Brain Injury Webcourse

Anti-cholinesterases inhibit the cholinesterase enzyme from breaking down ACh, increasing both the level and duration of the neurotransmitter action. According to the mode of action, AChE inhibitors can be divided into two groups: irreversible and reversible.

Administration for Community Living. Full definition below.

Acquired brain injury (ABI) includes a wide range of disorders/diseases affecting the brain, with onset after birth. While ABI can occur at all ages, beginning in the perinatal/newborn period through adulthood, the majority of individuals who sustain an ABI are adults. In addition to age of onset, the long-term consequences of ABI are associated with their severity and the sites of injury within the brain, and some acquired disorders/diseases are progressive (e.g., Chronic Traumatic Encephalopathy, a neurodegenerative disorder associated with repetitive head trauma). Progressive disorders are usually associated with a decline in cognitive status (i.e., dementia) and gradual compromise of functional capacity.

Routine personal activities that an individual performs throughout the course of their day, such as: eating, dressing, toileting/continence, transferring/mobility and personal hygiene.

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

Any tool, device or machine that is designed to improve an individuals participation in activities of daily living and mobility.

The U.S. Department of Health and Human Services (HHS) created the Administration for Community Living (ACL) in 2012. The Administration for Community Living (ACL) administers programs authorized through a variety of statutes. ACL brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as the Federal agency responsible for increasing access to community supports, while focusing attention and resources on the unique needs of older Americans and people with disabilities across the lifespan.

Community-based care designed to meet the needs of functionally and/or cognitively impaired adults who, for their own safety and well-being, can no longer reside independently at home during the day. Adult day care facilities such as senior or community centers offer protected settings which are normally open weekdays during business hours and include a mixture of health, social and support services. Specialized programs for individuals with Alzheimer's disease or related disorders also exist. Some facilities offer a wide range of therapeutic and rehabilitative activities as well as social activities, meals, and transportation.

One who pleads, supports or promotes the interests of a cause, individual or group. 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.

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

An equal partnership between Aging Services Access Points/Area Agencies on Aging (ASAPs/AAAs) and Independent Living Centers (ILCs) in order to provide access to more choices to individuals so they can choose the setting in which they receive Long-Term Services and Supports regardless of age, disability or income. In Massachusetts, they are organized into 11 geographical regions comprised of at least one ILC and one or more Aging Services Access Points. ADRCs have partnerships with many community agencies across the aging and disability network including social and health care services and supports. For example: ADRC organizations provide consumers with access to information and referral services, Option Counseling and assist them with decision support, assessment for services, service authorization and planning, consumer-directed options for LTSS and community integration.

A private, non-profit, state-designated agency under contract with the Massachusetts Executive Office of Elder Affairs to provide a single-entry point for seniors and caregivers to access a variety of programs and services. Formerly known as "Home Care Corporation".

Agitation, Psychomotor is excessive restlessness, including increased physical activity which is usually non-purposeful and repetitious.

A condition characterized by uncontrollable motor restlessness. Akathisia is often a side effect of antipsychotic drugs used to treat mental health conditions such as bipolar disorder and schizophrenia, but it can also occur with newer antipsychotics as well. Individuals with akathisia feel an uncontrollable urge to move and a sense of restlessness. To relieve the urge, they engage in repetitive movements: rocking back and forth while standing or sitting; shifting weight from one leg to the other; walking in place; pacing; shuffling while walking; lifting the feet as if marching; crossing and uncrossing the legs or swinging one leg while sitting.

Loss of spontaneous, voluntary muscle movement.

A problematic pattern of alcohol use leading to clinically significant impairment or distress and a cluster of behavioral and physical symptoms, such as withdrawal, tolerance and craving. This pattern of alcohol use often involves problems controlling drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when rapidly decreasing or stopping alcohol use. See also Substance Use Disorder.

To walk.

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

An almond shaped mass of gray matter in the front part of the temporal lobe of the cerebrum that is part of the limbic system. The amygdala is involved in the processing and expression of emotions, especially anger and fear.

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.

Anorexia (or Anorexia Nervosa) is an eating disorder characterized by a restriction of energy intake relative to requirements resulting in a significantly low body weight, intense fear of gaining weight or persistent behavior that interferes with weight gain and a distorted perception of body weight or shape.

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.

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

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

Help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants.

Opposing the actions of the neurotransmitter acetylcholine. Anticholinergic drugs inhibit the transmission of parasympathetic nerve impulses, thereby reducing spasms of smooth muscles (for example, muscles in the bladder).

Type of medication used to treat seizure disorders by decreasing the possibility of a seizure (e.g., Dilantin, Phenobarbital, Mysoline, and Tegretol). Anticonvulsants have been found to help control unstable moods as well.

These work by blocking of the reward receptors in the brain. Different addictions are being treated with the use of anti-craving medications after detox. These include alcohol, opiate, nicotine, and cocaine use disorders. These medications are used to help prevent relapse.

Medications commonly used to treat depression. Antidepressants are also used for other health conditions, such as anxiety, pain and insomnia.

Type of medication primarily used to manage psychosis. The word “psychosis” is used to describe conditions that affect the mind, and in which there has been some loss of contact with reality, often including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not really there). It can be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, bipolar disorder, or very severe depression (also known as “psychotic depression”). Antipsychotic medicines do not cure these conditions. They are used to help relieve symptoms and improve quality of life. Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions, including: Attention-Deficit Hyperactivity Disorder (ADHD); Severe Depression; Eating Disorders; Post-traumatic Stress Disorder (PTSD); Obsessive Compulsive Disorder (OCD); Generalized Anxiety Disorder.

Medications used to treat cerebral and spinal cord related spasticity. See definition for Spasticity.

Anxiety disorders share features of excessive fear and anxiety and related behavioral disturbance. The anxiety disorders differ from one another in the types of objects or situations that induce anxiety or avoidance behavior and the associated thoughts. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. Examples of anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder , specific phobias and separation anxiety disorder.

Having or showing little or no feeling, emotion, interest or concern.

Absence of feelings or emotions. Person is indifferent.

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.

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

A regional agency that is authorized by the Administration on Aging, funded through the Old Americans Act and partners with the Executive Office of Elder Affairs to assist older people with their life-long needs including: information and referral for in-home services, counseling, legal services, transportation, and nutrition

The physiological and psychological state of being alert, awake and attentive. Arousal is primarily controlled by activation of the reticular activating system (extending from medulla to the thalamus in the core of the brain stem). Cognition is not possible without some degree of arousal.

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

A lack of oxygen or excess of carbon dioxide in the body that is usually caused by interruption of breathing and that causes unconsciousness.

When fluid or food enters the lungs through the wind pipe. Can cause a lung infection or pneumonia.

Any technology that enables a person to live independently and perform self-care, work and community activities (play, leisure, exercise, etc.). Some assistive technologies can be beneficial in compensating for cognitive impairments. Examples include: personal digital assistants, voice organizers and recorders, reminders, watches and smart phones.

Inability to coordinate voluntary muscle movements.

A wasting away or decrease in size of a cell, tissue, organ, or part of the body caused by lack of nourishment, inactivity or loss of nerve supply.

The ability to focus on a given task or set of stimuli for an appropriate period of time

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that includes a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development. ADHD can lead to unstable relationships, poor work or school performance, low self-esteem, and other problems. In some cases, ADHD is not recognized or diagnosed until the person is an adult. ADHD treatment includes medications, psychological counseling (psychotherapy) and treatment for any mental health conditions that occur along with ADHD.

Newer or second generation antipsychotic medications are also called "atypical" antipsychotics. See definition for Antipsychotic Medications.

