Traumatic Brain Injury Legal Terms

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*Words in italics are defined elsewhere in the glossary.

Abstract Concept: A concept or idea not related to any specific instance or object and which potentially can be applied to many different situations or objects. People with cognitive deficits often have difficulty understanding abstract concepts.

Abstract Thinking: Being able to apply abstract concepts to new situations and surroundings.

Acalculia: The inability to perform simple problems of arithmetic.

Acuity: Sharpness or quality of a sensation.

Adaptive/Assistive Equipment: A special device which assists in the performance of self care, work or play/leisure activities or physical exercise.

Adjustment Disorder: This diagnosis involves the development of emotional or behavioral symptoms in response to an identifiable stress. It is not as severe a reaction as is found in posttraumatic stress disorder or acute stress disorder.

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

Affect: The observable emotional condition of an individual at any given time.

Agnosia: Failure to recognize familiar objects although the sensory mechanism is intact. May occur for any sensory modality.

Alert: State of being watchful or ready.

Ambulate: To walk.

Amnesia: Lack of memory about events occurring during a particular period of time.

Aneurysm: A balloon-like deformity in the wall of a blood vessel. The wall weakens as the balloon grows larger, and may eventually burst, causing a hemorrhage.

Anomia: Inability to recall names of objects. Persons with this problem can often speak fluently but have to use other words to describe familiar objects.

Anosmia: Loss of the sense of smell.

Anoxia: A lack of oxygen. Cells of the brain need oxygen to stay alive. When blood flow to the brain is reduced or when oxygen in the blood is too low, brain cells are damaged.

Anterograde Amnesia: Inability to consolidate information about ongoing events. Difficulty with new learning.

Anticonvulsant: Medication used to decrease the possibility of a seizure (e.g., Dilantin, Phenobarbital, Mysoline, Tegretol).

Apathy: A lack of interest or concern.

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

Apraxia: Inability to carry out a complex or skilled movement not due to paralysis, sensory changes or deficiencies in understanding.

Arousal: Being awake. Primitive state of alertness managed by the reticular activating system (extending from medulla to the thalamus in the core of the brainstem) activating the cortex. Cognition is not possible without some degree of arousal.

Arterial Line: A very thin tube (catheter) inserted into an artery to allow direct measurement of the blood pressure, the oxygen and carbon dioxide concentrations in arterial blood.

Articulation: Movement of the lips, tongue, teeth and palate into specific patterns for purposes of speech. Also, a movable joint.

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 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.

Audiologist: One who evaluates hearing defects and who aids in the rehabilitation of those who have such defects.

Augment and Alternative Communication: Use of forms of communication other than speaking, such as: sign language, “yes, no” signals, gestures, picture board and computerized speech systems to compensate (either temporarily or permanently) for severe expressive communication disorders.

Awareness: Conscious of stimulation, arising from within or from outside the person.

Balance: The ability to use appropriate righting and equilibrium reactions to maintain an upright position. It is usually tested in sitting and standing positions.

Brainstem: The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brainstem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert).

Cerebellum: The portion of the brain (located at the back) which helps coordinate movement. Damage may result in ataxia.

Cerebrospinal Fluid: Liquid (CSF) which fills the ventricles of the brain and surrounds the brain and spinal cord.

Circumlocution: Use of other words to describe a specific word or idea which cannot be remembered.

Clonus: A sustained series of rhythmic jerks following quick stretch of a muscle.

Cognition: The conscious process of knowing or being aware of thoughts or perceptions, including understanding and reasoning.

Cognitive Rehabilitation: Therapy programs which aid persons in the management of specific problems in thinking and perception. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits.

Coma: A state of unconsciousness from which the person cannot be aroused, even by powerful stimulation; lack of any response to one’s environment.

Community Resources: Public or private agencies, schools or programs offering services, usually of a social nature, to the public. They are usually funded by governmental bodies, community drives, donations and fees.

Concrete Thinking: A style of thinking in which the individual sees each situation as unique and is unable to generalize from the similarities between situations. Thinking in which language is interpreted literally.

