Eval, Assessment and Management of Brain Injury Flashcards
Model of Clinical Practice
-Exam: measuring
-Eval: taking the exam and implications (ICF)
-Diagnosis
-Prognosis: ICF, co-morbidities, environment
-Intervention: treat, education
-Outcomes
Internal Classification of Function
Health Condition: Stoke
Body Function and Structure: weakness, sensory, pain, location, tone, apraxia, executive function, BS issues
Activity: walking, sitting, speech, ADLs, IADLs
Participation: job, hobbies, ADLs, social
Environmental: home, stairs, bathroom, kitchen access
Personal Factors: insurance, support, money, depression
ANPT Neuro Core Measures
-Berg Balance
-Functional Gait Assessment
-Activities-Specific Balance Confidence Scale
- 6MWT
-10 Metter Walk Test
-5STS
-not always great for non-ambulatory
-should observe score and quality/compensations
-score on the lowest
ANTP Stroke Outcome Measure Recs
-StrokEDGE Recs: FIM, Fugl-Meyer, Postural Ass Scale for Stroke, Stoke Impact Scale, Trunk Impairment Scale
-Traumatic Brain Injury EDGE Recs
Stroke Impact Scale
-SIS
-subjective experience of stroke impact on life
-quality of life, impairments, activity limitation
-strength, memory, mood, communication, ADLS. mobility, hobbies, work
Postural Assessment Scale for Stroke Patients
-PASS
-maintaining and changing posture
Functional Independence/Assessment Measure
-FIM/FAM
-general rehabilitation
-not specifically post stoke
-Activities Supine to transfers to locomotion
-Assistance or not
7:Complete Independence
6: Modified Independence
5: Supervision or Set up No hands on
4: Min Assist= >75%
3: Moderate Assist= 50-74%
2: Max Assist= 25-49%
1:Total Assist=0-24%
Stroke Rehabilitation Assessment of Movement
-STREAM
-progressive
-voluntary mmt of limb
-measure the quality of movement
-measures impairment and activity level
Fugl-Meyer Test
-sensory and motor function, function and limitations
-synergies, reflexes
Glasgow Coma Scale
-GCS
-3-15, Eyes, Motor, Verbal
-used at scene of accident, ER, acute care
-predictor of future outcomes
3-8: severe injury, 44%, coma
9-12: moderate injury, 15%
13-15: mild injury, 41%
Limitations:
-language barriers
-prexisting conditions
-alcohol
Eyes: 1-4, none, pain, speech, spontaneous
Verbal: 1-5, None, incomprehensible, inappropriate, confused, oriented
Motor: 1-6, None, extension, flexion, withdraws, localizes, obeys
Rancho Los Amigos Level of Cognitive Functioning Scale
1-3
- No response (no sleep/wake cycles)
- Generalized Response
-limited, inconsistent responses
-general reflexes to pain - Localized Response
-purposeful responses, follow simple commands
-lots of tubes
-asleep or awake
-high risk for skin breakdown and seizures
-NPO
-unstable vitals
-extreme hypertonicity
-GCS 3-8
-disordered consiousness
Rancho Los Amigos Level of Cognitive Functioning Scale
4
- Confused, Agitated
-heightened state of activity, confusion, disorientation, agressive behavior
-internal confusion
-violence
Rancho Los Amigos Level of Cognitive Functioning Scale
5-6
- Confused, Inappropriate, non-agitated
-alet, distractable, verbally or sexually inappropriate
-doesnt learn new info - Confused, appropriate
-good directed behavior**
- needs cueing but can relearn**
-memory problems
Rancho Los Amigos Level of Cognitive Functioning Scale
7
- Automatic, Appropriate
-out of PTA
-robot like
-minimal confusion
-shallow recall
-needa structure
-problem solving
Rancho Los Amigos Level of Cognitive Functioning Scale
8
- Purposeful, Appropriate
-alert, oriented
-cognitively independent
-function at reduced levels in society
-integrates past events
Rancho Los Amigos Level of Cognitive Functioning Scale
9-10
- Purposeful and Appropriate- Stand by Assistance on Request
- Purposeful and Appropriate- Modified Independent
Trunk Impairment Scale
-Static Sitting Balance
-Dynamic Sitting Balance
-Co-Ordination
