Adaptive - Developing an individual's strengths and conditioning the ability to overcome a disabling condition.

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

Adiadochokinesia - Inability to stop one movement and follow it immediately with movement in the opposite direction.

Advocacy Organization - A group or nonprofit entity which provides resource information, support services and/or educational opportunities for individuals or families in need, and makes those needs known to rofessional care-givers as well as to the general public.

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

Affective Disorders - Mental illnesses characterized mainly by abnormalities in mood. The two principal categories are mania and depression.

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

Agraphia - Inability to express thoughts in writing.

Akinetic Mutism - A condition of silent, alert-appearing, immobility that characterizes certain subacute or chronic states of altered consciousness. Sleep-wake cycles have been retained, but no observable evidence for mental activity is evident; spontaneous motor activity is lacking; person appears to be aware but inactive.  Exhibited by persons with high brain stem lesions.

Alert - State of being watchful or ready.

Alexia - Inability to read.

Alter - To make different without changing into something else.

Ambulate - To walk.

Amnesia - Lack of memory about events occurring during a particular period of time. See also: anterograde amnesia, retrograde amnesia, post-traumatic amnesia.

Anaesthesia - Loss of sensation

Analgesia - Loss of pain

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

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

Anosmia - Loss of the sense of smell.

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

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

Anticoagulation - Process of slowing down normal blood clottings and thus preventing blood clots from forming. Sometimes referred to as "thinning the blood". Common medications utilized to accomplish this are Coumadin and Heparin.

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

Antidepressants - Medication used to treat depression.

Apallic Syndrome - (This is an older, non-specific term.) The behavior that accompanies diffuse bilateral degeneration of the cerebral cortex that sometimes follows anoxic brain injury. It describes patients with absent cortical function but with relatively intact brain stem function. See Persistent Vegetative State.

Apathy - A lack of interest or concern.

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

Aphasia (Expressive) - Inability to find or formulate the words to express oneself even though knowing what one wants to say.

Aphasia (Fluent) - Characterized by spontaneous use of language at normal speed that conveys little meaning.

Aphasia (Global) - Severely limited residual ability to communicate with others. Includes both expressive and receptive aphasia.

Aphasia (Non-fluent) - Characterized by awkward articulation, limited vocabulary, hesitant, slow speech output, restricted use of grammatical forms and a relative preservation of auditory comprehension.

Aphasia (Receptive) - Problems in understanding what others attempt to communicate.

Aphasia (Subclinical) - Refers to evidence of impaired linguistic processing on testing, which is not obvious in casual interactions with the person.

Aphemia - The isolated loss of the ability to articulate words without loss of the ability to write or comprehend spoken language.

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

Apraxia (Constructional) - Inability to assemble, build, draw, or copy accurately; not due to apraxia of single movements.

Apraxia (Ideomotor) - Deficit in the execution of a movement due to inability to access the instructions to muscles stored by previous motor experience.

Arousal - Being awake. Primitive state of alertness managed by the reticular activating system (extending from the medullato the thalamus in the core of the brain stem) activating the cortex. Cognition is not possible without some degree of arousal.

Art Therapy - Use of art techniques such as painting, crafts and group activities to develop motor skills, perceptual abilities and self-esteem.

Arteriovenous Malformation (AVM) - A "tangle" of blood vessels present from birth which may be prone to bleeding.

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

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

Associated Reaction - A non-purposeful movement that accompanies another movement (e.g., patient's arm may bend involuntarily when the patient yawns).

Astereognosia - Inability to recognize things by touch.

Ataxia - A problem of muscle coordination not due to apraxia, weakness, rigidity, spasticity or sensory loss. Caused by lesion of the cerebellum or basal ganglia. Can interfere with a person's ability to walk, talk, eat, and to perform other self care tasks.

Attendant Care - Provision of assistance in activities of daily living for a person with a disability.  Daily number of hours of required assistance, either physical or supervisory.

Atrophy - 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.

Attention - the cognitive process of selectively concentrating on one aspect of the environment while ignoring other things

Attention (Alternating) - The ability to move attention appropriately from one area to another. It requires directional control, as well as capacity.

Attention (Concentration) - The ability to focus on a given task or set of stimuli for an appropriate period of time.

Attention (Concentration/Arousal) - The ability to respond consistently to sensory stimulation by eye opening, localizing, and tracking with head or eye movement. To assess a patient's level of arousal one might determine if the patient brushes away pinching fingers; or, if the eyes or head turns to a variety of sensory stimulis.

Attention (Concentration/ Distractibility) - Refers to the patient's inability to sustain attention because of competing internal or external stimuli. The person with a brain injury may have decreased  ability to inhibit competing responses. For example, a restrained patient may focus more on his arm restraint than on a task presented by a therapist; a patient asked to complete arithmetic problems may focus more on construction work taking place outside.

Attention (Concentration Length) - Refers to the length of time a patient is able to focus on a given task. Complexity of task and patient fatigability will effect length of attention (attention span).

Attention (Divided) - Refers to an attentional task where the performer must attend to two or more inputs or activities at the same time, e.g., driving an automobile involves watching the road, mirrors, road signs, listening to a passenger or to the radio.

Attention (Selective) - Refers to selection of a particular action/task or train of thought, rather than others, as the focus of attention.

Attention (Sustained) - Refers to a person's ability to work on a particular task or train of thought over an extended period of time.

Attention Span - The length of time one is able to concentrate on a task at hand.

Attention to Task - Ability to focus on a given activity.

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

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

Automatic Speech - Words said without much thinking on the part of the speaker. These may include songs, numbers, and social communication; or, can be items previously learned through memorization.  Spontaneous swearing by individuals who did not do so before their injury is another example.

Awareness - Consciousness of stimulation, arising from within or from outside the person.

Awareness Deficit - The patient's inability to recognize the problems caused by impaired brain function.

Awareness Level - Rating by a qualified observer of the degree to which a patient is perceiving internal and external stimuli.

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

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

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

Behavior Disorder - Abnormal pattern of behavior.

Bilateral - Pertaining to both right and left sides.

Biofeedback - A process in which information not ordinarily perceived (such as heart rate, skin temperature or electrical activity of muscles) is recorded from a person and then relayed back instantaneously as a signal so that the individual becomes aware of any alteration in the recorded activity.

Blind - The condition in which a person has lost vision for ordinary life purposes; generally anyone with less than 10% of normal vision would be regarded as legally blind.

Brain Death - A state in which all functions of the brain (cortical, subcortical, and brain stem) are permanently lost.

Brain Injury - Damage to the brain that results in impairments in one or more functions, including: arousal, attention, language, memory, reasoning, abstract thinking, judgment, problem-solving, sensory abilities, perceptual abilities, motor abilities, psychosocial behavior, information processing and speech. The damage may be caused by external physical force, insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congenital disorders, birth trauma or degenerative processes.

Brain Injury (Acquired) - The implication of this term is that the individual experienced normal growth and development from conception to birth, until sustaining an insult to the brain at some later time which resulted in impairment of brain function.

Brain Injury (Closed) - 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.

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

Brain Injury (Mild) - A patient with mild traumatic brain injury is a person who has had a traumatically-induced physiological disruption of brain function, as manifested by at least one of the following:

1) any period of loss of consciousness,

2) any loss of memory for events immediately before or after the accident,

3) any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused),

4) focal neurological deficit(s) which may or may not be transient; but where the severity of the injury does not exceed the following:

a) loss of consciousness of approximately 30 minutes or less;

b) after 30 minutes, an initial Glasgow Coma Scale of 13-15;

c) Post Traumatic Amnesia not greater than 24 hours.

Brain Injury (Moderate) - A Glasgow Coma Scale score of 9 to 12 during the first 24 hours post injury.

Brain Injury (Penetrating) - Occurs when an object (for example a bullet or an ice pick) fractures the skull, enters the brain and rips the soft brain tissue in its path. Penetrating injuries tend to damage relatively localized ares of the brain resulting in discrete and somewhat predictable disabilities.

Brain Injury (Severe) - Severe injury is one that produces at least 6 hours of coma; Glasgow Coma Scale of 8 or less within the first 24 hours.

Brain Injury (Traumatic - TBI) - Damage to living brain tissue caused by an external mechanical force, usually characterized by a period of altered consciousness (amnesia or coma) that can be very brief  (minutes) or very long (months/indefinitely). The specific disabling condition(s) may be orthopedic, visual, aural, neurologic, perceptive/cognitive, or mental/emotional in nature. The term does not include brain injuries that are caused by insufficient blood supply, toxic substances, malignancy, disease-producing organisms, congenital disorders, birth trauma or degenerative processes.

Brain Plasticity - The ability of intact brain cells to take over functions of damaged cells; plasticity diminishes with maturation.

Brain Scan - An imaging technique in which a radioactive dye (radionucleide) is injected into the bloodstream and then pictures of the brain are taken to detect tumors, hemorrhages, blood clots, abscesses or abnormal anatomy.

Brain Stem - 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).

Capacity Mental - Refers to the amount of information or mental processing a person can attend to within a given time.

Capnometer - A device to monitor the patient's carbon dioxide (CO2) levels to assist in providing the appropriate ventilation.

Carbon Dioxide (CO2) - A colorless gas, heavier than air. In small quantities in inhaled air, it stimulates respiration. Careful monitoring of the carbon dioxide levels in the blood is necessary for the brain injured patient. Increases carbon dioxide levels have been shown to increase swelling in the brain and the TBI patient must be "hyperventilated" (maintained with purposely decreased levels of CO2) to prevent brain swelling.