Concussion: Any alteration in cerebral function caused by direct or indirect (rotation) force transmitted to the head resulting in one or more of the following: a brief loss of consciousness, lightheadedness, vertigo, cognitive and memory dysfunction, tinnitus, difficulty concentrating, amnesia, headache, balance disorder, nausea or vomiting.

Confabulation: Verbalizations about people, places and events with no basis in reality. The person appears to “fill in” gaps in memory with plausible facts.

Confusion: A state in which a person is bewildered, perplexed or unable to self-orient.

Consciousness: The state of awareness of the self and the environment.

Continent: The ability to control urination and bowel movements.

Contracture: Loss of range of motion in a joint due to abnormal shortening of soft tissues.

Contusion, Brain: A bruise. The result of a blow to the head which bruises the brain.

Cortical Blindness: Loss of vision resulting from a lesion of the primary visual areas of the occipital lobe. Light reflex is preserved.

Contrecoup: Bruising of brain tissue on the side opposite where the blow was struck.

Coup Damage: Damage to the brain at the point of impact.

CT Scan/Computerized Axial Tomography: A series of Xrays taken at different levels of the brain that allows the direct visualization of 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.

Cue: A signal or direction used to assist a person in performing an activity (telling a person the initial of your first name serves as a cue when he cannot remember your name).

Decerebrate Posture (Decerebrate Rigidity): Exaggerated posture of extension as a result of a lesion to the prepontine area of the brainstem, and is rarely seen fully developed in humans. In reporting, it is preferable to describe the posture seen.

Decorticate Posture (Decorticate Rigidity): Exaggerated posture of upper extremity flexion and lower extremity extension as a result of a lesion to the mesencephalon or above. In reporting, it is preferable to describe the posture seen

Decubitus: Pressure area, bed sore, skin opening, skin breakdown. A discolored or open area of skin damage caused by pressure. Common areas most prone to breakdown are buttocks or backside, hips, shoulder blades, heels, ankles and elbows.

Deficit: A deficiency in amount or quality of functioning.

Diffuse Axonal Injury (DAI): A shearing injury of large nerve fibers (axons covered with myelin) in many areas of the brain. It appears to be one of the two primary lesions of brain injury, the other being stretching or shearing of blood vessels from the same forces, producing hemorrhage.

Diffuse Brain Injury: Injury to cells in many areas of the brain rather than in one specific location.

Diplopia: Seeing two images of a single object; double vision.

Discrimination Sensory: A process requiring differentiation of two or more stimuli.

Disinhibition: Inability to suppress (inhibit) impulsive behavior and emotions.

Disorientation: Not knowing where you are, who you are, or the current date. Health professionals often speak of a normal person as being oriented “times three” which refers to person, place and time.

Dysarthria: Difficulty in forming words or speaking them because of weakness of muscles used in speaking. Speech is characterized by labored, imprecise articulation. Tongue movements are usually slurred and the rate of speaking may be very slow. Voice quality may be abnormal, usually excessively nasal; volume may be weak; drooling may occur. Dysarthria may accompany aphasia or occur alone.

Dysphagia: A swallowing disorder characterized by difficulty in oral preparation for the swallow, or in moving material from the mouth to the stomach. This definition also includes problems in positioning food in the mouth.

Edema: Collection of fluid in the tissue causing swelling.

Emotional Liability: Exhibiting rapid and drastic changes in emotional state (laughing, crying, anger) inappropriately without apparent reason.

Encephalography: Non-invasive use of ultrasound waves to record echoes from brain tissue. Used to detect hematoma, tumor or ventricle problems.

Epidural: Outside the brain and its fibrous covering, but under the skull.

Evoked Potential: Registration of the electrical response of brain cells as detected by electrodes placed on the surface of the head at various places. The evoked potential, unlike the waves on an EEG, 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.

Executive Functions: Planning, prioritizing, sequencing, selfmonitoring, self-correcting, inhibiting, initiating, controlling or altering behavior.

