of the behavior it follows
 

POST TRAUMATIC EPILEPSY

A type of seizure disorder occurring in greater than 5 percent of patients who suffer head trauma. The more severe the injury the greater the likelihood that seizures will appear. Seizures may consist of motor or sensory activity, emotional states or a combination.
 

PREMORBID

Prior to the onset of illness or injury
 

PROBLEM SOLVING

Considered to be one of the "higher" functions of the cerebrum, problem solving involves gathering information from different sources, assimilating it, generating a solution, trying the solution out and changing it if necessary.
 

PROCESSING

The third stage of information processing. Components include association, memory, problem solving, organization and planning.
 

PROMPT/CUE

A specific antecedent which generates a particular behavior
 

PROSODY

Stress, intonation, intensity and duration of voice that signals linguistic qualities; melody of speech caused by modifications of pitch, quality, strength and duration affecting mainly stress and intonational patterns.
 

PUNISHER (Negative Consequence)

A stimulus or event which decreases the probability of the behavior it follows
 

REFLEX

Involuntary response to a stimulus, such as pulling your hand away from hot stove
 

RANCHOS LOS AMIGOS RATING SCALE

A 10-level scale of cognitive recovery used for assessing recovery, communicating between health care professionals and facilities and in research. As a patient's recovery progresses, he or she will move up the scale.
 

REHABILITATION

The process of restoring to useful life a person who has a disabling condition
 

REINFORCER (Positive Consequences)

A stimulus or event which increases the probability of the behavior it follows
 

RESPONDENT

An instance of behavior or single action caused mainly by the antecedent presented, not the behavior's past consequence (e.g., jerking away & yelling OUCH after touching a hot pan) (See Operant .)
 

RESPONSE

How a person acts; what they say or do. Responses are reactions to what is happening around you.
 

RETICULAR FORMATION

A small, thick band of neurons within the brain stem that controls breathing, blood pressure, heartbeat, levels of consciousness and other vital functions. The reticular formation constantly monitors the state of the body through its connections with sensory and motor tracts.
 

ROAM ALERT

A system designed to provide security for patients who have the potential to wander and are confused or agitated. This system helps prevent elopement, therefore decreasing the potential for injury to self and others.
 

SCHEDULE OF REINFORCEMENT

A description of the relationship between a behavior and reinforcer , which indicates the frequency of reinforcement for that behavior
 

SLEEP RECORD

A record used by the nursing staff (and reviewed by physicians) to chart the hours a patient is awake/asleep. A sleep record assesses a patient's sleep pattern to determine if interventions are needed to restore and promote adequate sleep.
 

SEIZURES

Convulsions; involuntary muscular contractions/relaxations. The following are types of seizures:

1. Grand Mal
   Severe, generalized seizures in which the person usually loses consciousness

2. Petit Mal
   Seizures consisting of momentary loss of consciousness (blank stares, etc.)

3. Jacksonian
   Convulsions, often restricted to certain groups of muscles or limited to one side of the body; localized
    

SEQUELAE

The pathological sequences that follow a traumatic insult or onset of disease

 

SHEARING

The type of brain lesion often seen as a result of an abrupt deceleration in movement, resulting in a continuation of brain movement within the skull. Shearing lesions are recognized as tears in nerve fibers, particularly of axons through the white matter.
 

SOCIAL REINFORCER

A type of secondary reinforcer , such as praise, smiles, hugs and laughs, that can only be presented by another person
 

SOFT PALATE

A small flap of tissue that moves back and forth, allowing air to come out through the nose or mouth; plays an important role in speech. Damage to the brain can cause problems that prevent the soft palate from moving. Difficulties with breathing and speaking are the result.
 

SPASTICITY

A condition which causes spasms or other uncontrolled contractions of the skeletal muscles
 

SUBDURAL HEMATOMA

Bleeding between the dura membrane covering the brain and the arachnoid membrane (the innermost layer)
 

TARGET BEHAVIOR

The behavior which has been identified for modification or maintenance
 

THALAMUS

This tiny organ, a part of the forebrain, functions as a sensory relay station, taking information from the senses and routing it to the portions of the brain that need it.
 

THREE NEURO AXIS MODEL OF BRAIN FUNCTIONING

A model of brain functioning that suggests that any behavior is the product of three neuroanatomic axes:

1. The Anterior/Posterior Axis, which involves executive and control (output) processes (anterior), as opposed to the input, or reception/processing of information (posterior)

2. The Lateral Axis, involving the two hemispheric systems and their contrasting of information-processing styles. Left hemisphere systems are preferentially involved with the building blocks of language, parts of complex materials and temporally processed information. Right hemisphere systems are preferentially involved with spatially represented information, the relationship between parts and the configurational aspects of complex materials.

3. The Cortical/Subcortical Neuro Axis, involving complex feedback relationships between higher order planning systems (cortical axis) and the extensive subcortical systems mediating life support, arousal, drive responses and the regulation and execution of behavior in general.
    

TIME ESTIMATION SKILLS

See Time Sense .
 

TRANSIENT COGNITIVE IMPAIRMENT (TCI).

This term refers to episodic seizures. Seizures are not necessarily "on and then off" events. Children who have epilepsy may have intermittent
 

VENTRICLES

Open spaces or cavities in the brain which are filled with the same fluid that surrounds the brain and spinal cord
 

WORD-FINDING PROBLEM

Inability to evoke words corresponding to specific concepts