Find out All the Basics of Brain Injuries in Our Glossary

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A

Abstract Concept
An abstract concept is an idea not related to any concrete example, but which potentially can be applied to many different situations or objects. Examples include the concept of inertia and the concept of free will. Understanding abstract concepts requires an average or above level of cognitive ability.

Abstract Thinking
Abstract thinking occurs when a person is able to understand and apply abstract concepts to new situations or conditions.

Acquired Brain Injury
See Brain Injury, Acquired.

Activities of Daily Living (ADL)
Activities of daily living (ADLs) include those things that able persons must do very often or every day. These activities include tending to one’s own toilet needs, bathing, preparing meals and eating, selecting appropriate clothing and dressing, general grooming, walking or transferring to and from a wheelchair, shopping, washing clothing and dishes, and maintaining a living space. The level of a person’s disability is often gauged by how many and which of the ADLs he or she is unable to do without assistance.

Acute Care
Acute care is the active medical care that is provided in the cases of trauma, injury, emergencies, severe illness, and pre- or post-surgery. The care is usually short term and has a goal of stabilizing the patient.

Acute Rehabilitation Program
Acute rehabilitation programs typically last one to three months, starting when the patient is stable and strong enough to participate in therapy. These programs are usually inpatient. Along with nursing care 24 hours a day, the programs offer three hours a day of therapy, five to seven days a week. The therapy is organized and overseen by a case manager who works with the therapists and other medical personnel to ensure that the patient receives optimal care.

ADA Integration Mandate
See Integration Mandate.

Administrative Law Judge (ALJ)
An Administrative law judge (ALJ) is a judge who presides over trials and adjudicates the disputes or claims involving administrative law. An ALJ is appointed by and works for the federal government. In an ALJ’s court, there is no jury and all decisions are made by the bench. Cases heard by ALJs typically involve federal programs like Medicaid, Medicare, and Social Security as well as issues such as housing, education, and taxes.

Advance Directive
An advance directive is a way for an individual to establish what type of health care he wants if he becomes ill. The directive is becomes active only if the patient then through illness becomes unable to think clearly or unable to communicate. A directive typically includes the treatments that the patient does or does not want, medications he does not want, and information about previous treatments that may have an impact on the current illness.

Affect
Affect as a noun is emotion or feeling. Affect is sometimes used as a synonym for “affect display” which is the visible reaction to stimulus. For example, a “flat affect” means that the patient has no visible response to emotion or other motivation.

Affidavit
An affidavit is a sworn statement of fact that a person voluntarily makes. The person making the statement is under an affirmation or oath administered by a person authorized by law to do so.

Ambulation Training
See Gait Training.

Americans with Disabilities Act of 1990 (ADA)
The Americans with Disabilities Act (ADA) is a wide-reaching civil rights law that specifies that physical or mental disabilities cannot be the basis of discrimination. Essentially, it expands the Civil Rights Act of 1964 to include disabilities along with race, national origin, religion, and gender. However, ADA includes covered employers to provide reasonable accommodations to make it possible for disabled persons to work. The law also requires that public places are accessible to persons with various disabilities.

Amnesia
Amnesia is usually defined as a lack of memory of a specific time period. However, amnesia can include difficulty in learning new information or forming new memories. Most of the time, amnesia does not cause a loss of self-identity.

Anticonvulsant
Anticonvulsants are medications used to decrease the possibility of a seizure. These drugs are also called antiepileptic or antiseizure drugs. There is also exploration of using some of these medications to treat chronic pain and bipolar disorder.

Antidepressants
Antidepressants are medications used to treat depression and other conditions such as anxiety disorders, eating disorders, obsessive-compulsive disorders, substance abuse, and even chronic pain.

Aphasia
Aphasia is the inability to express or understand language. There are varying degrees of aphasia ranging from having trouble recalling a specific word to the inability to communicate. Aphasia is due to damage to brain cells rather than failure of the speech or hearing organs.

Appeal
Appeals are requests to reverse the decision of an agency or lower court. The process for filing an appeal is often lengthy and time consuming.

Apraxia
Apraxia is a neurological condition that makes it difficult or impossible to make specific motor movements. One of the more common forms is developmental apraxia of speech that is present from birth. In these cases, a child may be able to understand speech but cannot form words. This condition can be greatly improved by treatment. Apraxia in adults is usually caused by damage to the brain. While the muscles of the face and mouth are normal, the patient has difficulty with the motor planning to produce speech. Patients usually can understand written and spoken words but have problems stringing together syllables in the appropriate order, pronouncing complex words, or pronouncing consonants. In more severe forms, there is the inability to form words at all.

Ataxia
Ataxia means a lack of coordination, making it difficult or impossible for a person to control his own movements. Ataxia can be a symptom of other diseases such as multiple sclerosis or alcoholism. Severe ataxia can rob the patient of his abilities to walk, talk, speak, eat, or even move his eyes.

Attendant Care
Attendant care is provided when a person is unable to perform his own activities of daily living. Attendant care is usually offered in the patient’s home or in an inpatient facility.

Atrophy
Atrophy is the decrease in size or function of tissue, cells, organs, or other part of a body. Atrophy is often described as “wasting away.” This is usually due to a lack of nourishment or exercise, but it can also be due to a loss of nerve supply. Some forms of atrophy, such as thinning hair, are due entirely to age.

Attention/Concentration
Attention or concentration is the focus the subject can bring to stimuli for a given period of time. Cognitive growth requires a level of attention.

B

Basic Extended Care Facility
See Extended Care Facility–Basic.

