Final Flashcards
What causes increased ICP and collapsed lateral ventricles due to obstruction of CSF pathways?
edema (midterm)
If 02 sats are down and spont. vasodilation doesn’t occur in TBI, what are you at risk for?
hypotension and hypoxemia (midterm)
study decorticate
vs. decerebrate (midterm)
what status is coma/unresponsive more than 1 week?
severely disabled (midterm)
prognostic indicators for recovery from TBI
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
old vs. very old
75+ vs. 85+
mechanisms of recovery
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)
more mechanisms
redundancy, vicarious functioning (take on fx of something close by), functional substitution (secondary mechanism that was already here as backup)
hypernatremia vs. hyperchalemia
salt vs. sodium
hemorrhage
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
discharge disposition
will we take person on with many negative factors (resources, support, living situation, etc.)? start planning discharge at administration
Tx for low-level patients (Rancho I-III)
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
problems with initiation?
frontal lobe or apraxia
time post-onset for best recovery?
stroke: 6 mos.; TBI: depends on premorbidity and coma time (can’t tell you when, but seeing improvements…)
study SPAIN
handout
more low level
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
mid-level tx (Rancho IV-VI)
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
more mid-level
diminish confusion in environment; increase frequency and appropriateness of responses; increase cognition and incorporate into meaningful tasks
higher-level tx (Rancho VII-X)
increase and refine cog skills; increase internalization of structure; incorporate into functional/community environment
higher-level activities
increase cog load with amt. of material or complexity; compensatory strategies; cog-ling.: comparisons, analogues, fig. lang., sequencing, definitions, ant/syn, word association, categorization
HL math
balance checkbook, online banking, medications, calculate time, recipes
HL writing
checks, marking calendar, personal info. (and for reading Reader’s Digest b/c jokes, short stories, large print)
HL memory
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
FIMS
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
FIMS
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
need to study
posted TBI chapter?