Case Management - Facilitating the access of a patient to appropriate medical, rehabilitation and support programs, and coordination of the delivery of services. The role of the case manager 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.

Catheter - A flexible tube for withdrawing fluids from, or introducing fluids into, a cavity of the body.  Frequently used to drain the urinary bladder (Foley catheter).

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

Cerebral - of or relating to the brain or the intellect; of, relating to, affecting, or being the cerebrum.

Cerebral Angiography - The brain substance is pushed aside and compressed by the presence of a brain tumor, aneurysm, swelling or hematoma.

Cerebral Compression - The brain substance is pushed aside and compressed by the presence of a brain tumor, aneurysm, swelling or hematoma.

Cerebral Infarct - When the blood supply is reduced below a critical level to a specific region of the brain and the brain tissue in that region dies.

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

Chemically Dependent - Addiction to chemical agents such as prescription medicines, drugs or alcohol.

Chemotherapy - The treatment of a condition such as cancer by the systematic administration of chemical compounds.

Chest Tubes - Tubes inserted into the patient's chest between the lung and ribs to allow fluid and air to drain from the area surrounding the lungs. Removing this fluid and air from around the lungs allows them to more fully expand.

Chronic - Marked by long duration or frequent recurrence.

Chronic Care - Long-term care for those individual who require medical care, a maintenance program to prevent deterioration of skills, and to provide recreational and social opportunities in a structured environment. Emphasis is on sustaining a reasonable quality of life, and expectations regarding improvements in abilities are limited.

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

Client - A person under the protection of another, one who engages the professional advice or services.

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

Closed Head Injury - See Brain Injury (Closed).

Congenital Disability - A disability that has existed since birth but is not necessarily hereditary. The term birth defect is not desirable.

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

Cognitive - The scientific term for "the process of thought".

Cognitive Impairment - Difficulty with one or more of the basic functions of the brain: perception, memory, attentional abilities, and reasoning skills.

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

Coma - 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 eight or less.

Coma Vigil - A patient who has no meaningful interaction with his or her environment but exhibits sleep and wake cycles, spontaneous respiration and heart beat. See Persistent Vegetative State.

Commensurate Wage - A wage paid to a disabled worker which is comparable to wages paid to a non-disabled worker in the vicinity, performing similar work at a specific quality level, with the quality factor being the main variable.

Communicative Disorder - 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.

Community - A group of interacting people; intent, belief, resources, preferences, needs, risks, and a number of other conditions may be present and common, affecting the identity of the participants and their degree of cohesiveness.

Community Alternatives - Agencies, outside an institutional setting, which provide care, support, and/or services to persons with disabilities.

Community-based Programs - Programs for disabled which are located in a community environment, as opposed to an institutional setting.

Community Resources - Public or private agencies, schools, or programs offering services, usually funded by governmental bodies, community drives, donations, and fees.

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

Comprehension - Understanding of spoken, written, or gestural communication.

Concentration - Maintaining attention on a task over a period of time; remaining attentive and not easily diverted.

Concrete Thinking - A style of thinking in which the individual sees each situation as unique and is unable to generalize from the similarities between situations. Language and perceptions are interpreted literally so that a proverb such as "a stitch in time saves nine" cannot be readily grasped.

Concussion - The common result of a blow to the head or sudden deceleration usually causing an altered mental state, either temporary or prolonged. Physiologic and/or anatomic disruption of connections between some nerve cells in the brain may occur. Often used by the public to refer to a brief loss of consciousness.

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

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

Conjugate Movement - Both eyes move simultaneously in the same direction. Convergence of the eyes toward the midline (crossed eyes) is a disconjugate movement.

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

Continent - The ability to control urination and bowel movements.

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

Control of Attention - Control refers to a person's ability to guide the selective process by directing and organizing whatever attentional capacity he or she has.

Contusion (Brain) - A bruise. The result of a blow to the head which bruises the brain.

Convergence - Movement of two eyeballs inward to focus on an object moved closer. The nearer the object, the greater is the degree of convergence necessary to maintain single vision.

Coping Skills - The ability to deal with problems and difficulties by attempting to overcome them or accept them.

Core Therapies Brain Injury - Basic therapy services provided by professionals on a brain injury rehabilitation unit. Usually refers to nursing, physical therapy, occupational therapy, speech-language pathology, neuropsychology, social work and therapeutic recreation.

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

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

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

CT Scan (Computerized Axial Tomography) - A series of 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.

Cue - A signal, prompt, or direction used to assist a person in performing an activity

Dance Therapy (Movement) - The use of movement to music as a process which enhances, facilitates and  integrates physical, cognitive and psychosocial function.

Day Care - A service provided during ordinary working hours for the person who requires supervision, including assistance with medication, meal preparation, dressing or moving about. However, the family returns the person to their residence and assumes responsibility for care during the evenings and at night.

Deaf - A profound degree of hearing loss that prevents understanding of speech received through the ear. Hearing impaired (deafness) is the generic term preferred by some individuals to refer to any degree of hearing loss from mild to profound. It includes both hard of hearing and deaf. Hard of hearing refers to a mild to moderate hearing loss that may or may not be corrected with amplification.

Decerebrate - The elimination of cerebral brain function in an animal by removing the cerebrum, cutting across the brain stem, or severing certain arteries in the brain stem.

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

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

Deep Vein Thrombosis (DVT) - A blood clot in a vein, located deep from the skin, most commonly seen in the calf or thigh. Veins lying just beneath the skin are called superficial veins.

Deficit Functional - A deficiency in amount or quality of functioning.

Deinstitutionalization - a concept which has three interrelated processes:

1) avoiding placement in a public institution by developing, finding and using alternative community methods of care and training;

2) return to the community of those residents who can function appropriately and who can benefit from community-based rehabilitation and training programs; and

3) establishment and maintenance of a responsible institutional environment which protects the human and civil rights of persons with disability and which contributes to the appropriate and prompt return of the individual to the community.

Developmental Disability - Any mental and/or physical disability that has an onset before age 22 and may continue indefinitely. It can limit major life activities. Term includes individuals with mental retardation, cerebral palsy, autism, epilepsy (and other seizure disorders), sensory impairments, congenital disabilities, traumatic accidents, or conditions caused by disease (e.g., tuberculosis, polio, muscular dystrophy).

Diaschisis - A theoretical state following brain injury in which healthy areas connected to the damaged area show a temporary loss of function.

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

Diplegia - Paralysis of corresponding parts on both sides of the body, such as both arms.

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

Disability - Inability or limitation in performing tasks, activities and roles in the manner or within the range considered normal education. It may refer to a physical, mental, or sensory condition.

Discipline - When referring to health care or education it means a particular field of study, such as medicine, occupational therapy, nursing, recreation therapy or others.

Discrimination - The ability to make distintions between things.

Discrimination (Sensory) - A process requiring differentiation of two or more stimuli.

Discrimination (Auditory) - The ability to differentiate and recognize sounds. This involves distinguishing between words, noises, and sounds that might be similar. A person with poor auditory discrimination might answer the phone in his room although the actual ringing came from an alarm clock.

Discrimination (Tactile) - The ability to identify and distinguish between objects and stimuli solely through touch. This involves the ability to ascertain shape, size, and texture. For example, persons with impaired tactile discrimination might not be able to distinguish between a pencil and a letter opener.

Discrimination (Visual) - Involves the differentiation of items using sight. An individual with impaired visual discrimination may not be able to distinguish between a red and green light while driving or may have difficulty distinguishing between the letter "S" and the number "5".

Disinhibition - Inability to suppress/inhibit impulsive behavior and emotions.

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

Disposition - Plans for where the person will live after discharge from the hospital and who will be able to help that individual.

Distal - Far from the point of reference.

Doll's-Eye Maneuver - The eyes appear to move in the direction opposite to the motion of the head, when the head is gently rotated.

Dorsiflexion - The movement which decreases the angle between the foot and the leg, so that the toes are brought closer to the shin - usually a range of 20-30 degrees.

Dysarthria - 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.

Dysmetria - Inability to stop a movement at the desired point; also known as past-pointing.

Dysphagia - 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.

Echolalia - Imitation of sounds or words without comprehension. This is a normal stage of language  development in infants, but is abnormal in adults.

Edema - Collection of fluid in the tissue causing swelling.

Electrocardiogram (ECG/EKG) - The recording made by electrode pads located on the patient's chest to monitor heart rate and rhythm. These are connected to a monitor and used routinely in the intensive care unit.

Electroencephalogram (EEG) - A procedure that uses electrodes on the scalp to record electrical activity of the brain. Used for detection of epilepsy, coma and brain death.

Electromyography (EMG) - An insertion of needle electrodes into muscles to study the electrical activity of muscle and nerve fibers. It may be somewhat painful to the patient. Helps diagnose damage to nerves or muscles.

Embolism - The sudden blocking of an artery or a vein by a blood clot, bubble of air, deposit of oil or fat, or small mass of cells deposited by the blood flow.

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

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

Endotracheal Tube - A tube that serves as an artificial airway and is inserted through the patient's mouth or nose. It passes through the throat and into the air passages to help breathing. To do this it must also pass through the patient's vocal cords. The patient will be unable to speak as long as the endotracheal tube is in place. It is this tube that connects the respirator to the patient.