Function in Sitting Test
-reactive and anticipatory balance
-Nudge, EO/EC, picking up behind, lat, forward, scooting
Movement System Diagnoses
- Movement Pattern Coordination Deficit
- Force Production Deficit
- Fractionated Movement Deficit
- Postural Vertical Deficit
- Sensory Selection & Weighting Deficit
- Sensory
Prognostic Measures
-Orpington Prognostic Scale
-Clinical Signs of Poor Prognosis post Stroke
CPG for Locomotion for Chronic Stroke, TBI, InSCI
-to improve WALKING
- Walking mod to high intensity (post stroke and SCI)
- VR Walking Training following acute onset (post stroke and SCI)
- Strength train >70% 1RM
- Stepping/circuit/cycling 75-85% HRmax
- NO static/sitting balance
- NO robot ass gait training
- Can use static of dynamic balance with VRf
CPG for Use of AFOs and FES (E-Stim) Post Stroke
FES and AFO: Quality of life, chronic walking endurance, other mobility, Dynamic Balance, Gait speed, Chronic Muscle Strength/Activation (may provide AFO)
May Provide FES and AFO: Acute walking endurance
Should Not provide FES and AFO: Tone/Spasticity
Types of Activities
Functional Activities: work directly toward functional goals
Contrived Activities: work towards functional activities but not directly to goals
Education
Predictors of Poor Rehab Outcome
Dementia
Global Aphasia
Previous Stroke
Older Age
Incontinence
Severe Visuospatial deficits
Persistent Sensory Defifits
Core Tasks
- Sitting
- Sit to Stand
- Standing
- Walk and Turn
- Step up/down
- Reach, Grasp, manipulate
Movement Pattern Coordination
-inability to coordinate an intersegmental task because of a deficit wih timing and sequency
-improves with practice and instruction
S/s: Fractionated mmt, little to no ataxia
Force Production Deficit
-flaccid tone
-weakness and fatigue
S/s: fracionated mmt, little postural control
Fractionated Movement Deficit
-inability to fractionate movement
-hypertonic tone restricting
S/s: stiffness, extensor tone
Postural Vertical Deficit
-inaccurate perception of vertical orientation
-resist pushing
-backward disquilibrium behavior
S/s: difficulty planing, sensation issues, impulsiveness
Sensory Selection and Weighting Deficit
-inability to maintain posture or motor performance difficulty sreening for and attending to sensory input
-do not resist pushing
-sensitivity to sensory stimuli
S/s: fractionated mmt, self stimulation
Sensory Detection Deficit
-inability to execute intersegmental movement due to lack of join position sense
-sensation deficits
-proprioception deficits
S/s: poor timing, slow movements
Hypokinesia
-slow movements (initiatting and executing)
-stopping ongoing movement
S/s: rigid movement, undershooting movement, delayed reflexes
Dysmetria
-inability to grade forces appropriattely for task
-worse with higher speeds
-non equilibrium coordination
S/s: standing issues
Cognitive Deficit
-lack of aroussal, attention, or abiliity to apply meaning to a situation
-could be a modifier
UE Flexion Synergy
-Scapular Elevation
-Scapular Retraction*
-Shoulder Abd & ER
-Elbow flexion*
-Forearm Supination
-Wrist flexion*
-Finger Flexion*
UE Extension Synergy
-Scapular Depression*
-Scapular Protraction
-Shoulder extension*
-Shoulder add*
-Shoulder IR*
-Elbow Extension
-Forearm Pronation*
-Wrist Extension
-Finger flexion*
UE Resting Synergy
-Scapular Depression
-Scapular Retraction
-Shoulder extension
-Shoulder add
-Shoulder IR
-Elbow flexion
-Forearm Pronation
-Wrist flexion
-Finger Flexion
LE Flexion Synergy
-Pelvic elevation*
-Pelvic retraction*
-Hip Flexion*
-Hip Abd
-Hip ER
-Knee Flexion
-Ankle DF
-Foot Inversion*
LE Extension Synergy
-Pelvic depression
-Pelvic protraction
-Hip extension
-Hip Add*
-Hip IR*
-Knee Extension*
-Ankle PF*
-Foot Inversion*
LE Resting Synergy
-Pelvic elevation
-Pelvic retraction
-Hip Flexion
-Hip Add
-Hip IR
-Knee Extension
-Ankle PF
-Foot Inversion
