Glossary

Acquired brain injury (ABI): An acquired brain injury is an injury to the brain, which is not hereditary, congenital, degenerative, or induced by birth trauma. An acquired brain injury is an injury to the brain that has occurred after birth.

Acute: In reference to healthcare for TBI, describes the medical procedures undertaken to stabilize a patient in a hospital; care that is provided on a short-term basis for an immediate need, usually right after the injury occurred. Post acute care is care provided after initial stabilization on a longer-term basis.

Advocate: To argue for a cause, or plead on another’s behalf for education, legal, personal, or vocational rights, or a person who argues for their own, or another person’s rights.

Anoxia: The cessation of oxygen supply to the brain -- can lead to brain cell death and loss of function.

Antecedents: Factors or events that occur prior to a current situation. Attention to antecedents can assist in promoting desired behaviors and avoiding negative behaviors.

Ascending Reticular Activating System: A complex neural network that includes the reticular activating system.

Ataxia: Inability to coordinate voluntary muscle movements.

Autonomic Storming: When the brain’s ability to regulate the sympathetic and parasympathetic nervous system is damaged.

Axonal shearing: When the brain is moved back and forth against the skull after a head trauma, it is alternatively compressed and stretched because of its soft, gelatin-like structure. The long, fragile axons of the neurons that make up the brain are also compressed and stretched. If the impact is severe enough, axons can be stretched until they are torn. This is called axonal shearing. When this happens, the neuron dies. An injury with substantial axonal shearing is more diffuse/spread throughout the brain.

Axons: Long nerve fibers that conduct impulses away from the cell body of a neuron.

Brain Injury (BI): Any injury that results in brain cell death and loss of function.

Brain Injury Association of Michigan (BIAMI): A non-profit consumer organization that works to improve the lives of those affected by brain injury through education, advocacy, research and local support groups.

Brain swelling (cerebral edema): The brain swells after a severe trauma, just like any other part of the body. This is also a major cause of damage after brain injury. Very severe swelling can cause death by compressing the brain stem. Brain swelling can lead to neuronal damage by squeezing the cells or from anoxia caused by disrupting the flow of blood and oxygen to the brain.

Centers for Independent Living (CILs): Centers located throughout Michigan to provide services designed to maximize self-sufficiency and independence of people with disabilities.

Cognitive functioning: A function of the brain that refers to how one thinks, reasons, stores, and processes information.

Community Mental Health Services Programs (CMHSP): Programs contracted by the Michigan Department of Community Health to provide a full array of community-based support services for eligible individuals (persons with a qualifying developmental disability or mental illness) and their families. While some CMHSPs may directly operate treatment programs, most CMHSPs establish a network of agencies and professionals to provide treatment services.

Congenital condition: Circumstance that is present at birth.

Contusion (of the brain): Bruising and bleeding of the brain due to the tearing of small blood vessels upon impact. It can lead to the death of neurons. Small contusions (as in concussion) are not usually treated unless blood flow is interrupted.

Coordinating Agency (CA): Agencies contracted by MDHHS, Office of Drug Control Policy, to provide access to publicly funded substance abuse services. They have administrative responsibility for an Access Management System that determines eligibility, manages resources and assures quality of care.

Coup-contracoup: A pattern of contusion whereby one contusion occurs at the site of the initial impact on the brain ("coup") and another at the site directly opposite ("contracoup"). This pattern is the result of the brain moving back and forth inside the skull upon impact.

Cultural competence: The ability and the will to respond to the unique needs of an individual client or family that arise from the client’s culture and the ability to use the person’s cultural strengths as resources or tools to assist with the treatment, intervention or helping process. Cultural competence is generally regarded as a long term process towards which one strives. In addition, cultural competence can be thought of as an attribute of an individual provider and as an attribute of an organization.

Deep Vein Thrombosis: A blood clot in a vein, deep in the body.

Dementia: Loss of memory, language, problem solving and other thinking problems that are severe enough to interfere with daily life.

Department of Human Services (DHS): Formerly Family Independence Agency or FIA - Michigan state agency that directs the operations of public assistance and service programs in every county in Michigan. In particular, DHS determines eligibility for the Medicaid insurance programs and provides Adult Services to persons who are Medicaid eligible.

Depressed skull fracture: This is when bones of the skull are broken or cracked with loose bone fragments actually placing pressure or penetrating the brain, thereby causing damage.

Developmental Disability (DD): According to the Michigan Mental Health Code, a developmental disability is a severe mental or physical impairment that: 1) occurs before an individual is 22 years old; 2) is likely to continue indefinitely; 3) results in substantial functional limitation in three or more of the following areas of major life activities: self care, mobility, learning, self direction, receptive & expressive language, capacity for independent living, and economic self sufficiency; and 4) reflects the individual’s need for special, interdisciplinary treatment, or other services that are of lifelong or extended duration. For minors from birth to age five, a developmental disability is a substantial developmental delay or a specific congenital or acquired condition with a high probability of resulting in developmental disability if services are not provided.