Engram - A lasting mark or trace. The term is applied to the bioelectrical trace associated with storage of a memory in the nervous system.

Epidural - short for epidural anesthesia, a form of regional anesthesia involving injection of drugs through a catheter placed into the epidural space (space bewteen the vertebrae in the spinal cord). The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord.

Equilibrium - Normal balance reactions and postures.

Error Correction - Should follow error recognition and refers to the ability to replace an inappropriate response with an appropriate one.

Error Recognition - Refers to a person's awareness that a response is inappropriate for a task. Return of this ability may be reflected by a patient stating, for example, "This isn't right", or show a confused, quizzical look after making an inappropriate response.

Evaluation Program - Process of assessment according to a defined set of criteria.

Evaluation in A Workshop Setting - An evaluation which has the following characteristics: 1) client may or may not be paid; 2) client is exposed to tasks on which performance can be assessed; 3) client's performance is supervised and evaluated in coordination with the evaluation staff; and 4) existence of established evaluation program.

Evaluation in A Vocational Training Setting - An evaluation which has the following characteristics: 1) the client is not paid; 2) the existence of an established vocational training program; 3) primarily for the benefit of the client; 4) clients's performance supervised and evaluated by the instructional staff in coordination with evaluation staff; and 5) does not necessarily result in entry by the client  into that training program.

Evaluation On-the-Job - Contains at least these characteristics: 1) the client is not necessarily paid; 2) it is primarily for the client's benefit; 3) it will not necessarily result in employment; 4) the employer does not experience any immediate gain; 5) the client does not displace or fill any vacant worker slots; and 6) the client's performance is supervised and evaluated by the employer and/or the evaluation staff. The client is given the opportunity to experience, in various degrees of participation, the specific requirements necessary to do the specific job in an actual job setting.

Evaluation Program - Comprehensive assessment of the problems and capabilities of an individual  complete with recommendations for dealing with the problems.

Evoked Potential - Registration of the electrical responses of active brain cells as detected by electrodes placed on the surface of the head at various places. The evoked potential, unlike the waves on an EEG, is elicited by a specific stimulus applied to the visual, auditory or other sensory receptors of the body. Evoked potentials are used to diagnose a wide variety of central nervous system disorders.

Evoked Responses (Brain Stem) - Auditory brain stem responses provoked by discreet sounds delivered to  the ears through headphones. These sound waves are converted to nerve impulses by receptors in the ear. A machine is used to test whether the brain stem has received the signals. The quality of the brain stem's response in a comatose patient is thought to be an important indicator of the degree and site of brain injury. Because this test requires very specialized and expensive equipment, it is not available in all hospitals. A more common test is the EEG.

Excitotoxicity - the pathological process by which nerve cells are damaged and killed by glutamate and similar substances.  Excitotoxicity may be involved in spinal cord injury, stroke, traumatic brain injury and neurodegenerative diseases of the central nervous system (CNS)

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

Extended Care Facility

Basic - Residential facility which supplies 24-hour nursing care and supervision and assistance with activities of daily life.

Skilled - A residential facility for the patient who requires 24-hour nursing care (IV, intramuscular injections, special feeding tubes, oxygen) and rehabilitation therapy, such as physical therapy, occupational therapy, or speech therapy on a less intensive basis than as an inpatient in a comprehensive rehabilitation center. An extended care facility can be a short-term alternative (a few months) prior to placement at home (with outpatient therapy) or in a nursing home.

Extremity - Arm or leg.

Eye Tape - Tape used to close the eyes of a patient who has lost the ability to blink. To protect the eyes and to prevent them from drying out, eye drops may be put into the eyes and the eye tapes may be used to close them.

Figure-Ground - The differentiation between the foreground and the background of a scene; this refers to all sensory systems, including vision, hearing, touch.

Fixation, Visual - A pause of the line of sight on something of interest in the visual world.

Flaccid - Lacking normal muscle tone; limp.

Flexion - Bending a joint.

Fluently - Effortlessly smooth and rapid speech.

Focal - Restricted to one region (as opposed to diffuse).

Focus (Eye) - Can imply: 1) convergence of the two eyes, 2) accommodation of the lenses of the two eyes, 3) tracking something by moving the eyes, 4) attending to something.

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

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

Frustration Tolerance - 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.

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

Functional Independence - The capacity of a person to take care of one's own activities of daily life without the help of another person.

Functional Limitation - Restriction or lack of ability to perform an action in the manner or within a range consistent with the purpose of an organ or organ system.

Functional Outcome - The end result of a therapeutic intervention; practical activities in which a  person is capable of engaging on a regular basis.

Optimal - The best functional level an individual can realize in consideration of physical, mental and social limitations.

Gainful Occupation - Includes employment in the competitive labor market, practice of a profession, farm or family work (including work for which payment is "in kind" rather than in cash), sheltered employment, work activity (to the extent that there is net pay), and home industries or other home-bound work.

Gait Training - Instruction in walking, with or without equipment; also called "ambulation training."

GI Tube - A tube inserted through a surgical opening into the stomach. It is used to introduce liquids, foods, or medication into the stomach when the patient is unable to take these substances by mouth.  Also referred to as a PEG Tube.

Glasgow Coma Scale - A standard system used to assess the degree of brain impairment and to identify the seriousness of injury in relation to outcome. The system involves three determinants: eye opening, verbal responses and motor response all of which are evaluated independently according to a numerical value that indicates the level of consciousness and degree of dysfunction. Scores run from a high of 15 to a low of 3. Persons are considered to have experienced a "mild" brain injury when their score is 13 to 15. A score of 9 to 12 is considered a reflect a "moderate" brain injury and a score of eight or less reflects a "severe" brain injury.

Glasgow Outcome Scale - A system for classifying the outcome of persons who survive. The categories range from "Good Recovery" in which the patient appears to regain the pre-injury level of social and career activity (even if there are some minor residual abnormal neurological signs); "Moderate Disability" in which the patient does not regain the former level of activity but is completely independent with respect to the activities of daily life; "Severe Disability" is defined as a state wherein the conscious, communicating patient is still dependent on the help of others. The original scale had five outcome categories, the newest scale has eight outcome categories. This scale relates to functional independence and not residual deficits.

Habilitation - Process of providing specific learning experiences for those persons with disabilities who have been isolated from such experiences so they can become aware of and develop their abilities and potentials.

Halo - A metal ring used for patients with spinal cord injuries of the neck which encircles the patient's head to allow for proper alignment of the neck and spinal cords.

Handicap - Describes a condition or barrier imposed by society, the environment, or by one's own self that limits or prevents the fulfillment of a role that is normal, depending on age, sex, and social and cultural factors, for the individual. Handicap can be used when citing laws and situations but should not be used to describe a disability. Not a synonym for disability.

Hard of Hearing - Mild to moderate hearing loss that may or may not be corrected with amplification.

Head Injury - Refers to an injury of the head and/or brain, including lacerations and contusions of the head, scalp and/or forehead. See Brain Injury.

Hearing Impaired - Generic term preferred by some individuals to refer to any degree of hearing loss from mild to profound. It includes both hard of hearing and deaf.

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

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

Subdural - Between the brain and its fibrous covering (dura).

Intracerebral - In the brain tissue.

Subarachnoid - Around the surfaces of the brain, between the dura and arachnoid membranes.

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

Hemiplegia - Paralysis of one side of the body as a result of injury to neurons carrying signals to muscles from the motor areas of the brain.

Hemiparesis - Weakness of one side of the body.

Hemorrhage - Bleeding that occurs following damage to blood vessels. Bleeding may occur within the brain when blood vessels in the brain are damaged. See Hematoma.

Hemorrhage (Intracerebral) - bleeding in the brain caused by the rupture of a blood vessel within the brain

Hemorrhages (Intracranial ) - a serious medical emergency because the buildup of blood within the skull can lead to increases in intracranial pressure, which can crush delicate brain tissue or limit its blood supply.

High Level Cognitive Processes - Refers to judgement, comprehension of problems, deductive and inductive reasoning, problem-solving and planning.

Human Services - Services provided for people to enable them to deal with their person environment in such a way that they can gain control over their own destinies and exercise freedom of choice in their lives.

Human Services Delivery System - The organizational structure by which necessary services are provided to those people who need them and includes health care, education, income maintenance, and manpower services.

Hydrocephalus - Enlargement of fluid-filled cavities in the brain, not due to brain atrophy.

Hypoxemia - An abnormally low level of oxygen in the blood. When a patient's arterial blood sample is measured and a low level of oxygen is noted it is more appropriate to refer to hypoxemia rather than hypoxia. Determination of hypoxia involves a much more sophisticated evaluation of the patient.

Hypoxia - Insufficient oxygen reaching the tissues of the body.

ICP - See Intracranial Pressure.

ICU - See Intensive Care Unit.

Impairment - Loss and/or abnormality of cognitive, emotional, physiological, or anatomical structure or function; including all losses or abnormalities, not just those attributable to the initial pathophysiology.

Imperception - Refers to a failure to perceive (notice) stimulation on one side of the body when both sides are being stimulated simultaneously (double simultaneous stimulation). It is not due to a primary sensory deficit such as deafness or blindness but appears to be an attentional deficit. It is less severe than "neglect"(see Unilateral Neglect) and may occur in a patient recovering from neglect.

Impulse Control - 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.

Income Maintenance Service - Services related to the economic support of persons; welfare and social security are two such services.