Behavior Disorders
Behavior disorders can take many forms from very mild to severe, but in general, the term refers to patterns of hostile or aggressive actions and conduct that interferes with normal functioning that persists for more than six months. Obviously, these disorders interfere with healthy functioning and personal interactions. The disorders may be caused by physical illness, malnutrition, brain damage, or hereditary factors and may be influenced by significant others in the patient’s life. Behavior or emotional disorders can also interfere with the patient’s ability to benefit from physical rehabilitation.

Brain Injury, Acquired (ABI)
An acquired brain injury (ABI) is any damage to the brain that happens after birth. Injuries to the brain that occur before birth are usually called birth defects, while injuries that occur as the birth takes place are usually called birth accidents. The term ABI is sometimes used to mean only injuries caused by pressure on the brain caused by strokes, heart attacks, illnesses, or near drowning. Other authorities include traumatic brain injuries in the definition of ABI. However, ABIs do not include damage to the brain caused by degenerative brain conditions such as Alzheimer’s disease or Parkinson’s disease.

Brain Injury, Closed
Closed brain injuries are caused when the brain tissue is damaged by a blow rather than a foreign object in the brain. For example, an automobile accident in which the head hits the windshield causes a closed brain injury. Severe shaking, especially of babies or small children, can also cause closed brain injuries. The disabilities caused by closed brain injuries are highly variable.

Brain Injury, Mild
A mild brain injury results in a physiological disruption of brain function, characterized by at least one of the following: a loss of consciousness, amnesia for events before or after the injury, disorientation or confusion, and transient or permanent focal neurological deficits.

Brain Injury, Traumatic
Traumatic brain injury is damage to the brain tissue by external force. The injury usually results in a loss of consciousness lasting from minutes to months, and in some cases indefinitely. The disabilities caused by the injury can be widely varied including cognitive, neurologic, orthopedic, or emotional changes. The term does not include brain issues caused by cancer, toxic substances, disease, birth trauma, or degenerative processes.

Brain Scan
A brain scan is a diagnostic tool used to detect hemorrhages, clots, abscesses, and abnormal growths in the brain. A radioactive dye is injected into the blood stream and then pictures of the brain are taken.

Brain Stem
The brain stem is where the brain is attached to the spinal cord. Certain neurological functions necessary for survival, such as breathing and heart rate, are located in the brain stem. The brain stem also controls arousal.

Brain Ventricles
See Ventricles, Brain.

C

Capacity
See Competency.

Case Management
Case management is the coordination of all services—including medical, rehabilitative, and support— necessary for the patient. A case manager serves as a liaison between the patient and provider, ensuring that the patient has the best care available.

Cerebellum
The cerebellum is the portion of the brain that coordinates movement. If the cerebellum is damaged, the patient will experience some level of ataxia, which may make it difficult or impossible to walk or feed himself.

Chronic
The term chronic means of long duration or frequent occurrence. It is considered the opposite of acute.

Class Action
A class action is a lawsuit where a person or small group of persons represents a larger group that happens to share a similar complaint or legal problem. The resulting judicial decision then affects all persons in the larger group, or “class.”

Closed Brain Injury
See Brain Injury, Closed.

COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) has provisions for persons who have left employment either voluntarily or involuntarily. COBRA allows these persons to maintain employee health insurance, including family coverage, for up to 18 months as long as they pay for it themselves. The act also allows persons who become disabled soon after losing their jobs to extend this period to up to 29 months.

Cognition
Cognition is the acquisition of knowledge through the senses or through thought processes. It is sometimes used to mean all the mental abilities related to knowledge, including attention, evaluation, memory, judgment, reasoning, etc.

Cognitive Rehabilitation
Cognitive rehabilitation is therapy designed to restore the functions of memory, thinking, perception, and problem solving. When this is impossible due to brain deficits, cognitive rehabilitation also encompasses teaching the patient how to perform functions in a new way that the damaged brain can handle.

Coma
A coma is a state of unconscious in which the patient cannot be aroused, despite strong stimulus. Comas can be caused by a number of factors such as swelling of the brain, stroke, toxins, untreated diabetes, and infection. The level of a coma is measured on the Glasgow Coma Scale.

Communicative Disorder
Communicative disorders are those that result in an impairment in the ability to use speech, language, or other symbol systems. The impairment may be as simple as a sound substitution or as complex as a failure to understand even the patient’s native language.

Community Integration Program
A community integration program is a set of services geared toward allowing the patient to function as independently as possible in the community. These programs may include recreational activities, faith-based services, cultural opportunities, or training in the areas of life skills or workforce readiness. Services may be offered in residential facilities, day treatment programs, or the patient’s home. To reach maximum effectiveness, the services may be offered over several weeks or several months.

Community Skills
Community skills are the abilities a patient needs to live independently. They include money management, meal planning and preparation, and a degree of business communication skills.

Comparative Negligence
In some states, laws recognize that both the person who caused an accident and the person who was hurt or killed in an accident may have played a part in the accident’s results. The laws allow the courts in those states to award damages based on comparative negligence. Damages are divided between the parties based on the level to which each party was responsible for the results of the accident.

Competency or Capacity
Although competency and capacity are often used interchangeably, they are slightly different in medical use. Capacity is a functional term meaning that a person has the cognitive or mental ability to understand the effects of one’s acts. Competency is a legal term. A judge must determine, during a hearing, if a person is able to make informed choices about his or her living situation, money issues, and health care.

Comprehension
Comprehension is the ability to understand something. In its simplest form, comprehension refers to the understanding of spoken, written, or gestural communication.

Computerized Axial Tomography
See CT Scan.

Concentration
Concentration is the ability to maintain attention on a task without being easily distracted.