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. Diffuse axonal injury (DAI) is a clinical diagnosis that describes a process of widespread axonal damage following acute or repeated incidents of TBI.

Long nerve fibers that conduct impulses away from the cell body to other cells.

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

The total collection of actions and reactions exhibited by a person.

For the patient exhibiting patterns of behavior preventing participation in active rehabilitation, including destructive patient behavior to self and others; continuum of controlled settings.

The field of medicine concerned with a person’s activities or habits and how these affect physical, mental, and social well-being. Behavioral health can refer to individuals with a mental health and/or substance use diagnosis.

Neurobehavioral effects include affective changes, including over-emotional or over-reactive affect or flat (i.e., emotionless) affect. Agitation and/or combativeness; anxiety disorder; depression; difficulty identifying emotions in others (alexithymia); emotional lability and mood changes or mood swings; excessive drowsiness and changes in sleep patterns, including difficulty falling or staying asleep (insomnia), excessive sleepiness (hypersomnia); feeling of disorientation or fogginess; increased state of sensory sensitivity accompanied by exaggerated response to perceived threats (hypervigilance); impulsivity; irritability and reduced frustration tolerance; stress disorders.

A class of medications often used in the treatment of anxiety, panic disorder, seizures or sleep disorders. May also be used as general anesthesia, muscle relaxation and during alcohol withdrawal or drug associated agitation. Examples of benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan).

any of a group of drugs (as propranolol) that combine with and block the activity of a beta-receptor to decrease the heart rate and force of contractions and lower high blood pressure and that are used especially to treat hypertension, angina pectoris, and ventricular and supraventricular arrhythmias.

Having or relating to two sides, affecting both sides.

This is the most common form of excessive drinking and is defined as consuming: For women, more than 3 drinks during a single occasion. For men, more than 4 drinks during a single occasion. For older women, more than 2 standard drinks per occasion. For older men, more than 3 standard drinks per occasion.

Formerly called manic depression, this disorder is a mental health condition that causes periods of unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. These distinct periods are called "mood episodes". These moods can range from periods of extremely "up," elated, and energized behavior (known as manic or hypomanic episodes) to very sad, "down," or hopeless periods (known as depressive episodes).

Refers to the percent of alcohol (ethyl alcohol or ethanol) in a person’s blood stream. It is a measure of alcohol intoxication used for legal or medical purposes.

Any injury that results in brain cell death and loss of function. For more specifics see definitions for Acquired Brain Injury (ABI) and Traumatic Brain Injury (TBI).

A private, nonprofit, statewide organization, the Brain Injury Association of Massachusetts provides Support & Resources to brain injury survivors and their families; Prevention Programs to educate the public on the impact of brain injuries; Education & Training for brain injury survivors, caregivers and professionals; and Legislative Advocacy for improved community services and safety laws (seat belts, helmets).

The lower extension of the brain where it connects to the spinal cord. Neurological functions located in the brain stem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert). It also houses the reticular formation which plays a crucial role in behavioral arousal and consciousness.

A brain tumor is a mass or growth of abnormal cells in your brain or close to your brain. Many different types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in your brain (primary brain tumors), or cancer can begin in other parts of your body and spread to your brain (secondary, or metastatic, brain tumors).

Used in medication-assisted treatment (MAT) to help people reduce or quit their use of heroin or other opiates, such as pain relievers like morphine. Buprenorphine represents the latest advance in medication-assisted treatment (MAT). Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified U.S. physicians can offer buprenorphine for opioid dependency in various settings, including in an office, community hospital, health department, or correctional facility.

A medication primarily used as an antidepressant and smoking cessation aid. Trade names include Wellbutrin and Zyban. The Zyban brand of bupropion is used to assist smoking cessation by reducing cravings and other withdrawal effects. See definition for Antidepressant Medications.

A delusional condition characterized by the false belief that known individuals (such as family members) have been replaced by doubles or impostors

An adult (typically a family member or friend) who provides unpaid assistance to another adult who can no longer independently attend to his or her personal needs and/or perform his or her normal activities of daily living.

Facilitating the access of a patient to appropriate medical, rehabilitation and support programs, and coordination of the delivery of services. This role may involve liaison with various professionals and agencies, advocacy on behalf of the patient, and arranging for purchase of services where no appropriate programs are available

One of 13 major operating components of the Department of Health and Human Services; and leads the nation’s public health efforts to prevent and control infectious diseases, injuries, workplace hazards, disabilities, and environmental health threats.

The central nervous system (CNS) consists of the brain and spinal cord. The CNS takes in sensory information, processes information and sends out motor signals.

The portion of the brain (located at the back of the skull) which plays a role in motor movement regulation and balance control. Damage may result in ataxia.

Swelling that occurs in the brain, often following trauma. Swelling is caused by an accumulation of excess fluid in the brain tissues which can lead to neuron damage by squeezing the cells or by disrupting the flow of blood and oxygen to the brain, causing anoxia. Very severe swelling can cause death by compressing the brain stem.

Marked by long duration or frequent recurrence.

Occurs when the head accelerates and then rapidly decelerates or collides with another object (for example the windshield of a car) and brain tissue is damaged, not by the presence of a foreign object within the brain, but by violent smashing, stretching, and twisting, of brain tissue. Closed brain injuries typically cause diffuse tissue damage that results in disabilities which are generalized and highly variable.

A comprehensive and dynamic program of support and opportunities for people with severe and persistent mental illnesses.

Related to cognition is the conscious process of knowing or being aware of thoughts or perceptions, including understanding and reasoning.

Cognitive behavioral therapy combines behavioral and cognitive interventions and is based on the belief that thought, emotion and behavior are interrelated. Treatment focuses on assisting individuals in monitoring their thoughts and actions in order to improve their emotional well-being. Cognitive interventions aim to identify and modify negative or distorted thoughts, whereas behavioral interventions aim to decrease maladaptive behaviors and increase adaptive ones. CBT is usually time-limited and like many other treatments the clinician assists the individual in determining realistic goals for therapy and effective strategies for reaching those goals.

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

Cognitive impairments or deficits describe the impairment of different domains of cognition including, but not limited to, attention, memory, executive functions and language. Cognitive deficits may occur due to a range of diseases and conditions and it might be a short-term condition or progressive and permanent.

Therapy programs which aid persons in the management of specific problems in perception, memory, thinking and problem solving. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits. The interventions are based on an assessment and understanding of the person's brain-behavior deficits and services are provided by qualified practitioners.

A state of unconsciousness from which the patient cannot be awakened or aroused, even by powerful stimulation; lack of any response to one's environment. Defined clinically as an inability to follow a one-step command consistently; Glasgow Coma Scale score of 8 or less.

An impairment in the ability to 1) receive and/or process a symbol system, 2) represent concepts or symbol systems, and/or 3) transmit and use symbol systems. The impairment may be observed in disorders of hearing, language, and/or speech processes.

Provides services designed to accomplish functional outcomes focused on home and community integration, including productive activity. Services may be provided in residential facilities, day treatment programs, and the consumer's home. They may be of short-term (several weeks) or long-term duration (several months).

Those abilities needed to function independently in the community. They may include: telephone skills, money management, pedestrian skills, and use of public transportation, meal planning and cooking.

These are strategies utilized to maximize skills of the individual by either modifying the environment and/or providing internal and external supports and capitalizes on intact skills to overcome deficits resulting from TBI . Compensatory strategies can include both internal (e.g., mnemonics, imagery, association) and external (e.g., memory aids, PDAs, calendars) strategies. External strategies involving assistive technology may support a variety of cognitive-communicative impairments, including attention, memory, navigation, time management, organization, and emotional function.

Understanding of spoken, written, or gestural communication.