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

Incoordination - A problem with coordination of movement of parts of the body, resulting from dysfunction of the nervous system rather than weakness of the muscles.

Independent - The ability to perform a task without assistance or supervision.

Individual Vocational Case Record - All information obtained about the client prior to, during, and in follow-up. Includes referral information, social and work history, medical information, referral questions, program goals and plans, services to be provided, signed reports and notations related to performance and progress during the evaluation, notes from case conferences, the termination decision, and final report of findings and recommendations.

Industrial Standards - Actual worker requirements from industry based on the expectations of the employer in terms of quality, quantity, and work behaviors.

Inflexible - Inability to adjust to changes.

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

Insight Regarding Impairment - The extent to which an individual accurately judges one's own strengths and limitations; also called metacognition. A patient's ability in this area may be judged on the basis of actions or statements regarding intended actions. Patients with brain injuries often overestimate their strengths and underestimate their limitations. For example, a patient with right hemisphere damage may attempt to drive a car while out on pass and get involved in a serious accident. A patient with two broken legs in casts may state he can't walk because he's "too tired."

Intake - Those activities which result in an individual's entry into the agency and the action taken to finalize arrangements (i.e. funding, housing, programming) necessary for such entry.

Intellect - Pertains to many of the higher functions of the brain.

Intelligence Quotient (IQ) - It is a measure of general intelligence obtained by testing. It consists of either a ratio of mental age to chronological age or a score of deviation from an expected test performance by age.

Intensive Care Unit (ICU) - Hospital unit that utilizes highly sophisticated equipment and specially trained physicians and nurses to care for patients who are in such serious condition that they must be continuously monitored.

Intensive Rehabilitation - An active, multi-disciplinary rehabilitation program provided for several hours daily, using a team approach. Focus is usually on skill development, rather than on treatment of specific deficits.

Intercerebral - Between the cerebral hemispheres.

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

Intermittent Catheterization Program (ICP) - Bladder training program where a catheter is inserted to empty the bladder at regular time intervals.

International Classification of Disease (ICD-9) - A three digit "N" code used to indicate the pathological nature of an injury. The ninth revision of this classification (ICD-9) has been in use for several years. Unfortunately, the term "brain injury" does not appear as a category. There are ten  rubrics which cover most brain/head injuries. The ICD is less useful than desired because rubrics are not mutually-exclusive. Differences occur in coding from one institution to another. A new version, ICD-10, is under preparation.

Interpersonal Skills - The ability to relate to others in a socially appropriate, meaningful way.

Intracranial Pressure (ICP) - Cerebrospinal fluid (CSF) pressure measured from a needle or bolt introduced into the CSF space surrounding the brain. It reflects the pressure inside of the skull.

Intracranial Insult - Something that causes injury to the brain. Includes hematomas (intraparenchymal and extraparenchymal; immediate or delayed) elevations of intracranial pressure (ICP), brain swelling, edema and vasospasm.

Intravenous (IV) - Tubing inserted into a vein through which fluid and medications can be given.

Ipsilateral - Same side of the body.

Ischemia - A severe reduction in the supply of blood to body tissues.

Ischemic Brain Injury - a brain injury caused by the reduction of blood to the body tissues

Jargon - Spoken language that has normal rate and rhythm but is full of nonsense words.

Jejunostomy Tube (J Tube) - A type of feeding tube surgically inserted into the small intestine.

Job Analysis - Involves the systematic study of an occupation in terms of what the worker does in relation to data, people, and things; the methods and techniques employed, the machines, tools, equipment, and work aids used; the materials, products, subject matter or services which result, and the traits required of the worker.

Job Bank - A computerized system, developed by the Department of Labor, which maintains an up-to-date listing of job vacancies available through the State Employment Service.

Job Clusters (Work Families) - Related occupations grouped on the basis of similar job requirements, such as specific duties on the job, materials and equipment used, skill and knowledge, and worker characteristics required.

Job Development Specialist - Individual who contacts community businesses and industries for the purpose of placing clients with disabilities in competitive employment or on-the-job training stations. Includes analyzing the client's capabilities and consulting with the client's counselor, the facility, and the client in recommending the client for a specific job. May also involve provision of follow-up services relative to the client's on-the-job performance.

Job Seeking Skills - Those skills that enable a person to seek out job vacancies and apply for them. Includes knowledge of where to find information about job openings, how to fill out an application, how to take employment tests, and how to handle a job interview.

Job Task - A single work activity that is taken in its entirety, without any changes, directly from a specific job.

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

Judgment (Safety) - The extent to which an individual can correctly judge the dangers and risks in a variety of situations. An individual with poor judgment may leave candles burning, touch a hot stove burner, or show extreme friendliness or intimacy to strangers. Brain-injured persons with poor insight regarding their impairments are also likely to show poor judgment of safety.

Kinesthesia - The sensory awareness of body parts as they move (see Position Sense and Proprioception)

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

Laceration - A ragged tear of body tissues.

Language - The system used to communicate thoughts through symbols.

Latency of Response/Delay - The amount of time taken to respond after the stimulus has been presented.

Learning - See Memory/Learning.

Leg Bag - A small, thick plastic bag that can be tied to the leg and collects urine. It is connected by tubing to a catheter inserted into the urinary bladder.

Leisure Counseling - The exploration of what types of leisure/recreation were of interest to a person before the injury and which are of interest now; how to make the best of leisure time, what recreational resources are available in the community and how to take advantage of them; and what changes have to be made to continue previous leisure pursuits.

Leisure Skills - The ability to participate in recreational activities and to independently make effective use of one's leisure time and opportunities.

Lethargic - Awakens with stimulation; drowsy but awake.

Linguistics - The study of human speech, including the units, nature, structure and modification of language.

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

Log Book - A diary-like listing of the individual's daily activities which can be used to help remember what happened during the course of the day, names or persons with whom contact occurred, and the order in which events occurred. The brain-injured person, family members and staff are encouraged to make entries. Used to compensate for memory deficits.

Logical Ability - Ability to formulate a general rule or principle which one can use to objectively solve a problem. Also the ability to plan, regulate and control one's own activities.
Lucid Interval - A period shortly after injury when the patient was reported to have talked.

Malingering - To pretend inability so as to avoid duty or work.

Manpower Development - Cooperative process in which agencies in the community strive to assure the availability of an adequate present and future supply of qualified personnel to work in programs providing services to persons with disabilities.

Medically Stable - Reaching a point in medical treatment where life-threatening injuries and disease have been brought under control.

Memory - The process of organizing and storing representations of events and recalling these representations to consciousness at a later time.

Memory (Audio-Visual) - Auditory memory is the ability to recall a series of numbers, lists of words, sentences, or paragraphs presented orally. Visual memory requires input of information through visuo-perceptual channels. It refers to the ability to recall text, geometric figures, maps and photographs. A brain-injured survivor with impaired visual memory may have to refer to a road map numerous times to reach a nearby destination. A brain-injured inpatient may need frequent assistance from staff to locate his room A patient with impaired auditory memory will likely require frequent reminders of orally presented task instructions from staff. Notably, information may be encoded in memory using words or visual images independent of the mode of presentation.

Memory (Delayed) - Recall of information after a delay, often with other information presented to prevent active rehearsal. There is no particular specification of the required time interval; typically it is ten minutes or more.

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

Memory (Fund of Information) - A type of remote memory as well as an estimate of the amount of information an individual retains about past experiences.

Memory (Immediate) - The ability to recall numbers, pictures, or words immediately following presentation. Patients with immediate memory problems have difficulty learning new tasks because they cannot remember instructions. Relies upon concentration and attention.

Memory/Learning - Change in person's understanding or behavior due to experience or practice. Often thought of as acquisition of new information. For example, a person who learns quickly will likely remember an entire set of instructions after hearing them a single time. A patient with severely impaired learning ability will show little gain in recall after numerous repetitions. Learning and memory are interdependent. If immediate memory is poor, learning will be poor because only a portion of the information will be available for rehearsal/repetition. It is important to note that patients may have intact learning ability, but poor delayed memory. For example, a brain-injured patient may learn a set of instructions after several repetitions, but forget them the next day.

Memory (Long Term) - 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.

Memory (Recall) - Ability to retrieve information without renewed exposure to the stimulus.

Memory (Recognition) - Ability to retrieve information when a stimulus cue is presented. Free recall of the information is often deficient if cues must be provided.

Memory (Remote) - Information an individual correctly recalls from the past, stored before the onset of brain injury. There is no specific requirement for the amount of elapsed time, but it is typically more than six months to a year. Preserved information from delayed memory becomes part of remote memory.

Memory (Semantic) - Memory for facts, usually learned through repetition.

Memory (Short Term )- 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 task.

Mental Competence - The quality or state of being competent; having adequate mental abilities; legally qualified or adequate to manage one's personal affairs. An individual found by a court to be mentally incompetent has a guardian appointed to make personal and/or economic decisions on their behalf.

Mental Competence - All of the recognized forms of mental illness, severe emotional disorders, or mental retardation. Terms such as neurotic, psychotic, and schizophrenic should be reserved for technical medical writing only.

Mental Illness - A condition where there is loss of social and/or vocational skills due to impaired thought processes or emotional distress. Terms such as "mentally deranged", "crazy", "deviant" are not used.

Metacognition - Insight into accurately judging one's own strengths and limitations, particularly with regard to cognitive skills.

Microcomputer - A small computer; may be used to present information and stimuli to a patient as part of a cognitive rehabilitation program.