Extremity: Arm or leg.

Falccid: Lacking normal muscle tone; limp.

Flexion: Bending a joint.

Foley Catheter: This is a tube inserted into the urinary bladder for drainage of urine. The urine drains through the tube and collects into a plastic bag.

Frontal Lobe: Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of “higher cognitive functions.”

Functional Ability: Capacity for performing an act that results in a practical end result.

GI Tube: A tube inserted through a surgical opening into the stomach. It is used to introduce liquids, food or medication into the stomach when the person is unable to take these substances by mouth.

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.

Hematoma: The collection of blood in tissues or a space following rupture of a blood vessel.

Hemianopsia: Visual field cut. Blindness for one half of the field of vision. This is not the right or left eye, but the right or left half of vision in each eye.

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.

Hemiparesis: Weakness of one side of the body.

Hypoxia: Insufficient oxygen reaching the tissues of the body.

ICP: See Intracranial Pressure.

Impairment: An anatomical, physiological, mental or psychological loss or abnormality. Reduced capacity for functioning. This term may be used in describing the reduction in functions of a single muscle, or organ that results in reduced capacity for social and family relations, independent living or enjoyment of life as the result of some event or illness, including pain.

Impulse Control: Refers to the person’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.

Incontinent: Inability to control bowel and bladder functions. Many people who are incontinent can become continent with training.

Inflexible: Inability to adjust to changes.

Initiative: Refers to the individual’s ability to begin a series of behaviors directed toward a goal.

Interdisciplinary Approach: A method of diagnosis, evaluation, and individual program planning in which two or more specialists, such as medical doctors, psychologists, recreational therapists, social workers, etc., participate as a team, contributing their skills, competencies, insights and perspectives to focus on identifying the developmental needs of the person with a disability and on devising ways to meet those needs.

Intracerebral: In the brain tissue.

Intracranial Pressure (ICP): Cerebro-spinal 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 person at the skull by either a ventriculostomy, subarachnoid bolt, or screw, and is then connected to a transducer, which registers the pressure.

Judgement: Process of forming an opinion, based upon an evaluation of the situation at hand in comparison with personal values, preferences and insights. The ability to make appropriate decisions.

Judgement of Safety: The extent to which an individual can correctly judge the dangers and risks in a variety of situations. A person with poor judgement may smoke in bed late at night, touch a red hot stove burner or show extreme friendliness to complete strangers. People with brain injury with poor insight regarding their impairments are also likely to show poor judgement of safety.

Lability: State of having notable shifts in emotional state (e.g. uncontrolled laughing or crying).

Locked-In Syndrome: A condition resulting from interruption of motor pathways in the ventral pons, usually by infarction. This disconnection of the motor cells in the spinal cord from controlling signals issued by the brain leaves the person completely paralyzed and mute, but able to receive and understand sensory stimuli; communication may be possible by code using blinking, or movements of the jaw or eyes, all of which are spared.

Memory: The process of perceiving events, organizing and storing representations of the events and recalling these representations to consciousness at a later time.

Memory/Learning: Acquisition of new information determined by the extent to which an individual benefits from repetition, rehearsal, or practice. For example, a person who learns quickly will likely remember an entire set of instructions after hearing them a single time. A person 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 note that persons may have intact learning ability, but poor delayed memory. For example, a person with brain injury may learn a set of instructions after several repetitions, but forget them the next day.

Mobility: Ability of an individual to move within, and interact with, the environment, usually involving utilization of public and/or private transportation, wheelchairs or ambulation.

Money Management: Ability to distinguish the different denominations of money, count money, make change, budget.

Motor: Pertaining to movement.

Motor Control: Regulation of the timing and amount of contraction of muscles of the body to produce smooth and coordinated movement. The regulation is carried out by operation of the nervous system.

Motor Planning: Action formulated in the mind before attempting to perform.

Nasogastric Tube (NG Tube): A tube that passes through the person’s nose and throat and ends in the person’s stomach. This tube allows for direct “tube feeding” to maintain the nutritional status of the person or removal of stomach acids.