A series of X-rays taken at different levels of the brain that allows the direct visualization of the skull and 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.

The ability to focus on a given task or set of stimuli for an appropriate period of time.

Concussion is often used interchangeably with mild TBI. While there is no universally accepted definition of mild TBI the primary severity indicators are duration of unconsciousness, Glascow Coma Scale scores and duration of PTA. See also Mild TBI.

Verbalizations about people, places, and events with no basis in reality. May be a detailed account delivered.

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

Existing at or dating from birth. Acquired during development in the uterus and not through heredity

Circumstance that is present at birth.

A person, official, or institution appointed by a court to take over and manage the estate of an incompetent.

Also known as a bruise, a contusion is an injury to the soft tissue. A brain or cerebral contusion is bruising of the brain tissue.

Harmonious working together of muscles or muscle groups to perform complicated movements.

Any region of the cerebral cortex, the outer layer of neural tissue of the brain.

A municipally appointed agency that provides services to elders, families and caregivers. While each COA is unique to its community, most councils offer information and referral, transportation, outreach, meals (congregate and home delivered), health screening, fitness and recreation programs and volunteer services.

A coup-contrecoup injury describes contusions that are both at the site of the impact and remote from the actual side of impact-often on the opposite side of the impact. This occurs when the force impacting the head is strong enough to cause a contusion at the site of impact and set the brain in motion resulting in an impact with the opposite side of the skull and an additional contusion. In a whiplash event, injuries can be caused solely by acceleration or deceleration in the absence of a direct impact.

To give a prompt or reminder.

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.

An integrated pattern of socially transmitted human behavior that includes thoughts, communication, actions, customs, beliefs, values, institutions, and all other products of human work or thought, characteristic of a particular community or population (Cross et al., 1989). Though culture is often viewed as simply race and ethnicity, the term encompasses much more. Other groups of people display distinct cultural characteristics and in turn receive culturally insensitive responses from society. Examples of such groups include the poor, the homeless, and the disabled.

Psychiatric outpatient program(s) provided in the community.

Department of Developmental Disabilities

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of your environment. The start of delirium is usually rapid — within hours or a few days. Delirium can often be traced to one or more contributing factors, such as a severe or chronic medical illness, changes in your metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug withdrawal.

Deterioration of intellectual abilities (e.g., vocabulary, abstract thinking, judgment, memory loss, physical coordination), the loss of which interferes with daily activities. Dementia can be caused by degenerative diseases (e.g., Alzheimer's, Huntington's and Parkinson's diseases), vascular diseases or stroke, metabolic disorders (thyroid, liver kidney dysfunction and certain vitamin deficiencies), AIDS, drugs and alcohol, and psychiatric disorders. Some dementias may respond to treatments, others do not.

Adaptation to a drug that produces physical symptoms of withdrawal when the drug is stopped.

When bones of the skull are broken or cracked, loose bone fragments may place pressure on or penetrate the brain, thereby causing damage.

Depression is a common but serious mood disorder which causes symptoms that negatively affect how you feel, think, and handle daily activities such as sleeping, eating, or work. Symptoms of depression may include sadness, anxiety, lack of interest, feelings of guilt, insomnia, difficulty with concentration, changes in appetite or weight, feelings of restlessness or agitation, moving or speaking more slowly, feelings of hopelessness, or suicidal ideation. To be diagnosed with depression (major depressive disorder or clinical depression) the symptoms must be present for at least two weeks.

Dialectical behavior therapy (DBT) is often used with individuals who have difficulty regulating emotions and behaviors. It is commonly used when emotional dysregulation leads to self-injurious behavior, including suicide. Clinicians use techniques to assist individuals in developing alternative ways to control their frequently overwhelming feelings. Together the therapist and client work on accepting and identifying uncomfortable feelings, and practice skills to increase distress tolerance and enhance coping skills.

Diffuse axonal injury (DAI) is a clinical diagnosis that describes a process of widespread axonal damage following acute or repeated incidents of TBI.

Inability to suppress (inhibit) impulsive behavior and emotions.

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.

Department of Mental Health

Domestic violence is a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner. Domestic violence can be physical, sexual, emotional, economic, psychological or technological actions or threats of actions or other patterns of coercive behavior that influence another person within an intimate partner relationship. Intimate partner violence (IPV) is domestic violence in an expanded definition to account for abusive behavior that is not limited to the domestic setting of families, marriages and those cohabitating. Domestic violence/interpersonal violence can happen to anyone regardless of race, age, sexual orientation, religion, gender, socioeconomic background and education level.

A chemical found in the brain that acts as a neurotransmitter and is an intermediate compound in the synthesis of noradrenaline. Dopamine is essential to the normal functioning of the central nervous system. For example, a reduction of dopamine in the brain is associated with the development of Parkinson’s disease.

Relating to medications releasing or involving dopamine as a neurotransmitter. Drugs with this effect are used in the treatment of Parkinson's disease and some psychiatric disorders; some are subject to abuse.

Injury located in the region by the frontal lobes toward the top and side: hence dorso (top) and lateral (side). The dorsolateral prefrontal cortex is largely responsible for attention, executive function and working memory.

Department of Public Health

Drug addiction, also called substance use disorder, is a dependence on a legal or illegal drug or medication. Keep in mind that alcohol and nicotine are legal substances, but are also considered drugs. When you're addicted, you're not able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause an intense craving for the drug. You may want to quit, but most people find they can't do it on their own. Drug addiction can cause serious, long-term consequences, including problems with physical and mental health, relationships, employment, and the law. You may need help from your doctor, family, friends, support groups or an organized treatment program to overcome your drug addiction and stay drug-free.

Although SAMHSA does not use “Drug Use Disorder” as the names of disorders related to drug use each are named separately. For example, cannabis use disorder, stimulant use disorder, hallucinogen use disorder and opioid use disorder See Substance Use Disorders

A power of attorney that becomes effective immediately and is not affected by the principal's subsequent incapacity or that becomes effective only upon the principal's incapacity.

Department of Veteran’s Services

Difficulty in forming words or speaking them because of weakness of muscles used in speaking or because of disruption in the neuromotor stimulus patterns required for accuracy and velocity of speech.

Impairment of voluntary movements resulting in fragmented or jerky motions (as in Parkinson's disease).

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

Abnormality or impairment in the regulation of a metabolic, physiological, or psychological process.

Collection of fluid in the tissue causing swelling.

Is a written recording of the electrical activity of the heart. Electrocardiograms are used to evaluate cardiac function and diagnose arrhythmias and other disorders.

Any of the ions (as of sodium or calcium) that in biological fluid regulate or affect most metabolic processes (such as the flow of nutrients into and waste products out of cells)

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

Is a form of counseling intervention that draws on various theories of alternative medicine including acupuncture, neuro-linguistic programming, energy medicine, and Thought Field Therapy (TFT).

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

Any disease of the brain that alters brain function or structure.

Endocrine disorders are diseases related to the endocrine glands of the body. The endocrine system produces hormones, which are chemical signals sent out, or secreted, through the bloodstream. Hormones help the body regulate processes, such as appetite, breathing, growth, fluid balance, feminization and virilization, and weight control. The endocrine system consists of several glands, including the pituitary gland and hypothalamus in the brain, adrenal glands in the kidneys, and thyroid in the neck, as well as the pancreas, ovaries and testes. The stomach, liver and intestines also secrete hormones related to digestion. Most common endocrine disorders are related to improper functioning of the pancreas and the pituitary, thyroid and adrenal glands. Common endocrine disorders include diabetes mellitus, acromegaly (overproduction of growth hormone), Addison’s disease (decreased production of hormones by the adrenal glands), Cushing’s syndrome (high cortisol levels for extended periods of time), Graves’ disease (type of hyperthyroidism resulting in excessive thyroid hormone production), Hashimoto’s thyroiditis (autoimmune disease resulting in hypothyroidism and low production of thyroid hormone), hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroid), and prolactinoma (overproduction of prolactin by the pituitary gland). These disorders often have widespread symptoms, affect multiple parts of the body, and can range in severity from mild to very severe. Treatments depend on the specific disorder but often focus on adjusting hormone balance using synthetic hormones.

The Executive Office of Elder Affairs

A crystalline sympathomimetic hormone that is the principal blood-pressure raising hormone secreted by the medulla of the adrenal glands, is prepared from adrenal extracts or made synthetically, and is used medicinally especially to stimulate the heart during cardiac arrest and to treat life-threatening allergic reactions - also called adrenaline.

Memory for ongoing events in a person's life. More easily impaired than semantic memory, perhaps because rehearsal or repetition tends to be minimal.

Excessive drinking includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21. Binge drinking, the most common form of excessive drinking, is defined as consuming: For women, 4 or more drinks during a single occasion. For men, 5 or more drinks during a single occasion. Heavy drinking is defined as consuming 15 drinks or more per week for men and 8 drinks or more per week for women.

A set of cognitive processes that include planning, abstract reasoning, problem-solving, information processing, judgment, working memory, etc.

Executive Office of Health and Human Services.

Arm or leg.

Food and Drug Administration.

A specialized system that responds to an acute threat to survival that is marked by physical changes, including nervous and endocrine changes, that prepare a human or an animal to react or to retreat. The fight or flight response is characterized by an increased heart rate (tachycardia), anxiety, increased perspiration, tremor, and increased blood glucose concentration (due to glycogenolysis, or breakdown of liver glycogen). These actions occur in concert with other neutral or hormonal responses to stress, such as increases in corticotropin and cortisol secretion, and they are observed in some humans and animals affected by chronic stress, which causes long-term stimulation of the fight-or-flight response.

Functional Magnetic Resonance Imaging (fMRI) is a technique that directly measures the changes in blood flow that occur with brain activity.

Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of "higher cognitive functions."

The ability to persist in completing a task despite apparent difficulty. Individuals with a poor frustration tolerance will often refuse to complete tasks which are the least bit difficult. Angry behavior, such as yelling or throwing things while attempting a task is also indicative of poor frustration tolerance.

Also known as Gamma-Amino Acid (GABA). GABA is a chemical that is made in the brain. GABA works by blocking brain signals (neurotransmissions). GABA is taken by mouth for relieving anxiety, improving mood, reducing symptoms of premenstrual syndrome (PMS), and treating attention deficit-hyperactivity disorder (ADHD). It is also used for promoting lean muscle growth, burning fat, stabilizing blood pressure, and relieving pain.

A drug that is an agonist for one or more of the GABA receptors, typically producing sedative effects.

A physician who specializes in the care of the elderly, primarily those who are frail and have complex medical and social problems.

A structure, arrangement, or pattern of physical, biological, or psychological phenomena so integrated as to constitute a functional unit with properties not derivable by summation of its parts. Gestalt theory emphasizes that the whole of anything is greater than its parts.

The GCS is a commonly used scale 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) 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.

An individual who takes on the legal responsibility to care for another person or for another person's property (guardianship).

A false perception of sensory experiences (such as a visual image or a sound). They are typically a symptom of a psychosis related disorder, but can also result from substance use and other medical conditions.

Is a type of power of attorney authorizing an agent to make health care decisions in the event of incapacity —called also medical power of attorney.

Impairment due to trauma can produce conductive and sensorineural hearing loss, central auditory processing deficits, vestibular impairments, and tinnitus.

An acute episode of coronary heart disease marked by the death or damage of heart muscle due to insufficient blood supply to the heart usually as a result of a coronary artery becoming blocked by a blood clot formed in response to a ruptured or torn fatty arterial deposit. NOTE: Symptoms of heart attack include discomfort or pain in the chest, shoulder, arm, back, neck, or jaw, shortness of breath, dizziness or light-headedness, heartburn, nausea, excessive sweating, and extreme fatigue - also called myocardial infarction.

Defined as consuming 15 drinks or more per week for men and 8 drinks or more per week for women.

Acronym for the brain injury screening tool described in this training. Each letter of the acronym stands for one of the five questions of the tool. The HELPS tool was developed by Dr. Piccard and team in 1991 and is a tool used by many agencies to date.

A hematoma is a collection (or pooling) of blood outside of blood vessels, resulting from trauma to the blood vessel. If the hematoma is severe and the buildup of blood causes pressure in the brain it can have serious consequences. Larger hematomas may be treated with decompression surgery, but some hematomas are small, cause few or minimal symptoms and don’t require surgery.

Weakness of one side of the body.

Loss of blood from a damaged blood vessel, may by inside or outside of the body and blood loss can be minor or major.

A structure in the cerebral cortex of the temporal lobe of the brain. The hippocampus forms part of the limbic system and is involved in processing emotions and has a major role in learning and memory.

This disorder is defined by the drive to collect a large amount of useless or valueless items, coupled with extreme distress at the idea of throwing anything away. Over time, this situation can render a space unhealthy or dangerous to be in. Hoarding disorder can negatively impact someone emotionally, physically, socially and financially, and often leads to distress and disability. In addition, many hoarders cannot see that their actions are potentially harmful, and so may resist diagnosis or treatment.

Programs that provide opportunities for Medicaid beneficiaries to receive services in their own home or community. These programs serve a variety of targeted population groups, such as people with intellectual or developmental disabilities, mental illnesses and/or physical disabilities.

An individual or family is experiencing homelessness if they lack a fixed, regular and adequate nighttime residence. This may include emergency shelters, transitional housing or sleeping in a place not meant for human habitation. There are three categories of homelessness – chronic, transitional, and episodic – which can be defined as follows: Chronic Homelessness - HUD defines a chronically unhoused person as “either (1) an unaccompanied unhoused individual with a disabling condition who has been continuously unhoused for a year or more, OR (2) an unaccompanied individual with a disabling condition who has had at least four episodes of homelessness in the past three years.” Such persons represent a far smaller proportion of the population compared to the transitionally unhoused. TRANSITIONAL HOMELESSNESS - Transitionally unhoused individuals generally enter the shelter system for only one stay and for a short period. Such persons are likely to be younger, are probably recent members of the precariously housed population and may have become unhoused because of some catastrophic event, and have been forced to spend a short time in a shelter before making a transition into more stable housing. Over time, transitionally unhoused individuals will account for the majority of persons experiencing homelessness given their higher rate of turnover. EPISODIC HOMELESSNESS -Those who frequently shuttle in and out of homelessness are known as episodically unhoused. They are most likely to be young, but unlike those in transitional homelessness, episodically unhoused individuals often are chronically unemployed and experience medical, mental health, and substance use disorders.

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease. HIV is a sexually transmitted infection. It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS. There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease.

Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain not due to brain atrophy. The excess fluid increases the size of the ventricles and puts pressure on the brain. Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column. But the pressure of too much cerebrospinal fluid associated with hydrocephalus can damage brain tissues and cause a large spectrum of impairments in brain function. Although hydrocephalus can occur at any age, it's more common among infants and older adults.

A sleep-inducing drug.

An emergency medical condition in which severe blood or other fluid loss prevents organs from getting the oxygen and nutrients they need to function, potentially leading to organ failure.

Insufficient oxygen reaching the tissues of the body.

Correlates with the electrical seizure activity in the brain in the middle of a seizure event. This is often called the ictal phase.

Refers to the individual'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.