Diffuse injury: An injury to the brain in which damage is not limited to one location in the brain, but affects multiple areas.

EEG: Electroencephalogram (EEG) is a neuro imaging diagnostic tool that detects electrical activity in the brain.

Eligibility: Requirements that need to be met by the applicant, in order to receive services or enroll in a program.

Executive functioning: Cognitive functions having to do with planning, abstract reasoning, problem-solving, information processing, judgement, working memory, etc.

fMRI: Functional magnetic resonance imaging (fMRI) is a neuro imaging diagnostic tool that measures magnetic susceptibility of deoxygenated blood and oxygenated blood.

fNIRS: Functional Near-Infrared Spectroscopy is a nuero imaging diagnostic tool that uses near-infrared light passing through tissue to measure oxygenated and deoxygenated blood levels.

Glasgow Coma Scale (GCS): The GCS is commonly used for initial assessment of brain injury severity. The GCS uses a 15 point scale to rate eye opening, motor, and verbal response functions. Unfortunately in practice, the time of the assessment can vary (e.g., at the scene of injury, upon arrival in the emergency department, etc.) making results from one patient to the next difficult to compare. Moreover, GCS results may not be valid for children, people under the influence of alcohol, or people with language differences.

Hematoma: If the blood vessels damaged by the impact inside the skull are large enough, they may bleed enough to create a pool of blood or hematoma. A hematoma can cause brain injury by directly damaging the neurons it comes in contact with or by squeezing neurons through increased pressure in the brain due to its volume. The treatment for a hematoma is to surgically drain it, if possible.

Hemorrhagic Stroke: A hemorrhagic stroke is when a blood vessel in the brain ruptures and the resulting bleeding in the brain and loss of blood flow to the remaining brain tissues causes cell death.

Heterotopic Ossification: Heterotopic Ossification is when bone grows in tissues where it typically wouldn’t. The formation of extra skeletal bone in muscle and soft tissue.

Hypovolemic shock: After injury, loss of blood volume can further compromise healthy brain tissue.

Hypoxia: When there is inadequate oxygen to the brain that results in damage to brain cells.

Incidence: In reference to Traumatic Brain Injury (TBI) data, incidence refers to the number of a given type of events, or new instances of TBI, in a year.

Increased intracranial pressure: Intracranial pressure occurs because of a build-up of pressure within the skull. Because the brain, membranes and cerebrospinal fluid are encased with the bones of the skull, the fluid formed as a result of swelling or bleeding "backstop" in the brain causing increased pressure inside the brain which results in further damage to brain tissue.

Individuals with Disabilities Education Act (IDEA): A federal law, first enacted in 1975 and most currently re-authorized and revised in 2004, that requires public schools to determine whether a child has a disability, develop a plan that details the education and support services that children and students will receive, provide the services, and re-evaluate the plan periodically. There is federal funding available for some of these responsibilities.

Initiation: The act of beginning a task or setting in motion a course of events.

Ischemic Strokes: When a blood clot blocks or plugs an artery leading to the brain.

Locked-in Syndrome: A condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking.

Long Term Care services: Long term care (LTC) services are the medical, social, personal care, and supportive services needed by people who have lost capacity for self-care due to a chronic illness or condition. It's different from acute health care because assistance is required for an indefinite period of time, and because recovery of function may be incomplete.

Medicaid Fee for Service (FFS): A Medicaid service plan in which covered services are reimbursed separately. Most individuals in Michigan who are on Medicaid are not covered by Medicaid FFS but are enrolled in a Medicaid (managed care) Health Plan. Most Long-Term Care is covered by Medicaid FFS.

Mental Illness (MI): A mental condition characterized by a substantial disorder of thought or mood that interferes with an individual’s ability to function in day-to-day life.

Michigan Department of Health and Human Services (MDHHS): The department of state government that is responsible for health policy and management of the state's publicly funded health service systems.

Michigan Protection and Advocacy Service (MPAS): A private, nonprofit organization that provides information and advocacy to people with disabilities in Michigan.

Michigan Rehabilitation Services (MRS): Part of the Department of Labor and Economic Growth, MRS offers services necessary to assist eligible individuals with disabilities in preparing for, securing, retaining, or regaining employment.

Mild TBI: Medically defined as any period of loss of consciousness (typically less than 15 minutes); any loss of memory for events immediately before or after the accident; or any alteration in the mental state at the time of the accident (e.g., feeling dazed, disoriented or confused). Mild TBI generally does not include posttraumatic amnesia greater than 24 hours (NIH, 1998). Mild TBI is associated with a Glasgow Coma Scale score of 13-15.