Concrete Thinking
Concrete thinking is a method of thinking that does not allow the individual to generalize across similar situations. For these persons, language is taken very literally so that the person is unable to understand, for instance, proverbs or adages.

Concussion
Concussions are the most common of traumatic brain injuries. They are typically caused by a blow to the head and may result in an altered mental state, at least temporarily. Symptoms may include loss of consciousness, changes in alertness, and headache.

Confusion
Confusion is a state of bewilderment caused by a concussion, a brain tumor, an overdose of alcohol or drugs, fever, or a number of other factors. A person in a state of confusion often is unable to identify his name, the date, or his birthdate.

Conservator
See Guardian.

Consumer Directed Services
Consumer directed services (CDS) has two meanings. Used by private insurance companies, it means that the consumer is allowed to use a doctor not in the insurance network by paying an extra fee. The term also is used to mean a federal program, based on Medicaid, which allows persons with disabilities to make their own choices about care that will allow them to live independently. Within the limits of funding, consumers can choose what care they want to receive, who will be hired as a personal care attendant (PCA) to provide the service, and where it will be provided.

Co-payment
A co-payment is a fixed amount established by the health insurance company that a consumer pays for an insurance-covered health care service. The co-payment may differ depending on the service or the place the service is delivered.

CT Scan / Computerized Axial Tomography
A CT scan, or Computerized axial tomography, is a special series of X-rays that take different cross-sectional images of the body and uses a connected computer to interpret them. A CT scan is most often used as a diagnostic tool to see if surgery is indicated or later to determine if treatment has been beneficial.

Custodial Care
Custodial care includes those non-medical services that assist persons with daily living. Most of these services can be provided by persons without medical training.

D

Damages
Damages are part of the result of a civil law case. The judge or court determines fault between the parties to the lawsuit. Then the judge or court awards money or other assets accordingly.

Decubitus sores
Decubitus sores are ulcers caused by a breakdown of the skin due to pressure. The most common of these sores are called bedsores. The skin becomes discolored and breaks down into an open sore. The most common areas are buttocks, hips, shoulder blades, heels, and elbows.

Deductible
The deductible is an amount of money established by the insurance policy that the consumer must pay before the insurance company will begin to pay for any care. There may be separate deductibles for different services.

Defendant
In every lawsuit, there is a plaintiff and a defendant. The defendant is the individual, group, or entity accused of wrongdoing.

Developmental Disability
A developmental disability begins before the age of 22 and lasts for a lifetime. The disability may be a severe mental or physical disability that limits three or more major life functions such as thinking, walking, eating, or bathing.

Diffuse Brain Injury
Diffuse brain injuries affect cells in different areas in the brain rather than in a single area. Diffuse brain injuries are more common in closed head injuries.

Discriminate
To discriminate is to treat one person or group differently than other people or groups. The Americans with Disabilities Act makes it illegal to discriminate based on perceived or real disabilities.

Drug Plan Formularies
Drug plan formularies are listings of prescription medications that the insurance company approves for coverage. If a consumer wants a drug not on the formulary, he or she must file an appeal for an exception. The drug formulary may also be called the covered medications list (CML) or preferred drug list (PDL).

Durable Power of Attorney
A power of attorney (POA) is a legal document that allows a person to empower another person or agency to make medical decisions or use money on the appointing person’s behalf. A POA may be limited to a specific action or time. A POA made while the appointing person is considered competent becomes invalid when that person becomes incapacitated or dies. A durable power of attorney remains in place until the appointing person dies. If a person is already unable to make medical and financial decisions, a court may appoint a provider such as a nursing home with a durable power of attorney.

E

Electroencephalogram (EEG)
An electroencephalogram (EEG) is a diagnostic procedure to detect epilepsy, brain death, coma, or other brain conditions. Electrodes are attached to the scalp to record electrical activity in the brain.

Electromyography (EMG)
Electromyography (EMG) is a diagnostic procedure to detect damage to nerves or muscles. Needle electrodes are inserted into muscles to study the electrical activity of muscle and nerve fibers. These tests may be somewhat painful to the patient.

Epidural Hematoma.
See Hematoma.

Episodic Memory
See Memory, Episodic.

Estate Plan
An estate plan is a detailed arrangement for a how a person’s property will be handled or distributed after the person becomes unable to make informed decision or dies. Part of the estate plan is a will.

Extended Care Facility–Basic
Any person who needs assistance with the activities of daily life may choose to enter a basic extended care facility. These residential facilities provide 24-hour care, but the services may be provided by aides rather than nurses or other medical personnel. This facility type has the fewest medical services available. If the patient needs more medical care, he or she may choose to be housed at a skilled extended care facility.

Extended Care Facility–Skilled
Any person who needs assistance with the activities of daily life may choose to enter a skilled extended care facility. These residential facilities provide around-the-clock supervision and more nursing care than a basic extended care facility can provide. For example, skilled care facilities can provide intramuscular injections, IVs, special feeding tubes, oxygen, and various therapies. This facility type is a median level of medical services. If the patient needs less medical care, he may choose to be housed at a basic extended care facility. If he needs more medical care, he may choose to be housed at a nursing facility.

F

Family and Medical Leave Act
The Family and Medical Leave Act (FMLA) requires companies with 50 or more employees to allow eligible workers up to 12 weeks of unpaid leave per year for family issues such as adding a child to the family (by birth, adoption, or foster placement) or illnesses of the employees or their families. Special considerations and longer leaves are permitted for situations arising from an employee’s immediate relative being on “covered active duty” with the armed services. The employee’s job must be protected during the leave period.

