4.1 - TBI - Treatment of Traumatic Brain Injury Flashcards
What 6 things should we consider when treating TBI patients?
Level of alertness
Attention span
Agitation
Level of memory impairment
Premorbid level of functioning/lifestyle
Functional goals/targets
What are the 4 General Principles for treating patients with TBI?
Identify appropriate treatment environment (influenced by cognitive level/ability)
Schedule treatment to maximize patient performance
Provide atmosphere of support and understanding
Select treatment tasks appropriate for the patient
What time of day is usually ideal for treating TBI patients?
10:00 a.m. - 2:00 p.m.
At what Ranchos Levels do we need to control a patient’s environment?
IV - VI
What are the two philosophies for treating patients with TBI?
Remediation approach
Compensation approach
What is a Remediation approach to treating patients with TBI?
Retraining specific cognitive domains with the expectation that specific skills will improve
What is the Remediation approach to treating patients with TBI based on?
The notion of neuroplasticity (still theoretical)
What is a Compensation approach to treating patients with TBI?
(2)
Compensatory strategies are used to address observed cognitive deficits
These may be temporary or permanent
What is often used in the Compensation approach to treating patients with TBI?
(2)
Modification of environments to maximize abilities
Can be Physical or Auditory/Visual
What are two ways we can modify environments to maximize abilities in patients with TBI?
Physically
Auditory/Visually
What should we focus on when setting goals for patients with TBI?
(2)
Cognitive domains
Function
What 5 things should be part of goals for patients with TBI?
Cognitive domain to be addressed
Duration when appropriate
Therapy environment (environmental compensation or control)
Level of supervision
Level of “verbal” cuing
What are 3 Duration lengths that may be used with TBI patients?
Seconds
Minutes
Entire session
What are 5 different Therapy Environment that may be used with TBI patients?
1:1
Group
Controlled
Normal
Office setting
Open gym setting
What are 4 Levels of Supervision that may be used with TBI patients?
Constant
Intermittent
Occasional
Independent
What 4 Levels of “Verbal” Cuing that may be used with TBI patients?
Constant verbal cuing
Intermittent verbal cuing
Occasional verbal cuing
No verbal cuing
What 8 Cognitive Domains might be addressed in TBI patients?
Attention
Memory
Organization
Planning
Problem solving
Reasoning
Executive skills
Pragmatics
When selecting goals for TBI patients, we should choose goals that will make an _______ and __________ on cognitive-communicative skills.
Immediate
Social impact
When selecting goals for TBI patients, we should choose the most __________ that may be produced and reinforced in other ____________.
Useful goals
Natural settings
When selecting goals for TBI patients, we should choose goals that expand ___________.
Cognitive-communicative skills
When selecting goals for TBI patients, we should choose goals that are _______ and _______ appropriate.
Linguistically
Culturally
What are the 5 sections to a treatment session for patients with TBI?
Introduction (2-3 min)
Teach Concept (2-5 min)
Practice (13-18 min)
Assess Learning (while practicing)
Summary/Conclusion (2-4 min)
What 8 Treatment Targets are regularly used with patients with TBI?
Orientation
Attention
Attention/Concentration
Memory
Memory Compensation
Problem Solving
Executive Function
Speech-Language/Communication
What 4 concepts are we looking for in patient orientation?
Person
Place
Time
Situation
What are the 5 different types of Attention?
Focused attention
Sustained attention
Selective attention
Divided attention
Alternating attention
What 2 types of Attention does Dr. Ellis feel are most important?
Sustained
Selective
How might we target Attention/Concentration for patients with TBI?
Present instructions within optimum thresholds
Identify attentional breakdowns (What is the root?)
Schedule breaks
Encourage client to assess level of function (if they understand their deficit, they will be better able to self-monitor)
What are the 6 different types of Memory?
Memory
Retrospective
Prospective
Declarative
Procedural
Episodic
Semantic
What does Dr. Ellis feel is the most important element of memory in TBI patients?
Can they distinguish between ST + LT memory
What are 4 ways we can target memory for patients with TBI?
Have client restate in their own words
Rehearse information
Complete real life tasks for practice
Compensatory strategies
What is one strategy for targeting Memory Compensation?
5
P – preview
Q – question
R – read
S – state
T – test
What are 10 components of Executive Function?
Self awareness + realistic goal setting
Planning
Self directing
Initiating
Self-inhibiting
Self-monitoring
Self-evaluating
Self-correcting
Flexible problem solving
Judgement
What are 6 ways we can target Executive Function in patients with TBI?
