Final

Question 1

What causes increased ICP and collapsed lateral ventricles due to obstruction of CSF pathways?

Answer 1

edema (midterm)

Question 2

If 02 sats are down and spont. vasodilation doesn’t occur in TBI, what are you at risk for?

Answer 2

hypotension and hypoxemia (midterm)

Question 3

study decorticate

Answer 3

vs. decerebrate (midterm)

Question 4

what status is coma/unresponsive more than 1 week?

Answer 4

severely disabled (midterm)

Question 5

prognostic indicators for recovery from TBI

Answer 5

age (younger, better: best is 6-35 due to plasticity), GCS (Glasgow, esp. motor), secondary medical issues (fewer), premorbid status (education, industrious, health, etc.), premorbid personality, duration of PTA

Question 6

old vs. very old

Answer 6

75+ vs. 85+

Question 7

mechanisms of recovery

Answer 7

resolution of temp. factors like edema/ICP/hemorrhage; modified neuronal connection regeneration (nerve cells) and collateral sprouting (grow to new connections); modified synaptic function (redundancy; biologic insurance)

Question 8

more mechanisms

Answer 8

redundancy, vicarious functioning (take on fx of something close by), functional substitution (secondary mechanism that was already here as backup)

Question 9

hypernatremia vs. hyperchalemia

Answer 9

salt vs. sodium

Question 10

hemorrhage

Answer 10

if don’t die within 72 hours, recovery changes better than ischemic; microphages clean up extra blood (recovery more gradual for ischemic); use CAT scan to visualize bleeding

Question 11

discharge disposition

Answer 11

will we take person on with many negative factors (resources, support, living situation, etc.)? start planning discharge at administration

Question 12

Tx for low-level patients (Rancho I-III)

Answer 12

prevent sensory deprivation (try to get cortical evoked potentials to see if ready for this); consider types/consistency of responses; modes of sending/receiving info.; visit 2x/day for 15 min. at different times if rehab (after bath good, but not after PT); use meaningful stimuli like pics of children or team jersey for tracking

Question 13

problems with initiation?

Answer 13

frontal lobe or apraxia

Question 14

time post-onset for best recovery?

Answer 14

stroke: 6 mos.; TBI: depends on premorbidity and coma time (can’t tell you when, but seeing improvements…)

Question 15

study SPAIN

Answer 15

handout

Question 16

more low level

Answer 16

develop yes/no system as soon as consistent response develops; develop pointing; need sophisticated scoring grid like NR/incomplete with rep; delayed with rep; complete with rep and cue; complete and timely (4); thermal stimulation with ice or vibrotactile

Question 17

mid-level tx (Rancho IV-VI)

Answer 17

decrease frequency, duration, intensity of agitation; short phrases but no carryover; increase attention to external environment (stimulating/overstimulating?); monitor cueing and decide whether antecedent to agitation

Question 18

more mid-level

Answer 18

diminish confusion in environment; increase frequency and appropriateness of responses; increase cognition and incorporate into meaningful tasks

Question 19

higher-level tx (Rancho VII-X)

Answer 19

increase and refine cog skills; increase internalization of structure; incorporate into functional/community environment

Question 20

higher-level activities

Answer 20

increase cog load with amt. of material or complexity; compensatory strategies; cog-ling.: comparisons, analogues, fig. lang., sequencing, definitions, ant/syn, word association, categorization

Question 21

HL math

Answer 21

balance checkbook, online banking, medications, calculate time, recipes

Question 22

HL writing

Answer 22

checks, marking calendar, personal info. (and for reading Reader’s Digest b/c jokes, short stories, large print)

Question 23

HL memory

Answer 23

increase length of time and no. of things, compensatory techniques (write, repeat, visualize, associate, chunking), relates to comprehension, use FIMS as benchmark, divided attention, log of what you did, names of therapists

Question 24

FIMS

Answer 24

areas to score include eating, comprehension, expression, social interaction, problem solving, memory; like NOMS for rehab; and IRFPAI eval done by interdisciplinary team within 72 hours of intake and again before discharge

Question 25

FIMS

Answer 25

NO HELPER: 7: complete independence, timely and safe; 6: modified independence, device; HELPER: 5: supervision; 4: min assist (75%+); 3: mod assist (50%+); HELPER COMPLETE DEPENDENCE: 2: max assist (25%+); 1: total assist (less than 25%); 0=didn’t occur

Question 26

need to study

Answer 26

posted TBI chapter?