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Neuromuscular (KK) > exam 3: moderate TBI > Flashcards

exam 3: moderate TBI Flashcards

1
Q

this describes what type of TBI:
- second most severe type
- middle GCS level
- mod-high medical needs
- some LOC
- post-trauma amnesia for at least 1 day and less than 7 days
- marked confusion by Rancho Level

A

moderate TBI

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2
Q

a mild TBI is also known as:
– 3 distinct characteristics:

A

concussion
- possibly no LOC
- <1 day of PTA
- no injury on neuroimaging

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3
Q

moderate TBI:
- GCS score:
- PTA days?
- loss of consciousness for how long?

A
  • 9-12
  • 1-7 days (O-log score <25 for at least 1 day and less than 7)
  • 30 min to 24 hours
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4
Q

Rancho levels for moderate TBI:
- level IV
- level V
- level VI

A
  • confused-agitated
  • confused-inappropriate
  • confused-appropriate
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5
Q

what Rancho level is this describing?
- hyperaroused
- behavior is bizarre and not purposeful
- unable to cooperate
- incoherent or inappropriate words or stories (confabulate)
- no selective attention
- lacks recall
- limited ability to learn

A

level IV - confused-agitated

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6
Q

what Rancho level is this describing?
- respond to simple commands
- random response to complex commands
- attention to environment but not task
- verbalizations are confabulatory or inappropriate
- memory is impaired
- inappropriate use of objects
- can perform old learned tasks, but difficulty learning new ones

A

level V - confused-inappropriate

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7
Q

what Rancho level is this describing?
- goal directed behavior but needs external input
- carry-over from relearned tasks
- follows simple directions
- past memories show up in more depth
- wrong answer to questions, but appropriate in answers

A

level VI - confused-appropriate

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8
Q

when taking history of a moderate TBI patient, should you completely rely on them for accurate information?
Should you still consult with the RN for behavior strategies at this stage?

A

no, often confused and confabulate due to limitations in arousal, consciousness and behavior
- yes, even though medical status is not as dynamic in this stage

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9
Q

5 categories of attention:
1. _______ attention - process and respond to specific info.
2. _____ attention - perform an activity continuously over a period of time
3. _______ attention - focuses on one thing, perform activity with distracting stimuli
4. _______ attention - shifts focus of attention between multiple stimuli
5. ______ attention - respond to multiple stimuli simultaneously

A
  1. focused
  2. sustained
  3. selective
  4. alternating
  5. divided
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10
Q

Do TBI patients typically have the capacity for attention?
- if so, what outcome measure would be best?

A

not usually
MARS

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11
Q

higher thought functions that represent advanced cognitive functions which are dependent on the presence of basic cognitive functions

A

executive functions

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12
Q

the ability to understand either oneself or an external situation

A

insight

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13
Q

the ability to form an opinion or reach a decision after comparing options

A

judgment

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14
Q

cognition drives behavior:
– paying attention requires ____ ____ –> leads to _____ _____ –> leads to _____ and _____

A

cognitive demand ; cognitive fatigue ; agitation and irritability

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15
Q

decreased executive function presents as

A

misbehavior

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16
Q

patient is diagnosed with a moderate TBI and has significant affect/behavioral changes upon meeting them. which outcome measure is most appropriate to use?

A

agitated behavior scale

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17
Q

which outcome measure is this?
- measures behavioral aspects of agitation during the acute phase of recovery from a TBI
- measures aggression, disinhibition and lability
- can also be used with dementia

A

agitated behavioral scale (ABS)

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18
Q

ABS scoring:
- ___ items scored
- min score ___
- max score ___
- _____ scores are better
- ____ = WNL, ____ = severe agitation

A
  • 14
  • 14
  • 56
  • lower
  • </=21 ; >/= 36
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19
Q

what is all included in your neuro screen of a moderate TBI patient?
–> what two are included only if appropriate?

A
  • PROM (tone)
  • motor exam
  • sensory exam
  • reflexes (identify improved CNS control)
  • postural stability
  • gait
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20
Q

what are the 6 outcome measures that look at gait, balance, and transfers for a general neurologic injury?

A
  • 6 MWT
  • 10 MWT
  • Berg balance scale
  • functional gait assessment (FGA/DGI)
  • activities-specific balance confidence scale
  • 5x sit to stand test
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21
Q

what 3 outcome measures are recommended for TBI in the inpatient setting?

A

FAM+FIM
Barthel index
Disability Rating Scale

22
Q

what 3 outcome measures are recommended for TBI in the outpatient setting?

A

high level mobility assessment
community balance and mobility scale
quality of life after brain injury

23
Q

14 item scale designed to measure balance of the geriatric adult or neuro patient in a clinical setting to assess for fall risk and takes 15-20 minutes to administer
- Has static and dynamic balance tests

A

Berg balance scale

24
Q

Berg balance scale scoring:
- higher score =
- score of _____ = independent
- score _____ = fall risk
- is this the best outcome measure for a TBI pt? why or why not?

