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NMR II > Final: TBI Pt 1 > Flashcards

Final: TBI Pt 1 Flashcards

1
Q

When is TBI rehab started?

A

No set standard - is dependent on the pt

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2
Q

What two conditions allow for TBI rehab to be initiated?

A
  1. Normalization of ICP
  2. Hemodynamic stability
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3
Q

What value is considered normal ICP that indicates that the pt is safe to start rehab?

A

< 20 mmHg

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4
Q

What are the four categories of TBI impairments?

A
  1. Neuromuscular
  2. Communication
  3. Cognitive
  4. Behavioral
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5
Q

What are the 6 common neuromuscular impairments following TBI?

A
  1. Impaired motor control
  2. Impaired coordination
  3. Hemiparesis
  4. Hypertonicity - posturing
  5. Somatosensory
  6. Impaired postural control
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6
Q

What are common behavioral impairments following TBI?

A

Easily frustrated, agitation, mental inflexibility, impulsivity, disinhibition, emotional lability, irritability

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7
Q

What are common cognitive impairments following TBI?

A

Arousal, attention, concentration, memory, learning, executive function

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8
Q

What does PTA stand for when discussing TBI?

A

Post Traumatic Amnesia

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9
Q

What is post traumatic amneisa?

A

Pt is unable to form new memories. Determined by neuropsychologist

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10
Q

What must the pt have in tact in order to be diagnosed with post traumatic amnesia?

A

Able to identify date, time, place, and situation consistently

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11
Q

What are other impairments that may be present following TBI?

A

Communication (not aphasia), CN involvement, visual deficits, perceptual deficits, dysphagia, secondary impairments due to immobility or comorbidities

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12
Q

What three medications address tone following TBI?

A
  1. Baclofen
  2. Diazepam
  3. Dantrolene
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13
Q

What four medications are used to control seizures following TBI?

A
  1. Depakote
  2. Keppa
  3. Dilantin
  4. Cerebyx
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14
Q

How is attention addressed with medication following TBI?

A

Neurostimulants, dopamine

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15
Q

What medication is used to address arousal following TBI?

A

Amantadine - dopamine agonist

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16
Q

When is amantadine prescribed?

A

4-16 weeks after diagnosis

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17
Q

What two medications are used for heterotopic ossification?

A

NSAIDs, biphosphonates

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18
Q

What medication is most effective to control depression following TBI?

A

Nontricyclic medications

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19
Q

Practice Question: When do we start PT rehab after brain injury?

1) one week post brain injury
2) when GCS reaches above 9
3) vitals and ICP stability
4) when the patient emerges from consciousness

A

3) vitals and ICP stability

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20
Q

Practice Question: Which of the following impairments is common after brain injury?

1) amnesia
2) apathy
3) aphasia
4) hypotonicity

A

1) amnesia

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21
Q

Practice Question: Which of the following medications has been shown to address a secondary complication of seizures?

1) amantadine
2) baclofen
3) dopamine
4) keppra

A

4) keppra

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22
Q

What is the term for Rancho level I-III?

A

Low Level Patient

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23
Q

What is the term for Rancho level IV?

A

Confused/Agitated Patient

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24
Q

What is the term for Rancho levels V-VI?

A

The Confused Patient

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25
Q

What is the term for Rancho levels VII-VIII?

A

High Level Patient

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26
Q

What are acute care concerns for a low level patient?

A

Ventilator, ICP, weightbearing restrictions, cardiac precautions, wounds, surgical sites, dysautonomia

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27
Q

What are the 5 goals for a low level patient?

A
  1. Consistently assess LOC
  2. Increase arousal and functional mobility
  3. Improve tolerance to upright
  4. Reduce risk of secondary impairments
  5. Improve or retain joint integrity and ROM
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28
Q

What is the name for Rancho Level I?

A

Coma

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29
Q

What are the four characteristics of a coma?

A
  1. Unresponsive to any stimuli
  2. Arousal system not functioning
  3. Eyes closed, ventilator
  4. No auditory, visual, cognitive, communication function
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30
Q

What is the name for Rancho Level II?

A

Unresponsive wakefulness

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31
Q

Describe unresponsive wakefullness

A

Awake but not aware, basic brainstem functions only, spontaneous eye opening, sleep/wake cycles, startle response, not able to follow commands or communicate, reflexive expressions, withdraw or posture to noxious stimuli

32
Q

What is the name for Rancho Level III?

A

Minimally conscious state

33
Q

Describe minimally conscious state

A

Awake and partially aware, inconsistent behaviors that are different than reflexes

34
Q

Pt’s need to do one or more of these things on a reproducible and sustained basis to be considered to be in a minimally conscious state?

A
  1. Follow simple commands
  2. Gestural or verbal yes/no response
  3. Intelligible verbalization
  4. Movement or emotional behavior that occur in relation to relevant stimuli, not attributable to reflexive activity
35
Q

What does MCS stand for?

A

Minimally conscious state

36
Q

What are examples of MCS?

A

Smiling or crying in response to verbal or visual emotional content, vocalization in direct response to comments or questions, visual fixations and tracking, localization to noxious stimuli

37
Q

Is a MCS pt able to communicate thoughts and feelings?

A

Yes

38
Q

The pt must demonstrate reliable and consistent demonstration of one or both of the following in order to be considered to be in emergence of MCS

A
  1. Accurate yes/no responses to 6/6 situational questions on 2 consecutive examinations
  2. Functional use of at least two different objects
39
Q

What is the gold standard to assess levels of consciousness?