Family Support Services
Family support services are any of a range of programs designed to help maintain the family unit when a family member has a disability. Programs include special classes, respite care, counseling for individuals or the family, crisis support, and nursing care.

Federal Law
Federal laws are those that apply equally to all Americans regardless of geographic location. These laws are separate from state laws, which apply to only those persons who live in the designated state.

Fee-for-Service
In fee-for-service (FSS) healthcare, each service is paid for by the consumer, usually at the time of the service. The provider sets the price and bills the consumer the full amount. The consumer is responsible for asking the insurance company for a reimbursement for all or part of the price.

Flaccid
When used in reference to a body part, flaccid means lacking normal muscle tone, soft, or hanging loosely.

Flexion
For every joint in the body, there are two motions of bending. When the action brings the axes of the joint closer together, this is called flexion. Bending a joint so the axes are further apart is called extension.

Foley Catheter
A Foley catheter is a specialized sterile tube that can be inserted through the urethra into the bladder. This allows the bladder to be emptied into an exterior plastic bag. Foley catheters can be left in place for days at a time, making them an indwelling catheter.

Free Appropriate Public Education (FAPE)
As part of the Rehabilitation Act of 1973, individuals with disabilities are guaranteed a free appropriate public education (FAPE). Any school that receives federal funding is prohibited from excluding a qualified individual from participating in a program of education solely on the basis of a disability. Children with disabilities must be provided with special education services to help them learn and participate in school.

Frontal Lobe
The frontal lobe is one of the four primary lobes of the human brain. It is recognized as the center of more advanced cognitive functions. The frontal lobe is involved in problem solving, organizing, selective attention, planning, and personality.

Frustration Tolerance
Frustration tolerance is the ability to continue in a task even if difficulty is encountered. Poor frustration tolerance leads to abandonment of a task before it is completed. Low frustration tolerance is often demonstrated by angry behavior when the patient is thwarted.

Fundamental Alteration Defense
The Americans with Disabilities Act (ADA) requires that disabled persons be allowed to have reasonable auxiliary aids or other accommodations to enable them to participate in programs or events. However, the courts have ruled that these accommodations must not be actually lower the requirements of the program or event for any participant. If the provider of the program or event can show that the requested accommodation would fundamentally alter the requirements, the provider is not required to make them available. The fundamental alteration defense to an ADA lawsuit is that the requested accommodation would make such a significant change to the essential nature of the program or event that it would negate the purpose of the event. Mere expense associated with making the accommodation may be considered as a defense but it is not automatically a successful one.

G

Gainful Occupation
Gainful occupation is the regular exchange of labor for pay or barter. Noncompetitive labor such as labor in family business for the good of the family or work in a sheltered workshop is included in gainful employment. Labor in illegal enterprises is not considered gainful employment. In psychological terms, gainful employment is the one of the keys to quality of life.

Gait Training / Ambulation Training
Gait training, or ambulation training, is a form of physical rehabilitation therapy that concentrates on standing and walking, with or without equipment.

Gastrointestinal (GI) Tube
A gastrointestinal (GI) tube is a method of introducing medicines, foods, or liquids through a surgical opening directly into the stomach when the patient is unable to take these items by mouth.

Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a neurological test to determine the level of consciousness. The system involves determinants such as eye opening, motor responses, and verbal responses, which are evaluated independently according to a numerical value that indicates the degree of dysfunction. Scores run from a high of 15 to a low of 3, with the lower scores indicating a more severe injury.

Guardian or Conservator
If a court determines a person to be unable to make informed decisions about his or her own welfare, a guardian or conservator may be appointed. This person or agency then has the authority to make financial decisions and other life choices for the disabled person.

H

Head Injury
Head injuries include lacerations and contusions of the head, scalp, and/or forehead. Head injuries may or may not result in brain injuries.

Hematoma
Hematomas are the collection of blood following the rupture of a blood vessel. In most cases, the sacs of blood that form hematomas dissolve without further action. If the blood instead forms a hard clot, surgeries may be needed. There are specialized hematomas in the head including:

• Epidural hematoma – outside the dura or fibrous covering of the brain, but under the skull.
• Intracerebral hematoma – within the brain tissue.
• Subarachnoid hematoma – around the surfaces of the brain, between the dura and arachnoid membranes.
• Subdural hematoma – between the brain and its fibrous covering (dura).

Hemiparesis
Hemiparesis is weakness on one side of the body only, a common result of a stroke.

Home- and Community-Based Services Waiver
See Medicaid waiver.

Hydrocephalus
In healthy brains, there is cerebrospinal fluid that forms a cushion between the skull and the brain tissue itself. Hydrocephalus is a condition in which this fluid builds up and puts pressure on the brain. This condition can be congenital or acquired. You can read more about hydrocephalus in newborns here.

Hypoxia
Hypoxia is a condition in which the body or some part of the body has insufficient oxygen. You can read more information on hypoxia causing brain damage here.

I

Immediate Memory
See Memory, Immediate.

Impairment-Related Work Expenses (IRWE)
If a disabled person must have special accommodations in order to work, the Social Security Administration recognizes the cost of these accommodations. The cost of impairment-related work expenses (IRWE) will be subtracted from gross income when calculating countable earned income.

Impulse Control
Impulse control is the ability to resist the temptation to say things or do things that are harmful to oneself or others. Poor impulse control can lead to awkward or even dangerous situations. Some conditions that include poor impulse control are pyromania, kleptomania, and intermittent explosive disorder.

Incapacity / Incompetency
Although competency and capacity are often used interchangeably, they are slightly different in medical use. Capacity is a functional term meaning that a person has the cognitive or mental ability to understand the effects of one’s acts. Competency is a legal term. A judge must determine, during a hearing, if a person is able to make informed choices about his or her own living situation, money issues, and health care.