The number of cases of disease having an onset during a prescribed period of time.

Not legally qualified. Lacking legal capacity (as because of age or mental deficiency) or incapable due to mental or physical condition.

A person's ability to be empowered and self-directed. An individual choice to live in one's own home with maximum personal control over how services are delivered, combined with the opportunity to work as appropriate.

Independent Living Centers (ILCs) are private, nonprofit, consumer-controlled, community-based organizations providing services and advocacy by and for persons with all types of disabilities. Their goal is twofold; to create opportunities to promote independence and to assist individuals with disabilities to achieve their maximum level of independent functioning within their families and/or communities.

The inability to adjust to everyday changes in routines, usually related to injury to the frontal lobes. Some head-injured persons may have little difficulty following a structured routine but may exhibit sudden frustration and confusion when their routine is changed.

Services with the purpose of improving individual skills related to personal finance, health, shopping and use of community resources, and other individual skills to help the individual live more independently in the community.

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

Refers to the individual's ability to begin a series of behaviors directed toward a goal.

Prolonged and usually abnormal inability to get enough sleep.

Tasks that are related to independent living and include: taking medications, preparing meals, laundry, housework, shopping, and errands.

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.

Pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. Pressure can build up within the skull following brain injury for multiple reasons including bleeding into the brain and swelling in the brain. This pressure can result in further brain damage.

Quick excitability to annoyance, impatience, or anger.

The process of forming an opinion, based on an evaluation of the situation at hand. Judgment involves cognitive skills, personal values and preferences, and insight into what our abilities and disabilities are. For example, an individual with judgment deficits may be able to make decisions, but the decisions may be unsafe or unsuccessful.

In reference to mood, the state of having notable shifts in emotional state (e.g., uncontrolled laughing or crying).

Loss of consciousness. As to level of consciousness/awareness.

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.

A type of diagnostic radiography using electromagnetic energy to create an image of soft tissue, central nervous system and musculoskeletal systems.

Significant exaggeration or false presentation of illness (physical or psychological symptoms) to gain external benefits such as an insurance settlement, disability status or avoiding work, legal consequences or other types of service.

Massachusetts Commission for the Blind

Massachusetts Commission for the Deaf and Hard of Hearing

In Massachusetts, MassHealth is comprised of the Medicaid and Children’s Health Insurance Program - the medical assistance and benefit programs administered by the MassHealth agency pursuant to Title XIX of the Social Security Act (42 U.S.C. 1396), Title XXI of the Social Security Act (42 U.S.C. 1397), M.G.L. c. 118E, an 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

A tool available to states that grants authority to modify certain requirements of publicly funded programs to allow for new approaches in service delivery.

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). The different parts of Medicare help cover specific services such as Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Plans), and Part D (Prescription coverage).

Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery.

A vertebrate hormone that is derived from serotonin, is secreted by the pineal gland especially in response to darkness, and has been linked to the regulation of circadian rhythms (sleep).

The process of perceiving information, organizing and storing it, and retrieving it at a later time as needed. Memory is a complex function that involves many parts of the brain working together. There are different types of memory, including immediate (repeating a phone number just related), recent (recalling what occurred the previous day), and remote (recalling the name of a childhood friend).

The ability to encode and retrieve our daily personal experiences. More easily impaired than semantic memory, perhaps because rehearsal or repetition tends to be minimal.

In neuropsychological testing, this refers to recall thirty minutes or longer after presentation. Requires storage and retrieval of information which exceeds the limit of short term memory.

Primary or 'working' memory; its contents are in conscious awareness. A limited capacity system that holds up to seven chunks of information over periods of 30 seconds to several minutes, depending upon the person's attention to the task. Relies upon concentration and attention.

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck. Most cases of meningitis in the U.S. are caused by a viral infection, but bacterial and fungal infections are other causes. Some cases of meningitis improve without treatment in a few weeks. Others can be life-threatening and require emergent antibiotic treatment. Seek immediate medical care if you suspect that someone has meningitis. Early treatment of bacterial meningitis can prevent serious complications. If left untreated in bacterial forms, may progress to confusion, stupor, convulsions, coma, and death.

Health conditions involving changes in emotion, thinking or behavior that can be associated with distress and/or problems with an individual’s ability to function in day-to-day life.

Refers to the biochemical and physiological activities (e.g. oxygen utilization).

A medication used in medication-assisted treatment (MAT) to help people reduce or abstain from use of heroin or other opiates. Methadone has been used for decades to treat people who are addicted to heroin and narcotic pain medicines. Methadone works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.

A strong central nervous system stimulant, primarily used as a recreational drug. See definition for Stimulants.

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. Of note, there is no universally accepted definition of mild TBI. See also Concussion.

In relation to alcohol and drug use, this term describes unhealthy use or patterns of use that put a person at risk for immediate or future harm. Misuse of prescription drugs means taking a medication in a manner or dose other than prescribed; taking someone else’s prescription, even if for a legitimate medical complaint such as pain; or taking a medication to feel euphoria (i.e., to get high). The term nonmedical use of prescription drugs also refers to these categories of misuse. (NIDA)

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.

Bill payer services provided to a person who requires assistance in managing his/her finances due to physical or cognitive difficulties.

A class of medications that are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression. Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat: Depression (usually along with an antidepressant); Schizoaffective Disorder, disorders of impulse control; certain mental illnesses in children.

Refers to the diseased state, includes complications and residual impairments.

Motivational interviewing (MI) is a technique in which you become a helper in the change process and express acceptance of your client. It is a way to interact with substance-using clients, not merely as an adjunct to other therapeutic approaches, and a style of counseling that can help resolve the ambivalence that prevents clients from realizing personal goals.

Relating to, concerned with, or involving muscular movement.

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.

These are neurological conditions that affect the speed, quality and ease of movement. Example of movement disorders include balance disorders, corticobasal degeneration, dystonia, essential tremor, Huntington’s disease, multiple system atrophy, Parkinson’s disease, and progressive supranuclear palsy. Examples of Motor disorders under DSM-5 include Developmental Coordination Disorder, Stereotypic Movement Disorder, Tourette syndrome (also called Tourette's disorder), Persistent (chronic) vocal or motor tic disorder, and Provisional tic disorder.

Involving or relating to movements of the muscles.

Impairments in the speed, quality and ease of movement caused by trauma, disease or any other condition affecting the muscular-skeletal system, spinal cord or sensory/motor nerves.

Action formulated in the mind before attempting to perform.

Massachusetts Rehabilitation Commission

The team that assesses students to determine eligibility for special education or early intervention services.

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms. There's no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.

Used in clinical practice to describe the resistance of a muscle to being stretched. When the peripheral nerve to a muscle is severed, the muscle becomes flaccid (limp). When nerve fibers in the brain or spinal cord are damaged, the balance between facilitation and inhibition of muscle tone is disturbed. The tone of some muscles may become increased and they resist being stretched--a condition called hypertonicity or spasticity.

A medication used in medication-assisted treatment (MAT) to treat both opioid and alcohol use disorders. Naltrexone is a medication approved by the Food and Drug Administration (FDA) to treat opioid use disorders and alcohol use disorders. It comes in a pill form or as an injectable. Naltrexone blocks the euphoric and sedative effects of drugs such as heroin, morphine, and codeine. It works differently in the body than buprenorphine and methadone, which activate opioid receptors in the body that suppress cravings. Naltrexone binds and blocks opioid receptors, and is reported to reduce opioid cravings. There is no abuse and diversion potential with naltrexone.

A drug (such as opium or morphine) that in moderate doses dulls the senses, relieves pain, and induces profound sleep but in excessive doses causes stupor, coma, or convulsions. Subject to restrictions.

