4.1 - TBI - Treatment of Traumatic Brain Injury Flashcards by Keco Voco

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

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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

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

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

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

IV - VI

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What are the two philosophies for treating patients with TBI?

Remediation approach

Compensation approach

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What is a Remediation approach to treating patients with TBI?

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

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

The notion of neuroplasticity (still theoretical)

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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

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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

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

Physically

Auditory/Visually

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

(2)

Cognitive domains

Function

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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

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

Seconds

Minutes

Entire session

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

1:1

Group

Controlled

Normal

Office setting

Open gym setting

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

Constant

Intermittent

Occasional

Independent

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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

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What 8 Cognitive Domains might be addressed in TBI patients?

Attention

Memory

Organization

Planning

Problem solving

Reasoning

Executive skills

Pragmatics

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

Immediate

Social impact

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

Useful goals

Natural settings

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

Cognitive-communicative skills

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

Linguistically

Culturally

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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)

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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

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What 4 concepts are we looking for in patient orientation?

Person

Place

Time

Situation

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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