A person who has been determined, through a legal hearing, to be unable to make informed choices regarding life choices will be identified as incapacitated. This is the first step in appointed a guardian or conservator to manage the person’s life to the extent that daily needs are met.

The term incompetent may be used to describe someone who has been adjudicated as incapacitated. However, the term has even more serious legal implications. Someone who is legally incompetent has been adjudged to be unable to meaningfully assist in his own defense. He may be unable to even understand the charges against him.

Inclusion
Inclusion means that persons with disabilities will be provided with the services or accommodations they need to participate in their schools and communities.

Incontinence
Incontinence is the lack of ability to control the bladder or bladder functions. Some degree of incontinence may occur in otherwise healthy individuals. In many cases, patients can regain control with therapy and/or medication.

Independent Living
Independent living is a philosophy that persons with disabilities should live as autonomously as possible. The goal is for the patient to live in his or her own home and make his or her own choices as to what services and opportunities to use.

Independent Living Services
With adequate training and support, persons with developmental disabilities may be able to live independently or with roommates. Independent living services help the disabled persons with advocacy, counseling, training, information, and sometimes housing and personal care assistance.

Individualized Education Plan (IEP)
Under the Individuals with Disabilities Education Act (IDEA), public schools must create an individualized education plan (IEP) for every student receiving special education. The IEP must include specific goals, a description of the student’s specific learning issues, and a plan for how the student will overcome the issues to reach the goal. The teacher, parents, and other school professionals must all agree to the plan. Once signed, the school is legally bound to provide all services it promised in the IEP.

Individualized Transition Plan (ITP)
Part of a student’s individual educational plan is a list of long-range goals for after he or she leaves school. This is the individualized transition plan (ITP), and it identifies what services the school, the state, vocational rehabilitation services, and other state and federal programs will provide to facilitate these goals. The plan serves as a map for long-term adult outcomes with intermediate goals and objectives clearly defined.

Individuals with Disabilities Education Act (IDEA)
The Individuals with Disabilities Education Act (IDEA) ensures that persons with developmental disabilities are provided with early intervention and related services from the earliest possible age. Public schools must make services available to all eligible children with disabilities in the least restrictive environment possible.

Integration Mandate / Olmstead Mandate
The Integration Mandate, or Olmstead Mandate, requires that services to disabled persons must be provided in the least restrictive setting that meets their specific needs and be as integrated into the community as possible. The Olmstead Mandate was named for a court case where a person with mental issues sued to be allowed to leave a mental hospital and live in the community. The mandate seeks to enforce the Supreme Court’s decision that states are required to stop isolating persons with disabilities.

Intermediate Care Facility (ICF)
Intermediate care facilities (ICFs) offer housing, meals, and skilled nursing care to persons with disabilities. However, these facilities do not offer the level of medical care that would be available in a hospital.

Intracerebral Hematoma
See Hematoma.

Intracranial Pressure (ICP)
Intracranial pressure is the pressure of the cerebrospinal fluid (CSF) on the brain. This pressure is measured by a needle introduced into the CSF space surrounding the brain.

J

Job Analysis
Job analysis is the methodical study of an occupation with regard to what is required of an employee to perform the job, the specific tasks that are to be performed, and what equipment and aids are needed for successful performance.

K

Kinesthesia
Kinesthesia is the awareness of the movement of body parts. Kinesthesia is a key component in hand-eye coordination and muscle memory.

L

Lability
Lability is the condition of changeability, frequently without stability. Emotional lability is the condition characterized by frequent, unexplainable, and often inappropriate bouts of laughing or crying.

Life Care Plan
A life care plan is a comprehensive document that includes the person’s levels of disability, what services will be needed, how those services will be provided, and how they will be paid for. These services include medical and non-medical needs. The plan also addresses where the person will live, what health care and support he or she will accept, and who will provide the support and care.

Lifelong Living
Lifelong living has a goal of allowing patients to live independently by providing services to offset the effects of disabilities. Services may be concrete, such as modifications to homes to allow wheelchair access. Classes and social activities may be offered to stimulate the mind and combat the feelings of isolation and ostracism the disabled person often feels. Services may be presented in individual homes, residential facilities, or in community settings.

Long-Term Care
Long-term care is a range of services and support to meet the personal care needs of a person with disabilities. This includes medical care and assistance with activities of daily living. Services may be provided at home, in the community, or in skilled nursing facilities.

Long-Term Memory
See Memory, Long-Term.

M

Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (also sometimes called nuclear magnetic resonance imaging or magnetic resonance tomography) is a diagnostic tool used to create an image of the nervous system, musculoskeletal system, or soft tissue.

Managed Care Organization
A managed care organization provides its enrollees with variety of health care services in exchange for a set monthly fee and usually copayments and deductible costs.

Medicaid / Medical Assistance
Medicaid, or Medical Assistance, is a federally funded and state-administered program to provide medical services to low-income individuals and families. Each state may make its own rules about regarding Medicaid, including eligibility requirements, scope of services, and rates of pay.

Medicaid Waiver / Home- and Community-Based Services Waiver (1915c(b) waiver)
Medicaid waivers, or Home- and Community-Based Services Waivers, are an option in Medicaid that supports the effort to keep Medicaid recipients in their homes rather than in institutions. A waiver allows persons to receive certain medical and supportive services in the community. Using a waiver, the state may make exceptions to the Medicaid rules to avoid institutionalization of select individuals.

Medicaid Buy-In
Some persons with disabilities are able to work but have high medical expenses. The cost of private insurance would be prohibitive, but they make too much money to be eligible for Medicaid. Some states allow a medical buy-in, which allows these individuals to qualify for Medicaid at a price.