When the consequence of a behavior resulted in avoiding or getting out of an unpleasant situation, and the effect is to encourage the behavior again in the future.

A disregard of duty resulting from carelessness, indifference, or willfulness; especially: a failure to provide a dependent under one's care with proper food, clothing, shelter, supervision, medical care, or emotional stability.

Related to the nervous system and its structure and functions.

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).

A physician who diagnoses, treats and manages disorders of the brain and nervous system.

A specialized cell transmitting nerve impulses throughout the brain and nervous system.

A comprehensive evaluation of skills and abilities linked to brain function including cognitive, behavioral and emotional functioning. Neuropsychological evaluation aims to assess and identify cognitive strengths and weaknesses, identify neurocognitive etiologies and provide recommendations for treatment goals/objectives.

A professional who specializes in the relationship between brain and behavior, particularly as these relationships can be applied to the diagnosis of brain disorder, assessment of cognitive and behavioral functioning and the design of effective treatment.

Refers to any toxic agent that affects or damages the nervous system.

Endogenous chemicals that transmit nerve impulses across a synapse to a postsynaptic element, such as another nerve, muscle, or gland. Common neurotransmitters include serotonin, dopamine and glutamate.

A class of medications that work to antagonize, or inhibit the action of, the N-Methyl-D-aspartate receptor (NMDAR). They are used as anesthetics for animals including humans. Examples include methadone, tramadol and ketamine.

Liberating, activated by, or involving norepinephrine in the transmission of nerve impulses a progressive deterioration of central noradrenergic pathways.

A catecholamine that is the chemical means of transmission across synapses in postganglionic neurons of the sympathetic nervous system and in some parts of the central nervous system, is a vasopressor hormone of the adrenal medulla, and is a precursor of epinephrine in its major biosynthetic pathway.

A class of medications that inhibit the reuptake of both norepinephrine and dopamine, therefore increasing levels of both in the brain. Examples include buproprion (Wellbutrin) and methylphenidate (Ritalin, Concerta).

Nucleus Accumbens is a nucleus forming the floor of the caudal part of the anterior prolongation of the lateral ventricle of the brain and receiving dopaminergic innervation from the ventral tegmental area as part of the mesolimbic pathway. It is considered the neural interface between motivation and action.

A state-licensed residential facility that provides a room, meals, help with activities of daily living, recreation, and general nursing care to people who are chronically ill or unable to take care of their daily living needs. It may also be called a Long-Term Care Facility. While the terms are used somewhat interchangeably, a Skilled Nursing Facility requires certification by Medicare, and provides rehabilitative therapies and more intensive nursing care. Sometimes a Long Term Care Facility will have a section or floors that provide Skilled Nursing – often on a more short term basis.

OCD is characterized by repetitive, unwanted, intrusive thoughts or urges (obsessions) and repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or rigid rules (compulsions). Symptoms typically begin during childhood, the teenage years or young adulthood, although males often develop them at a younger age than females. To be diagnosed with OCD, a person must have: Obsessions, compulsions or both. Obsessions or compulsions that are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day. A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.

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

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.).

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.

Drugs naturally derived from the active narcotic components of the opium poppy, whereas the "opioid" label includes synthetic and semi-synthetic drugs that are modified versions of these opiate building blocks. "Opioid" is usually used in reference to prescription drugs. The terms “Opiates and Opioids are often used interchangeably. Opiates cover a huge variety of drugs, ranging from legal and illegal drugs such include: Heroin, Morphine, Oxycodone (trade names include: OxyContin and Percocet), Hydrocodone (trade names include: Vicodin and Lortab), Codeine and Fentanyl.

A problematic pattern of opioid use leading to clinically significant impairment or distress and a cluster of behavioral and physical symptoms, such as withdrawal, tolerance and craving. Opioid use disorder can arise from prescription opioids or illicit opioids (e.g. heroin) and consists of signs and symptoms reflecting compulsive, prolonged self-administration of opioid substances either for a purpose other than a legitimate medical one or for use in a “non-medical” manner. See also Substance Use Disorder.

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. These drugs are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to overdose incidents and deaths. (NIDA)

Injury located in the region that sits just above the orbits (also known as the eye sockets). It is thus found at the very front of the brain, and has extensive connections with sensory areas as well as limbic system structures involved in emotion and memory. The Orbital frontal cortex is associated with decision-making and affect control.

Awareness of one's environment and/or situation, along with the ability to use this information appropriately in a functional setting.

The patient residing outside the hospital but returning on a regular basis for one or more therapeutic services.

The ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced. An overdose may result in a toxic state (non-fatal) or fatal.

Paralysis of the legs (from the waist down).

One of the two parietal lobes of the brain located behind the frontal lobe at the top of the brain. The upper middle lobe of each side of the brain, involved in receiving and understanding sensations, and closely linked to speech fluency and writing.

A progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But while a tremor may be the most well-known sign of Parkinson's disease, the disorder also commonly causes stiffness or slowing of movement.

The study of disease and injury and of the changes that they cause.

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

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.

A person trained to provide assistance with the personal care activities of daily living, such as bathing, shampooing, personal hygiene, and medication reminders, usually arranged by a home care agency.

Assistance with one or more of the Activities of Daily Living and Self-administered Medication Management, either through physical support or supervision. Supervision includes reminding or observing Residents while they perform activities.

Positron Emission Tomography (PET) Scan is an imaging test that is especially useful in showing tissue or an organ is functioning, as opposed to just showing the structure. In a PET scan, radioactive atoms are introduced into the body, where their chemical behavior is the same or as similar as non-radioactive atoms. For example, a PET scan show blood flow through the brain, areas of high metabolic activity that indicate potential tumors, as well as areas of damaged heart tissue.

A physician who specializes in physical medicine and rehabilitation. Some physiatrists are experts in neurologic rehabilitation, trained to diagnose and treat disabling conditions. The physiatrist examines the patient to assure that medical issues are addressed; provides appropriate medical information to the patient, family members and members of the treatment team. The physiatrist follows the patient closely throughout treatment and oversees the patient's rehabilitation program.

A professional who treats injury or physical dysfunction with exercises and other physical treatments to restore or facilitate recovery of physical abilities.

Treatment that uses physical agents such as exercise and massage to restore or facilitate recovery of physical abilities.

The ability of cellular or tissue structures and their resultant function to be influenced by an ongoing activity.

A temporary or permanent leveling off in the recovery process.

The simultaneous use of multiple drugs to treat a single ailment or condition.

Refers to the process of rewarding or reinforcing behavior in order to increase the likelihood of the behavior occurring again. The process involves adding something positive or desirable when the behavior occurs.

As the seizure ends, the postictal phase occurs - this is the recovery period after the seizure. Some people recover immediately while others may take minutes to hours to feel like their usual self. Common symptoms after a seizure impact: Awareness, Sensory, Emotional or Thought Changes (may include Slow to respond or not able to respond right away; Sleepy; Confused; Memory loss; Difficulty talking or writing; Feeling fuzzy, lightheaded or dizzy; Feeling depressed, sad, upset; Scared; Anxious; Frustrated, embarrassed, ashamed) and/or Physical Changes (which may include injuries, such as bruising, cuts, broken bones or head injury if fell during seizure; May feel tired, exhausted or sleep for minutes or hours; Headache or other pain; Nausea or upset stomach; Thirsty; General weakness or weak in one part or side of the body; Urge to go to the bathroom or lose control of bowel or bladder)

Describes the care provided after initial stabilization is achieved after the injury occurred on a longer-term basis.

Are programs designed to provide intensive, 24-hour rehabilitation to improve cognitive, physical, emotional, and psychosocial abilities, to facilitate better independent living skills. Facilities typically provide a full spectrum of clinical therapies, as well as life-skills training in a residential setting.