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

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

Monitor, Intensive Care - A TV-like screen with a continuous display of different wave forms representing different pressures and activities in the body such as blood pressure, intracranial pressure, and EKG. It may also show a corresponding number value for them (digital readout).

Monoplegia - Paralysis of one arm or one leg.

Motivation - Requires initiative and refers to the extent to which an individual desires to reach a goal and demonstrates actual follow-through. A greater level of motivation is required for completion of difficult tasks. A brain-injured person with reduced motivation may need frequent cueing to finish dressing even though being able to verbalize the complete procedure.

Motor - Pertaining to movement.

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

Motor Control (Fine) - Delicate, intricate movements as in writing or playing a piano.

Motor Control (Gross) - Large, strong movements as in chopping wood or walking.

Motor Lag - A prolonged delay between stimulus and initiation of motor response.

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

Movement Therapy - Using bodily expression, dance and exercise to facilitate movement, self expression and self esteem.

Muscle Tone - 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.

Music Therapy - Use of music and singing to develop language and movement skills.

Myelography - A medical test involving injection of dye into the spinal subarachnoid space so that an x-ray of the spinal cord can be taken. Used to detect spinal cord tumors, anatomical defects and disc problems.

Nasogastric Tube (NG Tube) - A tube that passes through the patient's nose and throat and ends in the patient's stomach. This tube allows for direct "tube feeding" to maintain the nutritional status of the patient or removal of stomach acids.

Neglect - Paying little or no attention to a part of the body.

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

Neuro Developmental Treatment (NDT) - A therapeutic approach based on the development of movement and emphasizing the restoration of normal movement in performing functional activities.

Neurolaw - The field of jurisprudence designed to meet the challenges presented by litigation regarding injuries to the central nervous system (brain or spinal cord).

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

Neurophysiology - The study of the functions of the nervous system.

Neuropsychologist - A psychologist who specializes in evaluating (by tests) brain/behavior 
relationships, planning training programs to help the survivor of brain injury return to normal 
functioning and recommending alternative cognitive and behavioral strategies to minimize the effects of brain injury. Often works closely with schools and employers as well as with family members of the injured person.

Neurosurgeon - A physician who specializes in surgery of the nervous system and its surrounding structures. Neurosurgeons operate on the brain, skull, scalp and spinal column.

Non-ambulatory - Unable to walk.

Non-Purposeful Movement - Movement that a person may make which has no apparent goal.

Normalization - Philosophy that developmentally disabled individuals should be exposed to patterns and conditions of daily life which are consistent with the norms of society and that training should be provided to enable persons with developmental disabilities to function appropriately in the mainstream of society.

Noxious Stimuli - Stimuli presented to a comatose patient in order to elicit a response. Often the nurse or physician will pinch the patient or shine a bright light in the patient's face or perform some other procedure to try to elicit a response from the patient. Sometimes the healthcare provider will rub the patient's chest very strongly or tickle the eyelid of the patient with a soft kleenex to try to elicit a response. These procedures are referred to as "noxious stimuli".

Numerical Ability - Ability to solve numerical problems using the four fundamental rules of arithmetic: addition, subtraction, multiplication, and division.

Nursing Home - A residential facility for the patient who requires supervision in all activities, including assistance with medication, meal preparation, bathing, dressing, and moving about; the patient may also require special nursing care and/or ongoing therapy. There are nursing homes that provide minimal to maximum care; also called extended care facilities.

Nystagmus - Involuntary horizontal, vertical, or rotary movement of the eyeballs.

NDT - See Neuro Developmental Treatment.

NPO - Latin initials that stand for "Nothing by Mouth". This means no food or liquids for a set period, usually in preparation for certain tests, or when a person cannot safely swallow.

Observational Procedure - An organized method of recording what a client does for the purpose of documenting behavior; the emphasis is usually upon productivity, behavior patterns, expressed interest, and worker interaction. Used to gain information concerning a client's overall level of functioning.

Obtunded - Mental blunting; mild to moderate reduction of alertness.

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

Occupational Therapy - Occupational Therapy is the therapeutic use of self-care, work and play activities to increase independent function, enhance development and prevent disability; may include the adaptation of a task or the environment to achieve maximum independence and to enhance the quality of life. The term occupation, as used in occupational therapy, refers to any activity engaged in for evaluating, specifying and treating problems interfering with functional performance.

On-the-Job Training - A planned experience in an actual work situation through which the client, under supervision, learns to perform all job operations of an occupation.

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

Organization (Low Level) - Those individuals who can sustain attention and appropriately switch sets. Persons with low level organization ability usually "fall apart" in high stress situations.

Organization (High Level) - Those individuals who can deal with multiple pieces of information and integrate them for accomplishing relatively complex tasks. Some persons demonstrating high level cognitive organization may still "fall apart" in high stress situations.

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

Orientation (Left-Right) - The ability to discriminate between left and right body parts on oneself and on others, as well as the ability to discriminate between left and right within the environment.

Orientation (Personal) - General knowledge related to oneself includes information regarding date of birth, age, name, and location of home.

Orientation (Situational) - The ability to accurately describe present circumstances. For example, in the acute stages of injury, brain-injured patients may be unable to respond accurately to questions such as, "Why are you in the hospital?" Situational disorientation is commonly observed during the period of post-traumatic amnesia (PTA).

Orientation (Temporal) - Knowledge of the current date, day, month and year. Includes knowledge of facts related to time of day. For example, a disoriented patient asked to name the next meal at 4 PM might say, "breakfast."

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

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

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

Outcome - The end result.

Outcome (Socio-Ecologic) - The Interdisciplinary Special Interest Group (ISIG) Subcommittee on Outcome (of the American Congress of Rehabilitation Medicine) drafted the following statement at its meeting in June 1990: "Brain-injured persons have a capacity to function in the community. Rehabilitation can increase the ability to contribute to society and reduce the negative socio-ecological consequences of brain injury. We are committed to the reliable, valid measures of outcome that consider socio-ecological factors. Outcome measures can be viewed from a variety of perspectives, including impairment, disability and handicap. We recommend that in our Standards of Practice, we not limit measurement of outcome to the realms of impairment or disability. We advocate for outcome measures to include the issue of handicap or the socio-ecological context so that we define outcome around individuals inside of a support system or context."

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

Overnight Drainage Bag (ONDB) - A large thick plastic bag that is connected to a urodrain. It hangs on the bed and is used to collect urine at night or when someone needs to be in bed during the day.

O.T. - See Occupational Therapy.

Oximeter - A device to monitor the patient's oxygen saturation levels to assist in the prevention of hypoxia.

Palliative Care - A program designed to reduce the severity of symptoms and/or decrease their impact on the individual, and to improve the quality of life.

Paraparesis - Weakness of the lower limbs.

Paraphasic Error - Substitution of an incorrect sound (e.g. , free for tree) or related word (e.g., sofa for chair).

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

Parapnasias - Use of incorrect words or word combinations.

Parenteral - Not through the alimentary canal (gastrointestinal tract) but rather by injection through some other route, such as subcutaneous, intramuscular or intravenous.

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

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

Parietal Lobe (Left) - Damage to this area of the brain may disrupt a patient's ability to understand spoken and/or written language.

Pathology - Interruption or interference of normal bodily processes or structures.

Patient - One who is acted upon; an individual awaiting or under medical care and treatment.

Pattern of Movement - Motion of particular parts of the body (such as the hand and arm) in a typical, reproducible, sequence and direction.

Pediatric Acquired Brain Injury (PABI) - a brain injury sustained from traumatic or non-traumatic causes from birth to age 25, since the pediatric brain doesn’t finish developing until that time.  Traumatic causes can include motor vehicle accidents, falls, blast injuries from war, assaults/child abuse, sports concussions, gunshot wounds, or being struck by an object.  Non-traumatic causes include strokes, brain tumors, meningitis, poisoning, insufficient oxygen, ischemia, pediatric AIDS and substance abuse.

Perception - 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.

Perception (Motor) - Interaction of the perceptual abilities with motor abilities.

Perseveration - 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.

Persistent Vegetative State (PVS) - A long-standing condition in which the patient utters no words and does not follow commands or make any response that is meaningful. (The use of this term is currently under review).

Persistent Unawareness- The transition of a person who remains unconscious from a state of 'coma' to one of 'vegetative behaviors' reflects subtle changes over a period of several weeks from a condition of no response to the internal or external environment (except reflexively) to a state of wakefulness but with no indication of awareness (cortical function). A patient in this state may have a range of biological responses at the sub-cortical level such as eye opening (with sleep and wake rhythms) and sometimes the ability to follow with their eyes. Normal levels of blood pressure and respiration (vegetative functions) are maintained automatically. The label 'persistent' is not applicable until the person has been unconscious for a year or more. Also called Coma Vigil.

Personal Adjustment Training - Process of modifying behavior to conform to measurable criteria based on socially appropriate behavior; process of modifying behavior to enable one to adequately deal with one's environment.

Phlebitis - Inflammation of a vein.

Phonation - The production of sound by means of vocal cord vibration.

Physiatrist - 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.

Physical Demands - The physical requirements made on the worker by the specific job/work situation. They include strength (lifting, carrying, pushing and/or pulling), climbing, or balancing, stooping, kneeling, crouching and/or crawling, reaching, handling, fingering and/or feeling, talking and/or hearing and seeing.