Neologism: Nonsense or made-up word used when speaking. The person often does not realize that the word makes no sense.

Neurologist: A physician who specializes in the nervous system and its disorders.

Neuropsychologist: A psychologist who specializes in evaluating (by tests) brain/behavior relationships, planning training programs to help the person’s brain return to normal functioning and recommending alternative cognitive strategies to minimize the effects of brain injury.

Occipital Lobe: Region in the back of the brain which processes visual information. Damage to this lobe can cause visual deficits.

Occupational Therapy: Occupational Therapy (OT) is the therapeutic 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 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 creating problems interfering with functional performance.

Organization, Cognitive: Using selective attention skills, the person correctly perceives stimulus attributes or task elements, selects a strategy, monitors use of the strategy and reaches a correct solution.

Orientation (See Disorientation): An awareness of one’s environment and/or situation, and the ability to use this information appropriately in a functional setting.

Orthopedics: The branch of medicine devoted to the study and treatment of the skeletal system, its joints, muscles and associated structures.

Orthosis: Splint or brace designed to improve function or provide stability.

Orthotist: A skilled craftsman who develops and fits mechanical devices, such as a brace, splint or body jacket, designed to support or supplement a weakened body part or function.

Paraplegia: Paralysis of the legs (from the waist down).

Parietal Lobe: One of the two parietal lobes of the brain located behind the frontal lobe at the top of the brain.

Parietal Lobe, Right: Damage of this area can cause visuo-spatial deficits (e.g., the person may have difficulty finding their way around new or familiar places).

Parietal Lobe, Left: Damage to this area may disrupt a person’s ability to understand spoken and/or written language.

Perception: The ability to make sense of what one sees, hears, feels, tastes or smells. Perceptual losses are often very subtle, and the person and/or family may be unaware of them.

Preservation: Refers to 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.

Physical Therapist: The physical therapist evaluates components of movement, including: muscle strength, muscle tone, posture, coordination, endurance and general mobility. The physical therapist also evaluates the potential for functional movement, such as ability to move in the bed, transfers and walking and then proceeds to establish an individualized treatment program to help the person achieve functional independence

Physiatrist: (pronounced Fizz ee at’ rist): A physician who specializes in physical medicine and rehabilitation. A physiatrist is an expert in neurologic rehabilitation, trained to diagnose and treat disabling conditions. A physiatrist examines an individual upon admission to a program to assure that medical issues are addressed, provides medical information to the person, family and treatment team and oversees a person’s rehabilitation program.

Post Traumatic Amnesia (PTA): A period of hours, weeks, days or months after the injury when the person exhibits a loss of day-to-day memory. The person is unable to store new information and therefore has a decreased ability to learn. Memory of the PTA period is never stored, therefore things that happened during that period cannot be recalled. May also be called Anterograde Amnesia.

Post Traumatic Stress Disorder: This diagnosis involves significant emotional and behavioral distress, that lasts longer than one month, which is the result of exposure or involvement in a traumatic event.

Posture: The attitude of the body. Posture is maintained by low- grade, continuous contraction of muscles which counteract the pull of gravity on body parts. Injury to the nervous system can impair the ability to maintain normal posture, for example holding up the head.

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.

Prognosis: The prospect as to recovery from a disease or injury as indicated by the nature and symptoms of the case.

Prone: Lying on one’s stomach.

Proprioception: The sensory awareness of the position of body parts with or without movement. Combination of kinesthesia and position sense.

Prosody: The inflections or intonations of speech.

Proximal: Next to, or nearest, the point of attachment.

Psychometric Instrument: Standardized tests (utilizing paper and pencil) which measure mental functioning.

Ptosis: Drooping of a body part, such as the upper eyelid, from paralysis, or drooping of the visceral organs from weakness of the abdominal muscles.

Quadraparesis: Weakness of all four limbs.

Range of Motion (ROM): Refers to movement of a joint (important to prevent contractures).