A temporary state of confusion and memory loss that may follow a brain injury. It can be considered the length of time that it takes for the return of full awareness and normal memory function following trauma.

Post-Traumatic Stress Disorder (PTSD) is a disorder that may develop in a person who has had exposure to one or more traumatic events that involve actual or threatened death, serious injury or sexual violence. Not every person who is exposed to a traumatic event develops PTSD and not everyone with PTSD has directly experienced a traumatic event. Individuals may also be exposed by witnessing in person an event as it occurred to others, learning that the event occurred to a family member or close friend or repeatedly hearing aversive details of a traumatic event in the course of an occupation (e.g., police officers repeatedly exposed to details of child abuse). Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD.

A legal instrument authorizing one to act as the attorney or agent of the grantor. There are many types of POAs.

The brain region located at the front of the frontal lobe. Impairments related to injury to this site include: personality change; executive skill deficits; diminished cognitive flexibility; compromised capacity to initiate and sustain goal-directed behavior; behavioral disinhibition; attention deficits; diminished verbal and non-verbal fluency.

Characteristics of an individual present before the disease or injury occurred.

The proportion of a population who have a disease/disorder at any point in time.

In reference to TBI, brain damage, such as contusion and axonal shearing, that occurs at the time of the traumatic event.

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

A full-service Medicare and Medicaid managed care program that serves frail individuals 55 and older who meet the clinical criteria for admission to a nursing facility, and who, at the time of enrollment in PACE, are able to remain in the community with supports. PACE sites use an interdisciplinary team of clinicians in an expanded adult day health model to provide and manage all health, medical and social service needs.

A statewide system for receiving and investigating reports of abuse, and for providing needed protective services to abused persons when warranted. Abuse includes physical, emotional and sexual abuse, neglect by a caregiver, self-neglect and financial exploitation. The goal of protective services is to remedy or alleviate the abusive situation and to prevent the reoccurrence of abuse.

An assessment of mental, emotional, or behavioral disorders.

A physician who specializing in assessing, diagnosing and treating mental, emotional, or behavioral disorders. Unlike psychologist in most states, psychiatrists can prescribe medication for treatment of these disorders.

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

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.

A professional trained in one or more branches or subfields of psychology. Professional activities may include psychological counseling, consultation in other mental health care services, educational testing and assessment, research, teaching and business consulting.

The study of the effect of drugs on the mind and behavior.

A serious mental illness characterized by a disconnection with reality, whereby a persons thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not. Hallucinations and/or delusions are common symptoms. Psychosis may occur as the result of a psychiatric illness like schizophrenia, but it can also be caused by other medical conditions, medications or drug use.

Medications used to treat mental health disorders by affecting mood, thoughts, behavior, or perception Includes five main types of psychotropic medications: antidepressants, anti-anxiety medications, stimulants, antipsychotics and mood stabilizers.

As it relates to prolonged QT Interval is when an ECG measures electrical impulses as five distinct waves. Doctors label these five waves using the letters P, Q, R, S and T. The waves labeled Q through T show electrical activity in your heart's lower chambers (ventricles).The space between the start of the Q wave and the end of the T wave (QT interval) corresponds to the time it takes for your heart to contract and then refill with blood before beginning the next contraction. By measuring the QT interval, doctors can measure whether the QT interval occurs in a normal amount of time. If it takes longer than normal to occur, it's called a prolonged QT interval. The upper limit of a normal QT interval takes into account age, sex, and regularity and speed of the heart rate. Long QT syndrome results from abnormalities in the heart's electrical recharging system. However, the heart's structure is normal. Abnormalities in your heart's electrical system might be inherited or acquired due to an underlying medical condition or a medication.

A rapid conjugate movement of the eyes associated especially with REM sleep - also called REM.

Mode of thinking in which the individual recognizes a phrase that has multiple meanings and selects the meaning most appropriate to a given situation. The term "abstract" typically refers to concepts not readily apparent from the physical attributes of an object or situation.

The ability to understand the literal meaning of a phrase. Focuses on the physical world and emphasizes objective facts.

The ability to analyze information related to a given situation and generate appropriate response options. Problem solving is a sequential process that typically proceeds as follows: identification of problem; generation of response options; evaluation of response option appropriateness; selection and testing of first option; analysis as to whether solution has been reached. A patient/client may discontinue making a cup of coffee because the sugar bowl is empty, even though sugar is readily available in a nearby cabinet. A patient/client may easily navigate his way into a room crowded with furniture, but request staff assistance to navigate his way out.

Individual within the facility responsible for developing a program to assist persons with disabilities plan and manage their leisure activities; may also schedule specific activities and coordinate the program with existing community resources.

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.

Agency of multiple, coordinated services designed to minimize for the individual the disabling effects of one's physical, mental, social, and/or vocational difficulties and to help realize individual potential.

A consequence of a response that increases the probability of that response occurring again.

a state of sleep that recurs cyclically several times during a normal period of sleep and that is characterized by increased neuronal activity of the forebrain and midbrain, by depressed muscle tone, and especially in humans by dreaming, rapid eye movements, and vascular congestion of the sex organs—called also desynchronized sleep, paradoxical sleep, rapid eye movement sleep; compare slow-wave sleep

A medicine, application, or treatment that relieves or cures a disease.

Assumes a 24-hour residential environment outside the home and includes 24-hour provision of or access to support personnel capable of meeting the client's needs. (Adopted by the Post Acute Committee of ISIG on Head Injury October 28, 1991.)

Temporary care service to relieve a family caregiver of responsibility for an individual with long-term care needs. Relief care can be provided in the home, in day programs, nursing facilities, rest homes or an Adult Foster Care program.

Inability to recall events that occurred prior to the accident; may be a specific span of time or type of information.

Schizophrenia is a severe mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling. Schizophrenia is a chronic condition, requiring lifelong treatment.

A type of depression that's related to changes in seasons. SAD begins and ends at about the same times every year.

A treatment for SAD which involves light therapy (phototherapy). Also known as light boxes. For some people, light therapy may be more effective when combined with another SAD treatment, such as an antidepressant or psychological counseling (psychotherapy). Features such as light intensity, safety, cost and style are important considerations. Speak to a medical provider for guidance.

In reference to TBI, secondary events are changes that occur in the hours to days after the primary brain injury that can contribute to further damage to the brain. Examples include: brain swelling (edema), pooling of blood (hematoma), increased intracranial pressure, hypovolemic shock, and loss of oxygen (anoxia).

A relaxed, calm, or sleepy condition that results from taking a drug (called a sedative).

State in which the patient is sedated by the medication, but again becomes aggressive as the sedation starts to lift enough to allow for disinhibited, aggressive behavior. The patient can again be sedated enough to be quieted, this may continue the cycle of sedation alternating with aggression.

A medical condition that are characterized by episodes of uncontrolled electrical activity in the brain (seizures). Some seizure disorders are hereditary, while others are caused by birth defects or environmental hazards, such as lead poisoning etc. Seizure disorders are more likely to develop in patients who have other neurological disorders, psychiatric conditions, or immune-system problems. In some cases, uncontrolled seizures can cause brain damage, lowered intelligence, and permanent mental and physical impairment. Diagnosis is by observation, neurological examination, electroencephalogram (EEG), and in some cases more advanced brain imaging techniques.

A medical condition involving a sudden, uncontrolled burst of electrical activity in the brain. This can cause of wide range of symptoms including temporary changes in behavior, movements and states of awareness.

A class of antidepressants that inhibit the inactivation of serotonin by blocking its reuptake by presynaptic nerve cell endings.