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

PICU - Pediatric Intensive Care Unit.

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

Plateau - A temporary or permanent leveling off in the recovery process.

Posey Roll - A bar placed on the wheelchair to prevent a person from standing up or falling out.

Posey Vest/Houdini Jacket - A vest worn to keep the person in bed or in a wheelchair. This is for the person's safety. Many patients are also maintained in wrist restraints to prevent them from consciously or unconsciously pulling at tubes or to prevent injury to the patient and staff if the patient should become combative.

Position Sense - The sensory awareness of the location and orientation of body parts without moving them. See Kinesthesia and Proprioception.

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

Postural Tone (Excessive) - Greater than normal tone of muscles used to hold the body in ordinary positions such as sitting or standing.

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

Pre-Morbid Condition - Characteristics of an individual present before the disease or injury occurred.

Pre-Screening - The process of reviewing all available pertinent data on referrals to determine the need for additional information.

Prevocational Evaluation - An assessment, prior to work training, of the client's potential as a worker, giving special attention to one's work attitudes and habits, and evidence of personal responsibility.

Primary Care Nurse - The nurse principally responsible for the nursing care of a given patient. The primary care nurse develops and implements a care plan, participates in conferences, collaborates with the patient, the rehabilitation team, and the family, as well as evaluating the outcome of care.

Problem-Solving - Ability of the individual to bring cognitive processes to the consideration of how to accomplish a task.

Problem-Solving Skill - Ability to consider the probable factors that can influence the outcome of each of various solutions to a problem, and to select the most advantageous solution. Individuals with deficits in this skill may become "immobilized" when faced with a problem. By being unable to think of possible solutions, they may respond by doing nothing.

Production Work Evaluation - This is a method of evaluating clients through the use of actual industrial work brought into the evaluation facility. It is possible for the evaluation staff to vary all the customary conditions of the real job in an effort to discover difficulties that prevent the client from working effectively.

Productive Activity - Can be classified into the following categories:

1) Competitive - Competitive employment is defined as employment with a competitive wage and in a regular workplace. No formally structured extra supervision or assistance is provided outside of that normally expected for the job. (This category includes, however, subjects who work in competitive situations but who may nevertheless require some irregular or informal assistance, or who may have somewhat lowered productivity). Competitive academic enrollment means participating in regular course work in a mainstream curriculum at an accredited institution of education.

2) Vocational Training - This is enrollment in a formal vocational training program with a goal of competitive employment.

3) Noncompetitive or sheltered program - This is participation in a sheltered (noncompetitive), but paid, employment or therapeutic productive work environment that does not provide the demands of a normal work situation, or a noncompetitive academic program specifically designed for those having some form of disability, such as learning disabled or brain-injured class.

4) Volunteer - Participation in a nonpaid, but formally organized and routine, therapeutic work situation.

5) Recreational or day activity program - Participation in programs specifically designed to meet the subjects' socialization and activity needs, but which are unpaid, with little in the way of performance demands beyond acceptable social behavior, and which require formal staff input for structure and guidance.

6) No Productivity - No involvement in organized social, avocational, educational or vocational activity. No personal routine activity of socially goal-oriented nature.

7) Independent - homemaker or retired person living at home with or without requirement for attendant care or supervision.

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

Prone - Lying on one's stomach.

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

Prosody - The inflections or intonations of speech.

Prosthesis - An artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons or both.

Prosthetist - A skilled craftsman who designs and makes artificial replacements for missing body parts, for example, an artificial leg.

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

Proximal Instability - Weakness of muscles of the trunk, shoulder girdle or hip girdle which causes poor posture, abnormal movement of the arms or legs and the inability to hold one's head up. Strength of muscles of the hands or legs may be normal.

Psychologist - A professional specializing in counseling, including adjustment to disability. 

Psychometric Instruments - Standardized tests (utilizing paper and pencil) which measure mental functioning.

Psychomotor Skills - Skills that involve both mental and muscular ability such as playing sports or other activities where practice or concentration is involved.

Psychosocial Skills - Refers to the individual's adjustment to the injury (and resulting disability) and one's ability to relate to others. Includes feelings about self, sexuality and the resulting behaviors.

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

Purposeful Movement - Motor activity with an apparent goal.

Quadriparesis - Weakness of all four limbs.

Quadriplegia - Paralysis of all four limbs (from the neck down). British authors often use the prefix "tetra" to mean four, so they may describe a patient as having tetraplegia.

Quality of Life - A rating of what kind of existence a person experiences. In estimating the quality of  life the following items are usually considered:

1) mobility and activities of daily life;

2) living arrangements;

3) social relationships;

4) work and leisure activities;

5) present satisfaction; and

6) future prospects.

Random Movement - An action or process of moving without obvious aim, purpose, or reason.

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

Range of Motion (Active) - The muscles around the joint do the work to move it.

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

Reasoning - The cognitive process of looking for reasons for beliefs, conclusions, actions or feelings.

Reasoning (Abstract)- 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.

Reasoning (Association) - A skill dependent on a person's ability to determine the relationship between objects and concepts. A patient with impairment may touch a hot stove, failing to realize that pain is associated with touching a heated burner. Similarly, a patient given a knife, spoon, fork, and baseball may not be able to discriminate which of the objects "does not belong."

Reasoning (Categorization) - The ability to sort or group objects and concepts based on the shared attribute(s) and apply a label depicting the attribute(s). Task difficulty is greater in circumstances requiring formulation of new categories. Impaired patients may have difficulty sorting clothes or choosing items for a balanced meal. Categorization is similar to association in that patients must understand the relationship between objects or concepts. However, categorization requires an extra step; the ability to provide a label describing the group of objects or concepts.

Reasoning (Cause & Effect) - The ability to perceive and anticipate the consequences of a given action or statement. For example, a patient may sit for a long period in a darkened room without realizing that flipping a light switch will cause the light to turn on. A patient may turn the oven up to make a cake cook faster, not realizing that the increased heat will simply cause the food to burn.

Reasoning (Concrete) - The ability to understand the literal meaning of a phrase.

Reasoning (Deductive) - Drawing conclusions based upon premises or general principles in a step-by-step manner.

Reasoning (Generalization) - The ability to take information, rules and strategies learned about one situation and apply them appropriately to other, similar situations. For example, a patient who learns to lock his/her wheelchair brakes in physical therapy may not lock the brakes while sitting in his/her room.

Reasoning (Inductive) - Awareness of one's behavior and the accuracy or appropriateness of one's performance. Usually automatic and on-going.

Reasoning (Organization) - The ability to arrange or group information in a manner which improves task efficiency. Persons who lack organizational skills often demonstrate a sense of purposelessness and have difficulty effectively utilizing nonstructured time. They have difficulty completing a puzzle or arranging materials to cook or shower.

Reasoning (Problem-Solving) - 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.

Reasoning (Sequencing) - 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.

Recreation Therapist - Individual 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.

Referral - The process of directing a client to an agency for services.

Referral Data - Data about the client obtained from other specialists, persons, and agencies that are obtained verbally or through such documents as psychometrics, terminal reports, medical reports, intake, and social service reports.

Referral Source - That person or facility sending a client for services. This includes, but is not  limited to, service agencies such as vocational rehabilitation, physicians, industry, insurance companies, employment agencies, community action groups, and potential clients themselves.

Referring Agency - The agency which sends or directs the client for services.

Registry - A clinical or service-oriented system used to:

1) identify patients eligible for services,

2) evaluate treatment methods, and

3) monitor patient outcomes.

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

Rehabilitation Counselor - Also called Vocational Counselor. A specialist in social and vocational issues who helps the patient develop the skills and aptitudes necessary for return to productive activity and the community.

Rehabilitation Engineering - Use of technical advances, physics, computer science and other scientific 
devices to aid in improving the quality of life for the person with a disability, e.g., computerized communication boards, mechanically-assisted wheelchairs.

Rehabilitation Facility - 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.

Rehabilitation Nurse - A nurse specializing in rehabilitation techniques as well as basic nursing care.  Nurses assist the patient and family in acquiring new information, developing skills, achieving competence and exhibiting behaviors that contribute to the attainment of a healthy state.

Rehabilitation Objective - A goal of the comprehensive restoration of an individual to the best possible level of functioning following a physical, mental, or emotional disorder.

Rehabilitation Process - A planned, orderly sequence of services related to the total needs of the person with a disability and designed to assist one to realize maximum potential for useful and productive activity.

Rehabilitation Team - An organized group of health care specialists, who focus on providing a logical, 
practical and complete rehabilitation plan for the patient. Upon admission to the rehabilitation 
hospital, the patient is evaluated by each team member who defines both short-term and long-term goals 
for the patient's rehabilitation. Meetings of the rehabilitation team (sometimes called "rounds") are 
held regularly to discuss the patient's progress and, if necessary, to redefine the goals. Additional 
family conferences may also be scheduled.

Remediation - The process of decreasing a disability by challenging the individual to improve deficient
skills.

Report (Vocational Evaluation) - A well planned, carefully written means of communicating vital vocational information about a client. It is a studied, permanent record of significant vocational data observed as a client and an evaluator interact in various types of work or work-like situations. It puts the plan, action, findings, logic, and interpretation of the evaluation in writing. It usually includes a description of the client's work traits and how they compare to minimal requirements of selected jobs or work areas, physical capacities, learning ability, personal characteristics, social competence, other vocational factors, and recommendation for further services. It may also provide a prescriptive-descriptive sequence of experiences which are aimed at maximizing an individual's vocational potential.