Range of Motion Active: The muscles around the joint do the work to move it.

Range of Motion Passive: Movement of a joint by means other than contraction of muscles around that joint (e.g., someone else moves the joint).

Reasoning, Abstract: Requires that the individual recognize a phrase that has multiple meanings and select the meaning most appropriate to a given situation. The term “abstract” typically refers to concepts not readily apparent from the physical attributes of a given object or situation.

Rehabilitation: Comprehensive program to reduce/overcome deficits following injury or illness and to assist the individual to attain the optimal level of mental and physical ability.

Respirator/Ventilator: A machine that does the breathing work for an unresponsive person. It serves to deliver air in the appropriate percentage of oxygen and at the appropriate rate. The air is also humidified by the respirator.

Respite Care: A means for taking over the care of a person temporarily (for a few hours to a few days) to provide a period of relief for the primary caregiver.

Retrograde Amnesia: Inability to recall events prior to the accident; it may be a specific span of time or type of information.

Seizure: An uncontrolled discharge of nerve cells which may spread to other cells nearby or throughout the entire brain. It usually lasts only a few minutes. It may be associated with loss of consciousness, loss of bowel and bladder control and tremors. May also cause aggressive or other behavioral change.

Sensation: Feeling stimuli which activate sensory organs of the body, such as touch, temperature, pressure or pain. Also seeing, hearing, smelling and tasting.

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.

Shunt: A procedure to draw off excessive fluid in the brain. A surgically placed tube running from the ventricles which deposits fluid into either the abdominal cavity, heart or large veins of the neck.

Skull Fracture: The breaking of bones surrounding the brain. A depressed skull fracture is one in which the broken bone exerts pressure on the brain.

Spasticity: An involuntary increase in muscle tone (tension) that occurs following injury to the brain or spinal cord, causing the muscles to resist being moved. Characteristics may include increase in deep tendon reflexes, resistance to passive stretch, clasp knife phenomenon and clonus.

Spontaneous Recovery: The recovery that occurs as damage to body tissue heals. This type of recovery occurs with or without rehabilitation and it is very difficult to know how much improvement is spontaneous and how much is due to rehabilitative interventions. However, when the recovery is guided by an experienced rehabilitation team, complications can be anticipated and minimized, the return of function can be channeled in useful directions and in progressive steps so that the eventual outcome is the best that is possible.

Stimulus: That which causes sensation (i.e., light for vision, salt for taste, sound for hearing, etc.). When a person begins to emerge from coma, an organized program of controlled stimulation is sometimes used to begin “exercising” the brain. However, when a person becomes agitated, the amount and intensity of stimulation should be limited (e.g., only one task for one sense at A time).

Subdural: Beneath the dura (tough membrane) covering the brain and spinal cord.

Supported Employment: Competitive work in integrated work settings for individuals for whom competitive employment has not traditionally occurred, or for whom competitive employment has been interrupted as a result of a severe disability, and who, because of the disability, need ongoing support services to perform that work.

Temporal Lobes: There are two temporal lobes, one on each side of the brain, 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 out new information and are believed to be responsible for short-term memory.

Tracking, Visual: Visually following an object as it moves through space.

Transfer: Moving one’s body between the wheelchair and the bed, toilet, mat or car with or without the assistance of another person.

Unilateral: Pertaining to only one side.

Vegetative State: A condition in which the person utters no words and does not follow commands or make any response that is psychologically meaningful. The transition of a person who remains unconscious from a scare of “coma” to one of “vegetative behaviors” reflects subtle changes over a period of several months from a condition of no response to the internal or external environment (except reflexively) to a state of wakefulness but with no indication of awareness (cortical function). A person in this state may have a range of biological responses at the subcortical level such as eye opening (with sleep and wake rhythms) and sometimes the ability to follow with their eyes. Normal levels of blood pressure and respiration (vegetative functions) are maintained automatically. Also called Coma Vigil.

Ventricles, Brain: Four natural cavities in the brain which are filled with cerebrospinal fluid (CSF). 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.