Medical Malpractice
Medical malpractice is negligence caused by the acts or omissions of a healthcare provider, like doctors, nurses, and hospital staff. If a brain injury was caused by the negligence of a doctor or hospital, you may have a medical malpractice case.

Medicare
Medicare is a national health insurance program for persons who are over 65 years of age or are permanently disabled. Unlike Medicaid, the states may not make rules about eligibility. The program offers services similar to private insurance with monthly fees, co-payments, and deductibles.

Medicare Prescription Drug Program (Part D)
A relatively recent addition to Medicare is the Medicare Prescription Drug Program. This program covers much of the cost of prescriptions if individuals enroll in one of the private Medicare prescription drug plans active in their state. Enrollment in a prescription drug plan is voluntary but there are exceptions. Individuals who receive both Medicaid and Medicare (dual eligible) are required to have the drug program. In these cases, enrollment is done automatically by Medicare.

Memory, Episodic
Episodic memory is the ability to recollect events, including the emotions associated with those events. This is contrasted with semantic memory, which is the structured record of facts, meanings, and knowledge. Semantic memory is independent of personal experience.

Memory, Immediate
Immediate memory is the ability to recall key facts immediately following presentation. Immediate memory enables subjects to learn new tasks. Without immediate memory, subjects cannot remember necessary instructions to learn new tasks.

Memory, Long-Term
Long-term memory is the system for permanently storing and retrieving information over time. It is also called reference memory.

Memory, Short-Term
Short-term memory, also called primary or active memory, is the ability to hold small amounts of information in active awareness. Short-term memory is usually considered to be limited to an average of seven (plus or minus two) elements of information.

Mild Brain Injury
See Brain Injury, Mild.

Motor Control
Motor control is the body’s ability to regulate the timing and amount of contraction of muscles to produce coordinated movement. The regulation is a function of the nervous system.

Muscle Tone
Muscle tone, also called tonus, is the at rest state of balanced tension of the tissues of the body. The term usually refers to muscle tissue. When tonus is lost due to nerve damage, the result is flaccidity. When the muscles are over stimulated, the result can be spasticity. Muscle tone is sometimes used as a term to indicate muscle strength, but this usage is incorrect.

N

Nasogastric (NG) Tube
A nasogastric tube is a special sterile tube that is passed through the patient’s nose and throat and ends in the patient’s stomach. An NG tube allows nutrition and food to be deposited directly into the stomach or for stomach contents, such as excess acid, to be removed from the stomach.

National Disability Rights Network
The National Disability Rights Network is a nonprofit and voluntary association of like-minded programs that works to improve the lives of those with disabilities, primarily through advocacy. The organization promotes vigorous enforcement of laws protecting disabled persons and accountability for programs designed to help disabled persons.

Neologism
A neologism is a new word or expression. In psychological terms, neologism often refers to nonsensical words used by persons with certain psychotic disorders such as schizophrenia. These words may be mixed in with normal language or the patient might use exclusively neologisms. The patient believes the words are sensible.

Neurologist
Neurologists are physicians who specialize in the nervous system and its disorders. The training includes an undergraduate degree, four years of medical school, one year of internship, and at least three years of specialized training.

Neuropsychologist
Neuropsychologists study the structure and function of the brain. Neuropsychology is a mixture of neurology and psychology. Some neuropsychologists specialize in the remediation of or adaptation to injuries to or diseases of the brain. The training includes an undergraduate degree, a master’s degree, and a doctoral degree such as a PhD or PsyD.

The New Freedom Initiative
The New Freedom Initiative is a comprehensive program to fully enforce the Americans with Disabilities Act and promote full participation of persons with disabilities in community activities. Among its objectives are increased access to assistive technology, expanded employment, and education opportunities.

Non-ambulatory
Non-ambulatory means that the patient is unable to walk because of mental or physical issues. The term usually does not apply to persons who can walk if they have aids such as crutches or walkers.

O

Occipital Lobe
The occipital lobe is one of the four sections of the mammalian brain. Located at the rear of the brain, it is the section responsible for processing visual information.

Occupational Therapy
Occupational therapy is assessment and treatment used to develop, recover, or maintain the skills required for work or daily living. The therapy may include teaching the patient to use aids such as communication devices, crutches, or braces.

Olmstead Mandate
See Integration Mandate.

Orientation
In psychological terms, orientation means that the patient is aware and alert to his environment and situation. It also requires that the patient be able to utilize the information as appropriate.

Orthopedics
Orthopedics is the branch of medicine concerned with the study and treatment of the skeletal system and the associated structures. Treatment may include surgery for the repair of deformities in these parts.

Outpatient
Outpatient treatments are performed on patients who are not residing in the treatment facility. The patient resides outside the hospital but returns on a regular basis for one or more therapeutic services.

P

Paraplegia
Paraplegia refers to impairment in sensory or motor function in the lower part of the body, usually from the waist down. Paraplegia often is a result of vehicular or sporting accidents, gunshot wounds, or falls.

Parietal Lobe
The parietal lobe is one of the four primary sections of the brain. It processes sensory information such as touch, taste, or temperature. See brain regions for more information.

Perception
Perception is the identification, recognition, and organization of sensual information and the ability to interpret it in a way that makes it possible to understand the environment. The signals originate in physical or chemical stimulation to the sense organs, which in turn pass information to the nervous system. Perception is shaped by memories of previous experiences as well as current expectation and attention.