Respirator/Ventilator - A machine that does the breathing work for the unresponsive patient. It serves to deliver air in the appropriate percentage of oxygen and at the appropriate rate. The air is also humidified by the ventilator. Although these two terms are often used interchangeably, a respirator is a device used in workplaces to filter out particles whereas a ventilator is used for assistance with breathing.

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

Response Control - The development of the ability to recognize and suppress abnormal behaviors in one's 
self. Two behaviors fall within this category: impulse control, and perseveration.

Respiratory Therapist (RCP) (RT) - Also known as a respiratory care practitioner. In most states now the 
respiratory care practitioner is licensed to practice in his/her field. In today's medical environment, the respiratory care practitioner performs many functions. They not only monitor the ventilator, but also in some hospitals perform ventilatory management based upon a set of protocols developed by the hospital and based upon Clinical Practice Guidelines set up by the American Association of Respiratory are (AARC). The respiratory care practitioner draws and analyzes arterial blood gases and provides breathing treatments to improve ventilation. In some hospitals, the RCP or RT also performs more advanced duties such as monitoring of the swan ganz catheters and insertion of intravenous lines, nasogastric tubes, chest tubes, etc.

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

Scanning - The active search of the environment for information; usually refers to "visual scanning" which is a skill used in reading, driving and many other daily activities.

Scotoma - Area of blindness of varying size anywhere within the visual fields.

Secondary Condition - People with disabling conditions are often at risk of developing secondary conditions that can result in further deterioration in health status, functional capacity, and quality of life. Secondary conditions are causally related to a primary disabling condition and include, among others, contractures, physical deconditioning, mental depression, cardiopulmonary conditions and decubitus ulcers.

Secondary Gain - The benefit, resources or advantages, that comes from another, primary, event or circumstance.

Secondary Insult - Secondary or delayed brain injury; for traumatic brain injury, includes all events other than the mechanical injury sustained at the time of impact. Secondary phenomena may be divided into systemic and intracranial insults. Systemic insults include hypoxemia, anemia, hypotension, hypercarbia, hyperthermia, and electrolyte imbalance.

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

Selective Attention - Ability to focus on the most important aspect of a situation without becoming distracted.

Selective Placement - Work situation where provisions are made by the employer to meet the client's special needs.

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

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

Sensory Deprivation - A situation or environment where usual sensory stimuli, such as noise and light, as well as human contact, are absent or substantially decreased. In the case of noise, it may be masked by a continuous dull noise.

Sensory Integration - Interaction of two or more sensory processes in a manner that enhances the adaptiveness of the brain.

Sensory Stimulation - Arousing the brain through any of the senses.

Sequencing - Reading, listening, expressing thoughts, describing events or contracting muscles in an orderly and meaningful manner.

Sexuality Counseling - Using supportive techniques and special methods to help brain-injured survivors and their families deal with special and intimate relationship issues.

Sheltered Workshop - A work setting providing transitional and/or long-term employment in a controlled and protected working environment for those who are unable either to compete or to function in the open job market due to their disabilities. May provide vocational evaluation and work adjustment services.

Shock, Circulatory - A clinical condition characterized by signs and symptoms which arise when the cardiac output is insufficient to fill the arterial tree with blood under sufficient pressure to provide organs and tissues with adequate blood flow.

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

Simulated Job Station - A work setting which has the following characteristics:

1) replication of all aspects of a job (not limited to job tasks) or a work process as realistically as possible;

2) does not necessarily require payment to the client;

3) the setting is controlled by the evaluator; and

4) it is located within the evaluation facility.

Single Trait Work Samples - Assesses a single worker trait or characteristic. It may have relevance to a specific job or many jobs, but it is intended to assess a single, isolated factor.

Skill Training - Teaching an individual how to perform the operations of a particular occupation; distinguished from personal adjustment training, work adjustment, and the acquisition of basic employment skills.

Skill Remediation - A process in which the aim is to improve skills that have been imperfectly or inadequately learned.

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

Small Stature - Used to refer to very small persons; more socially acceptable than the terms dwarf or midget. Dwarfism is an accepted medical term, but it should not be used in general conversation.

Social Adjustment Group - A structured group experience that offers individuals opportunities for the 
redirection of energies toward positive social goals, raising of levels of aspiration, and/or reduction
of maladaptive behavior patterns.

Social Adjustment Training - Structured program designed to assist the disabled individual to interact with individuals and groups within the community in an acceptable manner.

Social Assessment - A social assessment includes general background data, description of family or other support group resources including emotional, financial and environment resources, their availability to the patient, and the patient's position and role in the family (child, parent, spouse) and educational and employment history. Also included are such topics as interests, lifestyle, friendships, goals, ambitions, personality traits, positive and/or negative relationships and previous problems (such as medical, psychiatric, drug abuse, alcohol). The assessment attempts to reveal the patient's and the family's level of understanding of the patient's current condition, probable long-range outcome, expectations of rehabilitation, degree of disruption in family functioning that the disability has produced, and the ability and interest of the patient and family members to adjust to changed circumstances.

Social Worker - The social worker serves as a liaison between the professional team and other parties 
concerned with the patient, including: the family, funding sources, friends, and representatives of past or future placements. An important role of the social worker is to help ensure that if home placement does not materialize, or if home placement is not indicated, the social worker provides assistance to the patient and family for finding other alternatives.

Societal Limitation - Restriction, attributable to social policy barriers (structural or attitudinal), which limits fulfillment of roles or denies access to services and opportunities that are associated with full participation in society.

Somatic - Relating to, or affecting the body.

Somatosensory - Sensory activity having its origin elsewhere than in the special sense organs (such as 
eyes and ears) and conveying information to the brain about the state of the body proper and its immediate environment.

Spenco Boots (Space Boots) - Padded support devices used to position the feet and ankles of the patient. Without this support and alignment, patients who are unconscious for long periods may develop deformities limiting future movement.

Spasm - An involuntary and abnormal muscular contraction; also, a sudden violent and temporary effort or emotion.

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

Spatial Ability - Ability to perceive the construction of an object in both two and three dimensions.  Spatial ability has four components: the ability to perceive a static figure in different positions, the ability to interpret and duplicate the movements between various parts of a figure, the ability to perceive the relationship between an object and a person's own body sphere, and the ability to interpret the person's body as an object in space.

Special - Describes that which is different or uncommon about any person. This term should not be used 
to describe persons with disabilities (except when citing laws or regulations).

Specialty Services - Categories identified by the Brain Injury Association (BIA) to classify frequently requested services. These services include: respirator-dependent, substance abuse, driver education, evaluation, visually-impaired and Spanish translation.

Specific Learning Disability - Permanent condition that affects the way individuals with average or 
above average intelligence take in, retain, and express information. The term "specific" is preferred 
because it emphasizes that only certain learning processes are affected.

Speech - Oral expression of language.

Speech Disorder - A condition where a person has limited or difficult speech patterns.

Speech and Hearing Therapist (ST) - The speech therapist provides instruction and practice in improving skills in comprehension and communication. The speech pathologist and audiologist identifies problem areas of visual (seeing) and auditory (hearing) comprehension, attention, memory (recent and past), language skills, writing skills and reading skills. The information gathered by the speech and hearing specialist is valuable to other team members; for example, whether or not to use reading as a means of communicating information to the patient.

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

Spontaneous Movement - A reaction resulting from a natural impulse without obvious planning or premeditation.

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

Staff Conferences (Staffing) - Formal or informal conferences held by the staff working with a client to review progress of the individual, develop further plans, maintain integration and coordination of the client's programs, and to make recommendations as to further action needed by and for the client.

Standards - A set of criteria used to measure the merit of an agency's program.

Status Epilepticus - Continuous seizures; may produce permanent brain damage.

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

Strabismus - A condition in which the eyes are not properly aligned with each other. It typically involves a lack of coordination between the extraocular muscles that prevents bringing the gaze of each eye to the same point in space and preventing proper binocular vision, which may adversely affect depth perception. Strabismus can be either a disorder of the brain coordinating the eyes or a disorder of one or more muscles, as in any process that causes a dysfunction of the usual direction and power of the muscle or muscles.

Strabismus (External) - Outward turning of the eye which may be due to a lesion of the oculomotor nerve 
(III) causing paralysis of the medial rectus muscle.

Strabismus (Internal )- Inward turning of the eye which may be due to a lesion of the abducens nerve (VI) causing paralysis of the lateral rectus muscle.

Stupor - Deep sleep; unresponsive but can be awakened with repeated, noxious stimulation. Awareness is 
depressed but present.

Subacute - The prefix "sub" means under, below, near or less than complete; "acute" means sharp, severe; having a sudden onset, sharp rise and short course. Thus, a subacute condition is one which has
not reached, or has already passed through, the acute phase.

Subarachnoid Screw (Subarachnoid Bolt) -  A device for measuring intracranial pressure which is screwed through a hole in the skull and rests on the surface of the brain.

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

Substance Abuse Program - A service offered by an agency to deal with chemical dependency of an 
individual. The dependency may have occurred prior to the brain injury or subsequent to the brain injury.

Supervision (Close-Distant) - Refers to the assistance provided when an individual requires no physical help but requires another person nearby for safety. Close Supervision:Assistant stands close to person, ready to give assistance if needed. Distant Supervision: Assistant can see the person and offer verbal assistance but is not close enough to touch the person.

