Glossary

An acronym for “activities of daily living,” functional activities individuals do throughout the day including bathing, dressing, toileting and eating.

Loss of the ability to express oneself and/or to understand language, caused by damage to the brain cells rather than deficits in speech or hearing organs.

Agitation is a state of extreme arousal and restlessness that makes it difficult for someone to relax and sit still. It can occur at any time during recovery but occurs most frequently and dramatically when the person passes through Rancho Level IV.

A condition in which too little oxygen reaches the body’s tissues.

A neurological disorder that can make it hard or impossible for a person to perform specific movements, even if they have the desire to do so and understand how to. This happens because brain damage hinders the brain from sending instructions to the body.

A failure of muscle control in the arms and legs, resulting in lack of balance and coordination or a disturbance of gait.

 In the context of TBI rehabilitation, awareness usually refers to the individual’s recognition of his or her own thinking or behavioral problems. It can also refer to the person’s understanding of how his or her limbs are positioned or the ability to monitor his or her own social behavior.

How a person acts or performs.

After a TBI, a person may experience difficulty in regulating their bowels and bladder. Retraining is started to help the person assume control over these functions. Diet, medications, fluid restrictions, intermittent catheterization and a toileting schedule are often used to help them regain control of these functions.

The ability to use newly learned skills or information and apply them to new situations. Carry over refers to the ability to use strategies and techniques taught in therapies in everyday life situations.

The mental processes that take place in the brain, such as thinking, learning, remembering, and using judgment. It also includes attention, language, perception, and decision-making. 

A state of unconsciousness from which the person cannot be aroused.

Also referred to as compensatory techniques, compensation strategies are ways to do certain tasks and activities that will help compensate for deficits. For example, a memory log is a compensation technique for decreased short-term memory. A task list to get ready in the morning is a strategy for impaired executive functions.

Thinking about the “here and now” with a decreased ability to consider other, more abstract factors. The individual understands clearly stated information but does not infer unspoken or unwritten intents. For example, the person may not infer that it is winter by the sentence, “I drove through a snowstorm on my way home for the holidays.” The person may take figures of speech and proverbs literally.

Fabrication of ideas which is partially or completely based on false information or misinterpretations of information. A person with memory problems may confabulate about a situation that occurred by exaggerating and distorting the facts. Individuals often try to “fill the gaps: in his or her memory and are not aware that the information is incorrect.

A medical condition that causes a prolonged alteration in a person’s awareness, arousal, and responsiveness. DOCs are typically categorized into a coma, a vegetative state or a minimally conscious state.

Weakness of the mouth or tongue may make speech sound slurred or mumbled. Dysarthria is sometimes accompanied by drooling and/or difficulty in chewing or swallowing.

A person may have difficulty swallowing which may be associated with pain. In some cases, swallowing may be impossible.

An acronym for Fiberoptic-endoscopic-evaluation-of swallow, a tool used to diagnose swallowing and assess useful strategies. It consists of passing a scope through the nose to view the throat while swallowing.

To perform an activity properly and normally.

Total or partial paralysis of one side of the body that results from disease or injury to the motor centers of the brain.

A tendency to overestimate one’s current abilities and to see self in terms of pre-injury capabilities. Impaired judgment is often associated with poor safety awareness, impulsiveness and a discrepancy between what the person says they can do and his or her actual ability. The person may become upset with family or staff, blaming them for preventing him or her from attempting unsafe activities.

Inclined to act on impulse rather than thought. Overly impulsive people may blurt out answers to questions or inappropriate comments, or run into the street without looking.

The extent to which an individual accurately judges his or her strengths and weaknesses.

A memory device in notebook form is used to assist a person with memory difficulties. It includes a calendar, information about the person and a daily entry section for recording therapy and other important information.

The awareness of an individual’s physical environment concerning time, place, personal identity and situation.

Repeating words or activities over and over involuntarily or becoming “stuck” on a certain idea or topic.

A period after the injury when the person exhibits loss of day-to-day memory. The person is unable to store new information and has a decreased ability to learn.

The ability of the individual to evaluate all factors, generate possible hypotheses and come to appropriate and effective solutions.

This scale is commonly used by both medical and rehabilitation providers to measure and track cognitive recovery after traumatic brain injury. It is a 10-point scale, although many medical professionals only use the first eight levels. All levels are defined below:

Level I No Response: Appears to be in a deep sleep and does not outwardly respond to pain or stimulation of the senses.

Level II Generalized Response: Will sometimes respond to stimulation by becoming more or less physically active. The person’s reaction may be the same to pain, noise, a visual stimulus or any other stimulation encountered. He or she will continue to “sleep” much of the time.

Level III Localized Response: Is awake a greater amount of the time and reacts more to what is happening around him or her. For example, the person may begin to turn toward sounds such as a door closing or to look at objects. Also, the person may begin to recognize familiar faces.

Level IV Confused, Agitated: Behavior may appear bizarre and out of character at this stage. The individual may act aggressively and attempt to remove restraints, and tubes, or crawl out of bed. Talking may be incoherent and not related to anything around them. The person has a hard time remembering current events and may only recall what happened before the accident.

Level V Confused, Inappropriate, Not Agitated: More alert and beginning to follow simple directions. Situations or activities that are unfamiliar or difficult may trigger restless behavior or outbursts, but this happens less frequently. Concentration improved, but redirection is still needed. Poor memory from moment to moment.

Level VI Confused, Appropriate: Now follows simple directions consistently. Beginning to show awareness of the injury and may become frustrated or annoyed when they can’t do things they could before the injury. Confused and disoriented at times. Attends activities for up to 30 minutes.

Level VII Automatic, Appropriate: Appears appropriate and normal on the surface. Goes through daily routine automatically, but may have little recollection of what has been happening day to day or week to week. Improving awareness. Lack of insight and judgment for safety.

Level VIII Purposeful-Appropriate, Standby Assistance: Oriented to person, place, time and space. Able to complete familiar activities in a distracting environment for short periods. Uses memory device with help. May still require supervision for some familiar executive tasks. Depression, irritability, and frustration are common.

Level IX Purposeful-Appropriate, Standby Assistance at Request: Able to shift attention back and forth between activities without help. Uses memory devices independently. Assistance with problem solving. Occasional help for socially acceptable behavior. Periods of depression, irritability and low tolerance for frustration.

Level X Modified Independence: Completes activities from before injury independently with extra time and compensatory techniques. Requires periodic breaks for fatigue. Anticipates and independently solves problems. May still have periods of depression and frustration especially when tired, under stress, or sick.

The amount of movement through which a joint can be straightened or bent.

Changing an activity or conversation to another subject to reduce confusion, agitation and frustration.

The process of restoring an individual or a body part to the highest possible level of function after a disabling disease or injury.

An involuntary increase in muscle tone (tension) that occurs following injury to the brain or spinal cord, causing the muscles to resist being moved.

Organizing a person’s day-to-day activities to provide a consistent and predictable environment for a person who is confused.

According to the Centers for Disease Control and Prevention, a TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.