Moderate TBI: Medically defined as a loss of consciousness that can last minutes or a few hours and is followed by a few days or weeks of confusion. Persons with moderate TBI may have a longer period of impaired consciousness, more impaired verbal memory shortly after the injury and a lower likelihood of achieving a good recovery within 6 months than persons suffering mild TBI (NIH, 1998). Moderate TBI often is associated with a GCS of 9-12.

Motor functioning: Involving or relating to movements of the muscles.

Neurologic: Related to the nervous system and its structure and functions.

Neurologic exam: An examination conducted by a neurologist, which might include the following: a detailed medical history and assessment of neurologic functions (reflexes, cranial nerve functioning, gross movements, muscle tone, and perception of sensory stimuli).

Neurons: Impulse conducting cells that constitute the brain, spinal column, and nerves, consisting of a nucleated cell body with one or more dendrites and a single axon.

Neuropsychological assessment/evaluation: A thorough testing of cognitive, emotional, and intellectual functioning that can assist in diagnosing brain injury and planning care.

Neuropsychologist: A professional who evaluates the relationship between brain and behavior; conducts extensive testing and counseling; does not prescribe medication.

Occupational Therapy (OT): The use of self-care, work and play activities to increase independent function, enhance development and prevent disability; OT may include the adaptation of a task or the environment to achieve maximum independence. An Occupational Therapist is a professional who helps a person to regain skills in activities of daily living (e.g., dressing, eating, bathing, etc.) and routine “occupations” (e.g., cooking, shopping, scheduling, driving, etc.).

PET Scan: A positron emission tomography (PET) uses radioactive drug to assess areas of function.

Physical Disability Services (PDS): PDS are those necessary services and expenditures targeted for medically stable persons 18 years of age or older who have functional limitations which are physical in nature. Services are provided to enable functionally limited people to live as independently as possible.

Physical Therapy (PT): Treatment that uses physical agents such as exercise and massage to restore or facilitate recovery of physical abilities. A Physical Therapist is a professional who treats injury or physical dysfunction with exercises and other physical treatments to restore or facilitate recovery of physical abilities.

Posttraumatic amnesia: The loss of memories of events after the brain injury; also refers to the length of time that it takes for the return of full consciousness and memory for recent events following trauma.

Posttraumatic depression: The occurrence of the psychiatric condition of depression following brain injury.

Primary event: In reference to TBI, brain damage, such as contusion and axonal shearing, that occurs during the initial phase of injury (during impact). The primary event is distinguished from the secondary event, or subsequent brain damage, that occurs because of the body’s reaction to the primary event (such as brain swelling and anoxia).

Psychiatric evaluation: An assessment of mental, emotional, or behavioral disorders.

Psychological testing: Standardized assessment of emotional and intellectual functioning, and the personality characteristics of an individual.

Psychological/behavioral strategies of pain management: Behavioral techniques to deal with physical pain. The focus of treatment is to increase a person’s ability to manage, function, and cope with pain. Such techniques may include relaxation training, developing coping skills to deal with emotions such as sadness, anxiety, or anger, and to deal with beliefs and expectations related to pain. Problem-solving techniques and communication skills regarding expressing and dealing with pain may also be included.

Secondary event: In reference to TBI, this is the injury or complication resulting from the reaction of the brain to the primary event, including: brain swelling (edema), pooling of blood (hematoma), increased intracranial pressure, hypovolemic shock, and loss of oxygen (anoxia).

Seizures: Waves of synchronized nerve cell activation that can involve the entire brain or can be confined to a particular area of the brain. When the entire brain is involved, it is called a generalized seizure or grand mal; and symptoms include loss of consciousness, rhythmic jerking body movements, and other possible symptoms. If only part of the brain is involved, it is called a partial or focal seizure; generally, the person does not lose consciousness and other symptoms depend on the area of the brain affected.

Self-monitoring: Regarding behavior, the ability to act appropriately and refrain from inappropriate behavior based on a given social situation.

Severe TBI: Medically defined by a loss of consciousness, or coma, for 6 hours or longer, either immediately after the injury or after an intervening period of clarity. Severe TBI is often associated with a GCS of 8 or lower.

Skull fracture: Bones of the skull are broken or cracked. Injury severity can range from simple, displaced fractures to compound fractures which involve loose bone fragments placing pressure on or penetrating the brain.

Spasticity: Involuntary increase in muscle tone (energy sent to the muscles from the brain and spinal cord) which causes the muscle to resist being stretched and move in a coordinated fashion.

Traumatic Brain Injury (TBI): TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by external force.