Supine - Lying on the back.

Support Group - A group established for families and/or persons with disabilities to discuss the problems they may have in coping with their life situation and to seek solutions to these problems.

Support Hose (Anti-embolic stockings) - Tight knee or thigh-high stockings that support the leg muscles and thus help prevent pooling of blood in veins of the legs.

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

Suppository - Medicine contained in a capsule which is inserted into the rectum so that the medicine can be absorbed into the blood stream.

Surveillance System - A means of gathering data; generally has public health emphasis containing only 
descriptive information used to assess the magnitude of particular types of health problems, and is  geared toward prevention of the problem.

Swan-Ganz Catheter - A catheter (tube) similar to the central venous pressure (CVP) line. It is used to 
measure blood pressure and blood gas concentration in the right side of the heart, in vessels of the lungs and in the left side of the heart.

Synergy (Movement) - Combined action of two or more muscles to form a pattern of movement.

Synthesizing - The process by which information from all resources is combined into a meaningful whole to determine approaches and directions.

Tactile Defensiveness - Being overly sensitive to touch; withdrawing, crying, yelling or striking when one is touched.

Tactile Discrimination - The ability to differentiate information received through the sense of touch.  Sharp/dull discrimination - ability to distinguish between sharp and dull stimuli; Two-point discrimination - the ability to recognize two points applied to the skin simultaneously as distinct from one single point.

Task Analysis - Breakdown of a particular job into its component parts; information gained from task analysis can be utilized to develop training curricula or to price a product or service.

Team - A number of persons associated together in work or activity. A team of health care professionals 
pools the talents of individuals to help the patient or client achieve the best result.

Team (Interdisciplinary) - A type of team functioning in which the persons representing each discipline 
(field of study) have a voice in establishing priorities for the goals to be undertaken by members of the team.

Team (Multidisciplinary) - A type of team functioning in which the persons representing each discipline  (field of study) set their own goals for evaluating and treating the patient/client and inform other team members of the results as they occur.

Team (Transdisciplinary) - A type of team functioning in which the persons representing each discipline  (field of study) are encouraged to deal with problems or issues as they occur during daily interactions with the patient or client even though the intervention used may fall within the primary domain of another discipline.

Telegraphic Speech - Speech which sounds like a telegram. Only the main words of a sentence (nouns, 
verbs) are present; the small words (ifs, ands, buts,) are missing. This type of speech often gets the message across.

Temperament - Personal traits consisting of the individual's characteristic mode or inclination of emotional response.

Temporal Lobes - There are two temporal lobes, one on each side of the brain located at about the level of the ears. These lobes allow a person to tell one smell from another and one sound from another. They also help in sorting new information and are believed to be responsible for short-term memory.

Right Lobe - Mainly involved in visual memory (i.e., memory for pictures and faces).
Left Lobe - Mainly involved in verbal memory (i.e., memory for words and names).

Third party Funding - Reimbursement for services rendered to a person in which an entity other than the 
recipient of the services is responsible for the payments, i.e., an insurance company.

Thrombus - Blood clot.

Time Study - Detailed , scientific analysis of time taken by a worker to perform each segment of a specific task/job, and the hand and body movements made in performing the task/job. Such a study may be made for the purpose of determining the most efficient method for doing the task/job, or to evaluate the task/job to establish a work standard or to set a wage.

Timed Voiding - Bladder training program where the person goes to the toilet at regular intervals whether feeling the urge or not. The goal is bladder continence through better control and timing.

Tone (Muscle) - The tension in resting muscles and the amount of resistance that is felt when a muscle is moved.

Tracheostomy - A temporary surgical opening at the front of the throat providing access to the trachea or windpipe to assist in breathing.

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

Traction - A weighted traction setup composed of pulleys and lines used in the care of the patient with a broken leg(s) or spine. After the repair of the fractures and application of appropriate casts, weights are used to keep the bones correctly aligned.

Training Environment - Refers to the setting in which the emphasis is on the learning and acquisition of skills or competencies.

Transducer - A sensitive electronic device which detects bodily functions, such as heart rate and blood pressure, and transmits signals representing those functions to a monitor so that they can be observed.

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

Treatment Modalities - Various therapy techniques.

Treatment Protocol - The written treatment plan specifying the procedures to be followed by the treatment team.

Tremor - Course, rhythmical movements of a body

Tremor (Intentional) - Course, rhythmical movements of a body part that become intensified the harder one tries to control them.

Tremor (Resting) - Rhythmical movements present at rest and may be diminished during voluntary movement.

Unconditional Positive Regard - Absolute or unreserved acceptance and respect.

Unilateral - Of or pertaining to only one side.

Unilateral Neglect - Paying little or no attention to things on one side of the body. Often this occurs on the side opposite from the location of the injury to the brain as the nerve fibers from the brain typically cross before innervating body structures. In extreme cases, the patient may not bathe, dress or acknowledge one side of the body.

Urinary Tract Infection - An infection cause by the increased growth of bacteria in the bladder. Can cause fever, chills, burning on urination, urgency, frequency, incontinence, and/or foul smelling urine.

Urodrain - An external urine-collection device for men.

Vegetative State - The return of wakefulness not accompanied by cognitive function; eyes open to verbal stimuli; does not localize motor responses; autonomic functions preserved. Sleep-wake cycles exist. See Persistent Vegetative State.

Ventricles, Brain - Four natural cavities in the brain which are filled with cerebrospinal fluid. A space-occupying lesion (hemorrhage, tumor) in one of the lobes of the brain may cause the outline of one or more of these cavities to change.

Ventriculostomy - A procedure for measuring intracranial pressure by placing a measuring device within one of the fluid-filled, hollow chambers of the brain.

Verbal Ability - Composed of verbal understanding and verbal fluency. Verbal understanding is the ability of an individual to understand the subtleties and meaning of words. Verbal fluency is the ability to imagine, process, and say words without associating them with any particular object. It also pertains to the ability to communicate by talking, writing, listening and reading.

Verbal Apraxia - Impaired control of proper sequencing of muscles used in speech (tongue, lips, jaw muscles, vocal cords). These muscles are not weak but their control is defective. Symptoms include labored speech, sound reversals, additional sounds, and word approximations.

Verbal Fluency - Ability to produce words.

Verbal Request - Asking for a specified response.

Vestibular - Of or pertaining to the vestibular system in the middle ear which senses movements of the head. Disorders of the vestibular system can lead to dizziness, inability to regulate postural muscle tone, and inability to detect quick movements of the head.

Visual Field Defect - Inability to see objects located in a specific region of the field of view 
ordinarily received by each eye. Often the blind region includes everything in the right half or left half of the visual field.

Visual Imagery - The use of mental pictures (visualization) to aid in memory recall.

Visual Perception - The ability to recognize and discriminate between visual stimuli, and to interpret these stimuli through association with earlier experiences.

Visually Impaired - A generic term that refers to all degrees of vision loss.

Vocational Adjustment Center - A rehabilitation facility that assists vocationally disadvantaged persons who experience emotional, physical or social disability transitioning in
employment. Issues that may be addressed may include: the capacity to function productively, the ability to secure appropriate employment, or the capacity to adapt on the job.

Vocational Counseling - A program designed to assist a person in understanding their vocational liabilities and assets, and providing occupational information to assist one in choosing an occupation suitable to one's interests and liabilities.

Vocational Counselor - The person who advises a client regarding vocational options.

Vocational Evaluation - An assessment that systematically uses work, real or simulated, 
and vocational exploration, for the purpose of assisting individuals in vocational development. Vocational evaluation includes medical, psychological, social, vocational, educational,cultural, and economic data in developing the goals of the overall evaluation process.

Vocational Evaluation Department - An organized program to provide vocational evaluation services by set standards.

Vocational Evaluation Case Manager - The person responsible for the evaluation program for an individual client. This includes reviewing all referral information, scheduling services, planning the individual program, maintaining a case file, holding conferences, as appropriate, making the termination decision, preparing the final report, and any follow up.

Vocational Evaluation Services - Services for vocational evaluation in accordance with established standards and procedures.

Vocational Objectives - Specific, job-related, time-oriented objectives established at the 
beginning of the client's rehabilitation program, and may be modified during the course of the program.

Vocational Training - Training relating to the skills or competencies required of students in preparation for employment.

Voluntary or Volitional Movement - Movements purposefully made by the person.

Volunteer - A person contributing time and talents to provide services to people without remuneration.

Wagner O'Day - Common name for Public Law 92-28 which directs the purchase by the Federal Government of selected commodities and services from qualified workshops serving blind and other severely disabled individuals, with the objective of increasing the employment opportunities for these individuals.

Word Retrieval Deficit - The difficulty recalling a specific word or words.

Work Activity Center - A workshop, or certer with a planned program designed exclusively to provide therapeutic activity for individuals whose physical or mental impairment is so severe as to make their production inconsequential.

Work Adjustment - An individualized, structured, planned, supervised, remedial work experience designed to promote the acquisition of good work habits, increased physical and emotional tolerance for work activity, interpersonal working relationships. The modification of aptitudes and behaviors which inhibit the satisfactory performance of work.

Work Aptitude - The measure of individual's natural ability or general suitability to work.

Worker Trait - Requirements made of the worker in terms of aptitudes, general educational 
development, vocational preparation, physical demands, and personal traits. These are reflected in: training time, aptitudes, temperaments, interests, physical demands, and environmental conditions.