Recognize the existence of a problem
Define the problem
Develop possible solutions
Identify best solution
Implement solution
Evaluate effectiveness
What might we see in Speech in patients with TBI?
Motor Speech deficits
What might we see in Language in patients with TBI?
2
Confused language
Intact semantically and syntactically
What might we see in Communication in patients with TBI?
1+3
Pragmatics deficits (due to cognitive influence)
- Confabulation
- Circumlocutory
- Tangential output
How should the Environment be modified in TBI patients at Racho Level IV?
(4)
Stimulation management
Freedom of movement
Avoid unstructured time
Fit schedule to client
What should we be aware of for Physical Management in TBI patients at RachoLevel IV?
(2)
Self Protection
Physical management of combative behavior
What else should we be aware of for TBI patients at Racho Level IV?
Medication Management
What should we be consider in TBI patients at Racho Level V + VI?
(4)
Medical management
Maintain structured environment
Team treatment approach
Basic cognitive rehabilitation
What should we be aware of in High Level Cognitive Rehabilitation for TBI patients at Racho Level VII + VIII?
(3)
Attention Concentration
Working Memory
Executive Functions
What else should we be aware of for TBI patients at Racho Level VII + VIII?
(3)
Behavior Impairments
Family Rehabilitation
Community Reintegration
What are
Instructional Techniques that might be employed when treating patients with TBI?
Direct Instruction
Errorless Learning
Component Training
Compensatory Training
What is Direct Instruction?
6
The “classic” style of treatment
Has clearly stated learning objectives and high mastery criteria
May use models and fading cues
Provides constant feedback
Individualized instruction and pacing
Provides ongoing assessment
What is the goal of Errorless Learning?
To substantially reduce, if not eliminate, errors during the acquisition of learning
How is Errorless Learning achieved?
5
Breaking down the targeted task into small, discrete steps or units
Providing sufficient models before the client is asked to perform the target task
Encouraging the client to avoid guessing
Immediately correcting error
Carefully fading prompts
What is Component Training?
2
Remediation of impaired cognitive-linguistic processes
Teaches cognitive processes one at a time
What Racho Level is required for Component Training?
3
V if not agitated
VI
VII
What is Compensatory Training?
Strategies to accommodate deficits that fit patient’s strengths and weakness
Should be able to be applied to patient’s daily environment
What are 4 Adjunctive Therapies that may be used for patients with TBI?
Nature Based Therapy
Environmental control
Behavior management
Pharmacologic management
What are the 2 components of Nature Based Therapy?
Individual should be examined with careful consideration of the dynamic interaction between the individual and his/her environment
Social, emotional, cognitive, and linguistic behaviors cannot be accurately assessed in isolation from their natural environment
What are 3 types of Nature Based Therapy?
Animal Assisted Therapy
Horticultural Therapy
Natural Environment Therapy
What do families need help understanding in the beginning stages of TBI rehabilitation?
That they will need to commit to long term management of behavior ands pharmacological management
What are the 2 different categories of Behavior Management?
Pseudopsychotic
Pseudodepressed
What are the 9 characteristics of Pseudopsychosis?
Disinheriting
Impulsiveness
Lability (uncontrolled crying - UMN issue)
Reduced anger control
Aggressiveness
Sexual acting out
Perseveration
Inefficient learning from consequences
Poor social judgment
What are the 13 characteristics of Pseudodepression?
Reduced initiation
Apathy
Lack of drive
Loss of interest
Lethargy
Slowness
Inattentiveness
Reduced spontaneity
Unconcern
Lack of emotional reactivity
Dullness
Poor grooming
Perseveration
What is Behavior Management?
2
Targets maladaptive behaviors
Facilitates successful performance by modifying behaviors that increase confusion and agitation
What is Pharmacologic Management?
Prescribing medication
Why may medications may be prescribed for patients with TBI?
1+5
To reduce….
- Agitation/aggressive behavior
- Depression
- Psychotic conditions
- Seizures
- Alertness/attention
Where might Group Treatment for patients of TBI?
May occur in inpatient and outpatient facilities
At what Ranchos Level do TBI patients need to be at before beginning Group Treatment?
V and above
What can Group Treatment address in patients with TBI?
2
Cognitive skills
Social skills
What is Community Reentry?
A supportive context to practice learned strategies for return to premorbid setting
Where are Community Reentry most likely to take place in?
2
Day Rehabilitation Programs
Transitional Living Facilities