The ability to monitor and regulate one’s emotions and behaviors to accommodate social situations.

An innovative full-service Medicare and Medicaid managed care program that is being offered to eligible Mass Health members age 65 and over, at all levels of need, in both the community and institutional settings. Qualified senior care organizations have been selected to contract with Mass Health and the Centers for Medicare and Medicaid Services (CMS), and have established large provider networks that are coordinating and delivering all acute, long-term care, and mental health and substance abuse services. Senior Care Options is based on a geriatric model of care, and is available nearly statewide.

Refers to all aspects of movement and sensation and the interaction of the two.

Sensory disorders affect how the brain processes sensory information or stimuli. These disorders may affect one sense, like hearing, touch, or taste or it may affect multiple senses.

A condition whereby there is impairment in one of the senses-sight, hearing, smell, touch, taste or spatial awareness.

Impairments, disorders and consequences of disease.

The ability to organize information or objects according to specified rules, or the ability to arrange information or objects in a logical, progressive manner. Nearly every activity, including work and leisure tasks, requires sequencing. For example, in cooking certain foods it is important that ingredients be added and mixed in a specified order; in dressing, undergarments must be put on prior to outer garments.

A neurotransmitter, derived from tryptophan, which is involved in sleep, depression, memory, and other neurological processes.

A class of drugs that inhibit the inactivation of serotonin and norepinephrine by blocking their reuptake by presynaptic nerve cell endings and that are typically used to treat depression, anxiety, and chronic pain (such as that associated with osteoarthritis, fibromyalgia, or peripheral neuropathy).

A document that describes in detail the individualized services that the Assisted Living Residence will provide to the resident.

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.

A program of the Executive Office of Elder Affairs providing free, confidential and unbiased health insurance counseling through a volunteer network of health benefits counselors. Information is provided to elders about Medicare, Medicare Advantage, Medigap Insurance, Medicaid, public benefits, retiree health plans, individual insurance, prescription drug coverage, health insurance counseling, and other health insurance options. Contact a SHINE counselor 1-800-age-info (1-800-242-4636)

Statewide Head Injury Program

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.

A nursing facility (in some cases, within a nursing home; sometimes a special unit inside a hospital) that has been certified by Medicare, with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.

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.

Brief periods of recurrent cessation of breathing during sleep that is caused especially by obstruction of the airway or a disturbance in the brain's respiratory center and is associated especially with excessive daytime sleepiness.

These disorders involve problems with the quality, timing and amount of sleep a person obtains. Some of the signs and symptoms of sleep disorders include excessive daytime sleepiness, irregular breathing or increased movement during sleep, and difficulty falling asleep. Sleep disorders can also be grouped according to behaviors, problems with the natural sleep-wake cycles, breathing problems, difficulty sleeping or how sleepy and individual feels during the day. Some common types of sleep disorders include: insomnia, sleep apnea, restless legs syndrome (RLS), and narcolepsy.

Also known as sleep hygiene, sleep routines refer to the activities and environmental factors that can affect a person’s ability to get enough rest.

These studies measure how well you sleep and how your body responds to sleep problems. A sleep study may be performed for people who suffer from insomnia, excessive daytime sleepiness, obstructive sleep apnea, breathing difficulties during sleep, or behavior disturbances during sleep.

The biological pattern of alternating sleep and wakefulness, in humans roughly 8 hours of nocturnal sleep and 16 hours of day time activity.

The quality or state of being drowsy.

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

Single Photon Emission Computed Tomography (SPECT) is a type of nuclear imaging test that shows how blood flows to tissues and organs. It is a nuclear imaging scan that integrates computed tomography (CT) and a radioactive tracer. See also PET scan definition.

A professional who evaluates and treats communication and cognitive skills including speaking and understanding written and spoken language.

A continuum of services including prevention, identification, diagnosis, consultation, and treatment of patients regarding speech, language, oral and pharyngeal sensorimotor function.

Increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration (National Institute on Drug Abuse, 2014). Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD.

A stroke occurs when the blood supply to the brain is blocked or when a blood vessel in the brain bursts. A stroke is a medical emergency. Early action can minimize brain damage and potential complications.

May follow a period of acute rehabilitation; not necessarily hospital based; typical length of rehabilitation stay 6-24 months (short to intermediate term); stay based on demonstrated improvement; identifiable team and program with specialized unit.

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

Services to treat substance use disorders that may include types of outpatient therapy, short-term and long-term residential treatment, detoxification, and intensive outpatient services.

A cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems. Areas include impaired control over substance use, social impairment, risky use and indication of tolerance or withdrawal symptoms. Diagnosis is based on a pathological pattern of behaviors related to use of the substance.

The misuse of a substance that can include the use of illegal substances or the misuse of prescriptions, other drugs or over-the-counter medications in ways other than recommended or intended. It also includes intentional inhalation of household or industrial chemicals for their mind-altering effects. Tobacco use and problem drinking are sometimes included in the definition of substance misuse. Substance misuse can have serious, even life-threatening, complications, such as overdose, poisoning, trauma, and suicidal or violent behavior.

Have or cause to have difficulty in breathing.

A group of people with a common experience, such a disease, disorder, caregiving, etc., where one can share one's thoughts, feelings and concerns and receive information and support from other members of the group. Groups may or may not be facilitated by an expert.

Setting is a home chosen by the consumer who is primarily independent. Program offers support to assist the resident in maximizing and/or maintaining independence and self-direction. Staff is available as needed and at planned intervals to offer assistance and support but not to provide supervision.

To reduce gradually.

A neurological disorder characterized by involuntary uncontrollable movements especially of the mouth, tongue, trunk, and limbs and occurring especially as a side effect of prolonged use of antipsychotic drugs.

A pair of areas on the right and left side of the brain that play a role in managing emotions, processing sensory information, memory storage and retrieval and language comprehension.

Reduced response to a drug with repeated use.

TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by external force. External mechanisms include, but are not limited to, falls, motor vehicle accidents, firearms, blast injuries and strikes by an object or person. A TBI is one type of an acquired brain injury.

Older or first-generation antipsychotic medications are also called conventional or “typical” antipsychotics. See definition for Antipsychotic Medications.

An area of the midbrain lying adjacent to the substantia nigra that contains the cell bodies of dopaminergic neurons projecting especially to the nucleus accumbens, amygdala, and olfactory tubercle as part of the mesolimbic system.

Conditions impacting the eye due to disease, trauma, congenital or degenerative etiologies which decrease ability to see partially or fully. Also see Visual Impairments.

Impairments in vision that occur when an eye condition affects the visual system and its vision functions. Sensitivity to light. And visual field deficits/visual neglect.

A tool used to gather the medical, psychological, social, vocational, educational, cultural, and economic data of an individual for the establishment and attainment of individual goals in vocational rehabilitation. The evaluation incorporates information obtained in available documents such as psychological testing, counseling, social summaries and occupational information provided to the VR counselor.

An organized and comprehensive service staffed by specialists who systematically and comprehensively utilize work activities (real or simulated) and/or educational services as the focal point for educational and vocational assessment and exploration.

Vocational Rehabilitation Counselors (VR Counselors) are specialists in social and vocational issues who help the individuals develop the skills and aptitudes necessary for return to productive activity and the community.

As it relates to Home and Community Based Services - 1915(c) Waivers, these waivers under the Center for Medicare and Medicaid Services (CMS) can waive certain requirements that otherwise apply to the Medicaid program, giving the state flexibility to define, such as: the target group of Medicaid beneficiaries to be served, subject to certain requirements; the maximum number of participants who may be served in a given HCBS waiver program; and the services available to the waiver target group (in addition to what is already available through the Medicaid State Plan).