CBIS Treatment Approaches and Interventions 3 — Questions and Answers
Question 1: A CBIS is developing a behavior intervention plan for a TBI survivor who becomes verbally aggressive when asked to transition between activities. The FIRST step should be:
- Implement a token economy system
- Prescribe antipsychotic medication
- Conduct a functional behavioral assessment (Correct answer)
- Apply a physical restraint protocol
Correct answer: Conduct a functional behavioral assessment
A functional behavioral assessment must precede intervention to understand why the behavior occurs and identify the most effective, individualized strategies.
Question 2: Which of the following best describes the goal of post-acute rehabilitation in TBI?
- Maximize medical stability and prevent secondary complications
- Restore pre-injury neurological function completely
- Optimize community reintegration and quality of life (Correct answer)
- Focus exclusively on physical motor recovery
Correct answer: Optimize community reintegration and quality of life
Post-acute TBI rehabilitation emphasizes functional independence, community participation, and quality of life rather than complete neurological restoration.
Question 3: Amantadine hydrochloride is used in TBI rehabilitation primarily to:
- Reduce post-traumatic seizure risk
- Accelerate functional recovery and reduce agitation (Correct answer)
- Improve sleep architecture
- Manage post-traumatic headache
Correct answer: Accelerate functional recovery and reduce agitation
Amantadine enhances dopaminergic and glutamatergic neurotransmission and has been shown in randomized trials to accelerate functional recovery in disorders of consciousness.
Question 4: Which type of group therapy is specifically designed to help TBI survivors recognize and compensate for their own cognitive deficits?
- Social skills group
- Metacognitive strategy training group (Correct answer)
- Reminiscence therapy group
- Psychoeducation group
Correct answer: Metacognitive strategy training group
Metacognitive strategy training groups teach self-awareness and self-regulation skills to compensate for executive function deficits after TBI.
Question 5: When treating post-traumatic depression in a TBI patient, SSRIs are preferred over tricyclic antidepressants primarily because TCAs:
- Are less effective for depressive symptoms
- Have anticholinergic effects that worsen cognition and lower seizure threshold (Correct answer)
- Cannot cross the blood-brain barrier after TBI
- Cause irreversible dopamine depletion
Correct answer: Have anticholinergic effects that worsen cognition and lower seizure threshold
TCAs have significant anticholinergic side effects that impair cognition and increase seizure risk, making SSRIs the safer first-line choice in TBI.
Question 6: A TBI survivor with intact motor function but poor task planning would most benefit from which occupational therapy approach?
- Neurodevelopmental treatment (NDT)
- Dynamic Interactional Model (DIM) (Correct answer)
- Proprioceptive neuromuscular facilitation (PNF)
- Kinesio taping
Correct answer: Dynamic Interactional Model (DIM)
The Dynamic Interactional Model addresses cognitive processing strategies during functional tasks, making it ideal for planning and organizational deficits.
Question 7: In TBI rehabilitation, the term 'deceleration of recovery' most commonly refers to:
- A plateau in functional gains despite continued rehabilitation (Correct answer)
- Worsening neurological status requiring re-hospitalization
- Reduction in therapy frequency by payer decision
- Transition from acute to subacute care
Correct answer: A plateau in functional gains despite continued rehabilitation
A recovery plateau—where measurable functional progress slows or stops—signals the need to reassess goals, modify interventions, or shift to maintenance strategies.
CBIS Treatment Approaches and Interventions 3
A CBIS is developing a behavior intervention plan for a TBI survivor who becomes verbally aggressive when asked to transition between activities.
The FIRST step should be: