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CCD > 4.1 - TBI - Treatment of Traumatic Brain Injury > Flashcards

4.1 - TBI - Treatment of Traumatic Brain Injury Flashcards

1
Q

What 6 things should we consider when treating TBI patients?

A

Level of alertness

Attention span

Agitation

Level of memory impairment

Premorbid level of functioning/lifestyle

Functional goals/targets

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2
Q

What are the 4 General Principles for treating patients with TBI?

A

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

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3
Q

What time of day is usually ideal for treating TBI patients?

A

10:00 a.m. - 2:00 p.m.

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4
Q

At what Ranchos Levels do we need to control a patient’s environment?

A

IV - VI

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5
Q

What are the two philosophies for treating patients with TBI?

A

Remediation approach

Compensation approach

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6
Q

What is a Remediation approach to treating patients with TBI?

A

Retraining specific cognitive domains with the expectation that specific skills will improve

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7
Q

What is the Remediation approach to treating patients with TBI based on?

A

The notion of neuroplasticity (still theoretical)

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8
Q

What is a Compensation approach to treating patients with TBI?

(2)

A

Compensatory strategies are used to address observed cognitive deficits

These may be temporary or permanent

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9
Q

What is often used in the Compensation approach to treating patients with TBI?

(2)

A

Modification of environments to maximize abilities

Can be Physical or Auditory/Visual

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10
Q

What are two ways we can modify environments to maximize abilities in patients with TBI?

A

Physically

Auditory/Visually

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11
Q

What should we focus on when setting goals for patients with TBI?

(2)

A

Cognitive domains

Function

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12
Q

What 5 things should be part of goals for patients with TBI?

A

Cognitive domain to be addressed

Duration when appropriate

Therapy environment (environmental compensation or control)

Level of supervision

Level of “verbal” cuing

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13
Q

What are 3 Duration lengths that may be used with TBI patients?

A

Seconds

Minutes

Entire session

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14
Q

What are 5 different Therapy Environment that may be used with TBI patients?

A

1:1

Group

Controlled

Normal

Office setting

Open gym setting

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15
Q

What are 4 Levels of Supervision that may be used with TBI patients?

A

Constant

Intermittent

Occasional

Independent

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16
Q

What 4 Levels of “Verbal” Cuing that may be used with TBI patients?

A

Constant verbal cuing

Intermittent verbal cuing

Occasional verbal cuing

No verbal cuing

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17
Q

What 8 Cognitive Domains might be addressed in TBI patients?

A

Attention

Memory

Organization

Planning

Problem solving

Reasoning

Executive skills

Pragmatics

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18
Q

When selecting goals for TBI patients, we should choose goals that will make an _______ and __________ on cognitive-communicative skills.

A

Immediate

Social impact

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19
Q

When selecting goals for TBI patients, we should choose the most __________ that may be produced and reinforced in other ____________.

A

Useful goals

Natural settings

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20
Q

When selecting goals for TBI patients, we should choose goals that expand ___________.

A

Cognitive-communicative skills

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21
Q

When selecting goals for TBI patients, we should choose goals that are _______ and _______ appropriate.

A

Linguistically

Culturally

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22
Q

What are the 5 sections to a treatment session for patients with TBI?

A

Introduction (2-3 min)

Teach Concept (2-5 min)

Practice (13-18 min)

Assess Learning (while practicing)

Summary/Conclusion (2-4 min)

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23
Q

What 8 Treatment Targets are regularly used with patients with TBI?

A

Orientation

Attention

Attention/Concentration

Memory

Memory Compensation

Problem Solving

Executive Function

Speech-Language/Communication

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24
Q

What 4 concepts are we looking for in patient orientation?

A

Person

Place

Time

Situation

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25
Q

What are the 5 different types of Attention?

A

Focused attention

Sustained attention

Selective attention

Divided attention

Alternating attention

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26
Q

What 2 types of Attention does Dr. Ellis feel are most important?

A

Sustained

Selective

27
Q

How might we target Attention/Concentration for patients with TBI?

A

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)

28
Q

What are the 6 different types of Memory?

A

Memory

Retrospective

Prospective

Declarative

Procedural

Episodic

Semantic

29
Q

What does Dr. Ellis feel is the most important element of memory in TBI patients?

A

Can they distinguish between ST + LT memory

30
Q

What are 4 ways we can target memory for patients with TBI?

A

Have client restate in their own words

Rehearse information

Complete real life tasks for practice

Compensatory strategies

31
Q

What is one strategy for targeting Memory Compensation?

5

A

P – preview

Q – question

R – read

S – state

T – test

32
Q

What are 10 components of Executive Function?