A

Coma Recovery Scale Revised (CRS-R)

40
Q

What are the subscales of the CRS-R?

A
  1. Auditory
  2. Visual
  3. Motor
  4. Oromotor
  5. Communication
  6. Arousal
41
Q

What does DOCS stand for?

A

Disorders of Consciousness Scale

42
Q

What are the six subscales of the DOCS?

A
  1. Social knowledge
  2. Taste/swallowing
  3. Olfactory
  4. Proprioception
  5. Tactile sensation
  6. Auditory and visual function
43
Q

What does SMART stand for?

A

Sensory Modality and Rehab Techniques

44
Q

What are the components of SMART?

A

Sensory and behavioral observation

45
Q

What does WNSSP stand for?

A

Western Neurosensory Stimulation Profile

46
Q

What is the WNSSP?

A

Assessment of arousal/attention, expressive communication, response to stimuli. Relies on visual comprehension and tracking

47
Q

What is the goal of multi-modal sensory stimulation programs?

A

Increase arousal and attention

48
Q

What is the Reticular Activating System?

A

Cortical processing in multi-sensory, to better engagement of cortical function through lots of stimulation. Neuroplasticity occurs through environmental factors

49
Q

What are the key aspects of providing stimuli?

A
  1. Controlled and structured
  2. Multi-sensory
  3. Balance of stimulation and rest
  4. Monitor pt response
  5. Assess with outcome measures
50
Q

What is FAST (familiar auditory stimulation training)?

A

5 min story telling by pt’s relatives that involve autobiographical events

51
Q

What are the results of FAST (familiar auditory stimulation training)?

A

Improvements in CRS and increased activation of language areas on fMRI

52
Q

What are the results of music therapy in MCS?

A

More eye contact and smiles, improves BP, greater activation of auditory network and physical responses

53
Q

What level of consciousness is multimodal stimulation more effective in?

A

It is more effective in MCS than VS or UWS

54
Q

What are key things to be mindful of with multi-modal sensory stimulation programs?

A

Begin early, perform frequently, avoid overstimulating, non-distracting environment, allow time to respond

55
Q

What are benefits of early mobilization?

A

Shorter length of stay, increase chance of discharging to home, decreased secondary complications, improve outcomes due to neuroplastic changes

56
Q

What are the two contraindications for early mobilization?

A
  1. Unstable spine
  2. Increased or increasing ICP
57
Q

What are the four precautions for early mobilization?

A
  1. WB restrictions
  2. Skin and joint integrity
  3. Autonomic instability
  4. CV status
58
Q

What is the goal of early mobilization?

A

Increase alertness with stimulation in different positions and environments to improve level of consciousness, GI motility, ROM, CV response

59
Q

What four secondary impairments are likely?

A
  1. Contractures
  2. Pressure sores
  3. Pneumonia
  4. DVT
60
Q

What are the weight shifting parameters for positioning in a wheelchair?

A

Every 30 minutes for 2 minutes (tilt in space, cushion)

61
Q

What are the parameters and conditions for positioning in bed?

A

Turn every two hours. Hips and knees should be slightly flexed

62
Q

What interventions are indicated to manage muscle tightness and joint stiffness?

A

Stretching, weightbearing, splinting, serial casting

63
Q

What are the four key concepts of family education and support?

A
  1. Maintain open communication
  2. Involve family in POC and decisions
  3. Educate on current evidence
  4. Provide realistic and consistent messages
64
Q

What are guidelines for pt’s with severe disorders of consciousness?

A

Multidisciplinary, standardized outcomes, can still have a favorable prognosis after 28 days, be aware of medical complications

65
Q

When can a MD prescribe amantadine, and what does it do?

A

4 weeks to increase arousal

66
Q

What % is there to regain consciousness after being in an unresponsive wakefullness state for one month?

A

50%

67
Q

What is the name for Ranchos Level IV?

A

Confused-Agitated

68
Q

Describe a confused-agitated pt

A

Heightened state of activity, not purposeful behavior, bizarre, confusion, brief attention, memory impaired, aggression, unable to cooperate, unable to learn new info

69
Q

What are the primary exam goals for a pt in a confused and agitated state?

A
  1. Identify behavioral and cognitive concerns
  2. Impairments and function
  3. Goal is not to progress function, use familiar activities and focus on participation and tolerance to session
70
Q

What are challenges for working with a pt in a confused and agitated state?

A

Amnesia, confused, decreased attention, distracted, uncooperative, agitation, aggressive, impaired insight into deficits

71
Q

What are environmental conditions for managing agitation?

A

Closed, allow for freedom of movement, low distraction, dim lighting

72
Q

What are methods for maintaining consistency when managing agitation?

A

Address inappropriate behaviors in a consistent manner, re-orient, follow schedule, use daily charts, expect no carry over without new learning

73
Q

Which is the first choice when dealing with an agitated pt, medical or behavior intervention?

A

Behavioral - restraints are last choice

74
Q

What are examples of medications to use to control an agitated pt?

A

Propanolol, trazadone, SSRIs, tegretol, seroquel, ativan

75
Q

What is the Agitated Behavior Scale?

A

Observation period in a set environment

76
Q

What are the rehab goals for a confused agitated state?

A

Motor relearning, no new learning is possible, endurance, activity tolerance, improve attention, education, prevent agitation, behavior

NMR II (27 decks)

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