Persistent Vegetative State (PVS)
A persistent vegetative state is a disorder of consciousness, a common symptom of severe brain damage. There is an apparent partial arousal but no true awareness and no response to commands. A person who has been nonresponsive in a vegetative state for four weeks is classified as being in a persistent vegetative state. The diagnosis is changed to permanent vegetative state three months following a non-traumatic brain injury or twelve months following a traumatic injury.

Physiatrist
A physiatrist, or rehabilitation physician, specializes in the treatment of injuries and illnesses that affect movement. Physiatrists often serve as liaisons between the patient and a team of other medical professionals and help the patient understand problems and treatment plans.

Physical Therapist
Physical therapists are primarily concerned with the improvement of mobility, function, movement, and quality of life. The therapy may be part of rehabilitation following an injury or illness or part of remediation of impairment or disability. Although many people think of physical therapy in terms of sports or orthopedic rehabilitation, there are many physical therapy specialties, including neurological and cardiovascular.

Plaintiff
In every lawsuit, there is a plaintiff and a defendant. The plaintiff is the individual, group, or entity who brings the suit. The plaintiff is also known as the claimant or complainant.

Plasticity
In biological terms, plasticity is the ability of an organism or the cellular or tissue structures of the organism to adapt to its environment. A high degree of plasticity would indicate that the organism is able to easily adjust to new situations and function well.

Plateau
A plateau is a temporary or permanent period of little to no change following a time of activity or change.

Post-Acute Care / Sub-Acute Care / Transitional Care
Post-acute care is a range of medical care services following hospitalization for illness or injury or for the management of a chronic illness or disability. These services help a patient return to his or her home or a specialized facility for continued care or rehabilitation.

Post-Acute Rehabilitation
Post-acute rehabilitation is geared toward moving the patient safely back to his or her own home while offering services to improve independent living skills. These services may include physical therapy, operational therapy, and counseling. Services may be provided in a residential facility or the patient’s home.

Post-Traumatic Amnesia (PTA)
Following a coma or a concussion, there may be a period of post-traumatic amnesia. This period may last hours, weeks, days, or months. During this time, the individual is unable to store memory and therefore unable to learn. The patient may be disoriented, highly distractible, or overly emotional.

Posture
Posture is the position in which the body is held against gravity. Proper posture keeps the bones and joints in the alignment that causes the least strain on the muscles. Poor posture can cause strain, pain, and fatigue. The ability to maintain a normal posture can be damaged by injuries to the nervous system.

Power of Attorney
A power of attorney (POA) is a legal document that allows a person to empower another person or agency to make medical decisions or use money on the appointing person’s behalf. A POA may be limited to a specific action or time. A POA made while the appointing person is considered competent becomes invalid when that person becomes incapacitated or dies. A durable power of attorney remains in place until the appointing person dies. If a person is already unable to make medical and financial decisions, a court may appoint a provider such as a nursing home with a durable power of attorney.

Pre-Morbid Condition
Pre-morbid condition, or premorbidity, is the physical or functional status of the patient before the onset of a disease or before an injury occurs.

Problem-Solving Skill
Problem-solving skill is the ability to use creative and analytical skills to find solutions for a task, project, or assignment. Persons with problem-solving skills can consider the probable factors that influence possible outcomes. Persons who have limited or no problem-solving skills sometimes become overwhelmed when presented with a problem for which there is not an immediately obvious solution. They may become “frozen,” or react by doing nothing at all.

Prognosis
The prognosis is the most likely course an ailment or disease will take. A true prognosis is based on based on the patient’s symptoms, responses to therapies, and the attitude and motivation of the patient.

Protection and Advocacy Program
Protection and advocacy programs provide legal-based services to people with disabilities. These services include the authority to investigate suspected abuse or neglect, to access records and facilities, to educate policy makers, and to pursue litigation on the behalf of persons with disabilities.

Protection and Advocacy TBI Program (PATBI)
In every state, there is a Protection and Advocacy TBI program (PATBI) for those persons suffering from a traumatic brain injury (TBI). See Protection and Advocacy Program for more information.

Psychologist
A psychologist is a professional who studies behavior and mental processes and may provide evaluation, diagnosis, and treatment services. A psychologist has a doctorate level degree in psychology but does not have a medical degree.

Q

Quadriplegia
The condition of having paralysis in all four limbs, or paralysis from the neck down.

Qualified Individual with a Disability
A qualified individual with a disability is a person who meets, with or without reasonable accommodations, the requirements of an education or employment position. This is a term from both the Americans with Disabilities Act and the Rehabilitation Act. To discriminate against these persons in hiring or enrollment decisions is unlawful under these acts.

Quality of Life
Quality of life refers to the type of existence a person has, usually expressed as a rating. Several factors are typically considered in determining quality of life, including one’s ability to carry out the daily activities of life; mobility; engagement in social relationships; independence of living arrangements; activities, including both work and leisure; and prospects for the future.

R

Range of Motion
Range of motion refers to the ability of a joint to move. Range of motion may be active, in which the joint is moved by the surrounding muscles, or passive, in which the joint is moved through some other method, usually another person.

Reasonable Accommodation
Reasonable accommodations are those changes to a site, work schedule, class, or job environment that make it possible for a qualified person with disabilities to participate. The accommodations are not required if they pose an undue hardship on the employment or educational opportunity.

Rehabilitation
Rehabilitation refers to a program through which a patient overcomes or reduces deficits after suffering an illness or injury. The goal of rehabilitation is to help the patient reach the highest possible level of physical and mental attainment.

Representative Payees
If a person receiving Social Security benefits is unable to manage his finances, a judge may appoint a representative payee. This person or agency accepts the Social Security payments and makes decisions in the best interest of the beneficiary. Persons under 18 must have a representative payee.