A

Self awareness + realistic goal setting

Planning

Self directing

Initiating

Self-inhibiting

Self-monitoring

Self-evaluating

Self-correcting

Flexible problem solving

Judgement

33
Q

What are 6 ways we can target Executive Function in patients with TBI?

A

Recognize the existence of a problem

Define the problem

Develop possible solutions

Identify best solution

Implement solution

Evaluate effectiveness

34
Q

What might we see in Speech in patients with TBI?

A

Motor Speech deficits

35
Q

What might we see in Language in patients with TBI?

2

A

Confused language

Intact semantically and syntactically

36
Q

What might we see in Communication in patients with TBI?

1+3

A

Pragmatics deficits (due to cognitive influence)

  • Confabulation
  • Circumlocutory
  • Tangential output
37
Q

How should the Environment be modified in TBI patients at Racho Level IV?

(4)

A

Stimulation management

Freedom of movement

Avoid unstructured time

Fit schedule to client

38
Q

What should we be aware of for Physical Management in TBI patients at RachoLevel IV?

(2)

A

Self Protection

Physical management of combative behavior

39
Q

What else should we be aware of for TBI patients at Racho Level IV?

A

Medication Management

40
Q

What should we be consider in TBI patients at Racho Level V + VI?

(4)

A

Medical management

Maintain structured environment

Team treatment approach

Basic cognitive rehabilitation

41
Q

What should we be aware of in High Level Cognitive Rehabilitation for TBI patients at Racho Level VII + VIII?

(3)

A

Attention Concentration

Working Memory

Executive Functions

42
Q

What else should we be aware of for TBI patients at Racho Level VII + VIII?

(3)

A

Behavior Impairments

Family Rehabilitation

Community Reintegration

43
Q

What are

Instructional Techniques that might be employed when treating patients with TBI?

A

Direct Instruction

Errorless Learning

Component Training

Compensatory Training

44
Q

What is Direct Instruction?

6

A

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

45
Q

What is the goal of Errorless Learning?

A

To substantially reduce, if not eliminate, errors during the acquisition of learning

46
Q

How is Errorless Learning achieved?

5

A

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

47
Q

What is Component Training?

2

A

Remediation of impaired cognitive-linguistic processes

Teaches cognitive processes one at a time

48
Q

What Racho Level is required for Component Training?

3

A

V if not agitated

VI

VII

49
Q

What is Compensatory Training?

A

Strategies to accommodate deficits that fit patient’s strengths and weakness

Should be able to be applied to patient’s daily environment

50
Q

What are 4 Adjunctive Therapies that may be used for patients with TBI?

A

Nature Based Therapy

Environmental control

Behavior management

Pharmacologic management

51
Q

What are the 2 components of Nature Based Therapy?

A

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

52
Q

What are 3 types of Nature Based Therapy?

A

Animal Assisted Therapy

Horticultural Therapy

Natural Environment Therapy

53
Q

What do families need help understanding in the beginning stages of TBI rehabilitation?

A

That they will need to commit to long term management of behavior ands pharmacological management

54
Q

What are the 2 different categories of Behavior Management?

A

Pseudopsychotic

Pseudodepressed

55
Q

What are the 9 characteristics of Pseudopsychosis?

A

Disinheriting

Impulsiveness

Lability (uncontrolled crying - UMN issue)

Reduced anger control

Aggressiveness

Sexual acting out

Perseveration

Inefficient learning from consequences

Poor social judgment

56
Q

What are the 13 characteristics of Pseudodepression?

A

Reduced initiation

Apathy

Lack of drive

Loss of interest

Lethargy

Slowness

Inattentiveness

Reduced spontaneity

Unconcern

Lack of emotional reactivity

Dullness

Poor grooming

Perseveration

57
Q

What is Behavior Management?

2

A

Targets maladaptive behaviors

Facilitates successful performance by modifying behaviors that increase confusion and agitation

58
Q

What is Pharmacologic Management?

A

Prescribing medication

59
Q

Why may medications may be prescribed for patients with TBI?

1+5

A

To reduce….

  • Agitation/aggressive behavior
  • Depression
  • Psychotic conditions
  • Seizures
  • Alertness/attention
60
Q

Where might Group Treatment for patients of TBI?

A

May occur in inpatient and outpatient facilities

61
Q

At what Ranchos Level do TBI patients need to be at before beginning Group Treatment?

A

V and above

62
Q

What can Group Treatment address in patients with TBI?

2

A

Cognitive skills

Social skills

63
Q

What is Community Reentry?

A

A supportive context to practice learned strategies for return to premorbid setting

64
Q

Where are Community Reentry most likely to take place in?

2

A

Day Rehabilitation Programs

Transitional Living Facilities

CCD (16 decks)

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