A
  • higher function
  • 45-56
  • < 45
  • no, ceiling effect possible
25
Q

measures confidence in performing various activities without losing balance or experiencing unsteadiness
- self report measure

A

Activities specific balance confidence scale (ABC)

26
Q

what is the disadvantage of the ABC scale?

A

subjective to patient
self-efficacy plays a role

27
Q

consists of 12 items added to the FIM to enhance its utility for the brain injury population

A

FAM (functional assessment measure)

28
Q

assesses ability of an individual with a neuromuscular or msk disorder to care for him/herself
- inpatient rehab measure
- not specific to TBI or stroke

A

barthel index

29
Q

Barthel index scoring:
- high scores =
- scoring based on _____

A
  • more independence
  • amount of assistance required
30
Q

the Barthel index is similar to the _____ but it includes ____

A

FIM
evaluation of independence

31
Q

observer rated measure of general functional changes over the course of recovery for individuals with moderate to severe TBI

A

Disability Rating Scale (DRS)

32
Q

the DRS evaluates 8 areas of functioning in 4 categories. what are the 4?

A
  1. consciousness
  2. cognitive ability
  3. dependence on others
  4. employability
33
Q

DRS scoring:
- rated on scale of 0 to either ___ or ____
- high score =
- max score =
- min score =

A
  • 3 or 5
  • higher level of disability
  • 29-extreme vegetative state
  • 0-person without disability
34
Q

designed to assess high level motor performance in TBI patients
- must be able to ambulate independently 20 meters w/o AD
- used in outpatient setting

A

High level mobility assessment tool (HiMAT)

35
Q

what type of activities are performed in the HiMAT?

A

13 items - running, skipping, hopping, jumping, stairs at max safe speed

36
Q

HiMAT scoring:
- higher scores =
- total scores range ____
- normative values (18-25 y.o) –> males: ____ females: _____

A
  • greater performance
  • 0-54
  • males: 50-54
    females: 44-54
37
Q

used to detect high level balance and mobility deficits based on tasks that are commonly encountered in community environments

A

community balance and mobility scale

38
Q

community balance and mobility scale is similar to HiMAT but …

A

not specific to TBI

39
Q

community balance and mobility scale scoring:
- score of 0 =
- score of 5 =
- max score of
- high score =

A
  • complete inability to perform the task
  • most successful completion of the item possible
  • 96
  • high function
40
Q

what is the main PTs role in the subacute phase for moderate TBI interventions?

A
  • motor relearning or return to mobility (compensation vs restoration)
41
Q

what rancho level should the PT focus on:
- managing behavior agitation in subacute phase

A

Rancho level IV –> reorientation is primary focus

42
Q

what rancho level should the PT focus on:
- managing orientation/cognition in subacute phase

A

rancho level V and VI

43
Q

intervention considerations for a moderate TBI pt:
- practice should be ______
- self ____ and executive _____
- ___ ____ performance
- _____ conditioning

A
  • distributed with frequent rest periods
  • efficacy ; function
  • dual task
  • aerobic
44
Q

what are 3 options for more alert patients w/ moderate TBI to help with return to mobility?

A

standing frame
body weight support system
sabina lift

45
Q

what are considerations for providing behavior managment?

A
  • work on familiar activities in closed environment
  • use your ANS to regulate theirs (calm, open, low stimulation)
  • do not escalate with them
  • promote your safety and theirs first
  • develop behavior modification plan (rancho V and VI)
46
Q

what are considerations for providing cognition/executive function interventions?

A

** this is focus of SLP and OT interventions, but we need to reinforce them
- promote safety and appropriate behavior
- start simple
- incorporate cognitive thought into mobility (mental walkthroughs, self reflection)

47
Q

considerations for providing caregiver training for a moderate TBI patient if they need:
- physical assist
- supervision for cognition

A
  • body mechanics and equipment
  • safety strategies, redirection techniques, stimulation schedules, behavioral management, de-escalation techniques
48
Q

when developing your plan of care and focusing on community reintegration after discharge, what are some things you need to do/consider?

A
  • help pt set their own schedule
  • interdisciplinary emphasis on return to work, school and pragmatic situations
  • emphasize self-responsibility
  • encourage independent and cooperative work
  • emphasize need for exercise
49
Q

what outcome measure could you use for a TBI patient after community integration?

A

quality of life after brain injury questionnaire

50
Q

quality of life after brain injury questionnaire scoring:
- ______ self rated items
- 0 =
- 100 =

A

37 self rated items
0 = worst possible QOL
100 = best possible QOL

Neuromuscular (KK) (21 decks)

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