Residential Services
Residential services provide an environment for 24-hour living outside the home. Services available in residential facilities differ based on the reason the person is in residential care. However, the residents will have access to support staff who can meet their needs.

Respirator / Ventilator
A respirator or ventilator is a device that breathes for a patient who is unresponsive.

Respite Services
The primary caretaker of a person with disabilities may become overcome with the stress of providing services. Respite services provide temporary relief for these persons. The care may last several hours or several days, may be routinely scheduled or on an irregular basis, and may be provided by professionals or family members.

S

Secondary Condition
Secondary condition refers to a condition in people with disabilities that is caused by the primary disability and leads to an increased or faster rate of deterioration in the ability to function or in quality of life or health status. Secondary conditions include such issues as depression, physical deconditioning, bed sores, ulcers, and other conditions.

Section 504 of the Rehabilitation Act
Section 504 of the Rehabilitation Act requires all state and federal government buildings and any entity that receives any federal funding to make programs and buildings accessible to people with disabilities. Governments must also ensure that people with disabilities have equal access to government jobs.

Section 508 of the Rehabilitation Act
Section 508 of the Rehabilitation Act is part of the Federal Acquisition Regulation (FAR) that addresses access specifically for those persons with physical, sensory, or cognitive disabilities. All agencies receiving any federal funds are required to make electronic information, telephone services, videos, and other media accessible to these persons.

Section 8 Housing Program (HCVP)
Section 8 Housing Choice Voucher Program is a federal program that assists the poor, the elderly, and the disabled to rent low-cost, safe, and decent housing in the private market. The housing choice vouchers are administered locally by public housing agencies. Under certain circumstances, the vouchers may be used to purchase a home.

Seizure
A seizure occurs when nerve cells in the brain discharge uncontrollably. The seizure may occur in a localized area of the brain or throughout the entire brain. Seizure are usually only a few seconds to a few minutes in length. Symptoms of seizures may include tremors, incontinence, loss of consciousness, or changes in behavior.

Self-Determination
Self-determination is the concept that persons should make their own choices and control their own actions. This concept is protected for persons with disabilities by a number of laws, allowing the persons to make decisions about their own health care, living situations, and other life choices.

Sensation
A sensation is the ability to feel a stimulus with one of the body’s sensory organs. Taste, sight, hearing, smell, touch, pressure, pain, and temperature are sensations.

Sensorimotor
Sensorimotor refers to movement, sensation, and any interaction between the two.

Settlement
A settlement is a joint decision by the parties in a lawsuit to resolve the issue without going to court.

Short-Term Memory
See Memory, Short-Term.

Shunt
A shunt is a medical procedure that removes excess fluid from the brain. The term also refers to the tube that removes such fluid.

Skilled Extended Care Facility
See Extended Care Facility–Skilled.

Skilled Nursing Care
Skilled nursing care is direct care supervised by registered nurses. This includes nursing and rehabilitative care. Medicare supports skilled nursing care provided in the home if it is part time and intermittent.

Social Assessment
A social assessment evaluates the social environment of a patient. Typically, such an evaluation will include a patient’s background, financial means, living environment, work history, education, role in the family, and availability of family or other members of a support group. The assessment will take into account the patient’s lifestyle, friendships, interests, long- and short-term goals, personality, and problem areas such as mental health issues or drug or alcohol abuse. The purpose of the assessment is to determine how well the patient and the patient’s family or immediate support group comprehend the patient’s condition, including how rehabilitation or long-term health prospects may affect the family situation and how support group members are able to adjust to necessary changes in that situation.

Social Worker
A social worker is a trained professional who acts as a go-between for the patient with various other parties, including medical staff, family, and financially invested parties. Social workers are particularly helpful in assisting the patient in the transition from medical to residential care.

Sub-Acute Care
See Post-Acute Care.

Sub-Acute Rehabilitation
Subacute rehabilitation may precede or follow acute rehabilitation. If the patient is unable to participate in acute rehabilitation because of fatigue or inadequate healing, he may be admitted to subacute rehabilitation until he is ready to engage in more strenuous rehab. Following acute rehabilitation, some patients may be moved to sub-acute rehabilitation to better prepare to return home. The services are usually offered for six to 24 months, based on improvement.

Subarachnoid Hematoma
See Hematoma.

Subdural Hematoma
See Hematoma.

Subrogation
Subrogation is the right granted by the insured to the insurance company to sue the person or other entity that caused the injury to the insured. The insurance company then has the authority to recover the funds paid to the insured.

Supervised Living
Supervised living definitions can differ from jurisdiction to jurisdiction. In general, the supervised residence houses several unrelated persons who may need assistance in daily living. Needed services may be offered in the residence, or the residential administration may assist the patient in accessing the care that is required. A staff person is always on duty when the residents are in the home to provide guidance and supervision as necessary.

Supported Employment
Supported employment is any of a range of programs that provide assistance for persons who have had trouble finding or maintaining employment. The programs may include job training, assistance with applications, on-site coaching, and other assistance.

Supported Independent Living
Supported independent living is an appropriate setting for persons who can tend to most of their daily needs but, for various reasons, should not live alone. Any offered programs are to support and assist the resident in maintaining his or her independence rather than to supervise the resident.

Supplemental Security Income (SSI)
Supplemental Security Income (SSI) is a federal program funded by general tax revenues to provide income for food, clothing, and housing for elderly or disabled persons.

Social Security Disability Income (SSDI)
The Social Security Disability Income (SSDI) program is for people who have been employed for several years but who have become severely disabled and unable to work for at least one year. Qualification requires that the person have almost no other resources to pay for basic needs.