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NMR II > Final: TBI Pt 2 > Flashcards

Final: TBI Pt 2 Flashcards

1
Q

What levels are consider to be confused patients?

A

Levels IV,V and VI

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2
Q

What is the name for Ranchos Level V?

A

Confused-Inappropriate

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3
Q

Describe the confused-inappropriate pt

A

Able to follow simple commands consistently, non-purposeful response to complex situations, socialization for short periods, distractible, inappropriate verbalizations, impaired memory, unable to learn new info, poor safety awareness

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4
Q

What is the name for Ranchos Level VI?

A

Confused-Appropriate

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5
Q

Describe a confused-appropriate pt

A

Goal directed behavior, recognize needs, perform automatic tasks, carryover of re-learned tasks, follow simple commands and schedule, long term memory better than short term, poor insight into cognitive deficits

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6
Q

What are the treatment goals for Ranchos Level V and VI?

A
  1. Increase safety and independence with mobility and ADLs
  2. Improved postural control, balance, gait
  3. Improve strength and endurance
  4. Education with consideration of cognitive and behavioral concerns
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7
Q

What are examination considerations for Ranchos Level V and VI?

A

Formalized testing, frequent re-orientation, still confused without new learning, memory deficits, needs to be supervised due to safety awareness

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8
Q

What are treatment strategies for Ranchos Level V and VI?

A

Work in meaningful environments, reduce distractions, short PT with breaks, limit task complexity, provide structure, salient

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9
Q

What are communication strategies for Ranchos Levels V and VI?

A

Repeat information as needed, use memory planner, avoid too many questions, explain what is going to happen between activities, allow time for processing and response

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10
Q

What is the Moss Attention Rating Scale?

A

Observational tool to evaluate attention following TBI. Rated by multiple team members over the course of 3 days, average score is used

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11
Q

What is an Orientation Log?

A

Valid and reliable measure of orientation to time, place, and circumstance

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12
Q

What is the Galveston Orientation and Amnesia Test?

A

Rarely administered by PT - measures post-traumatic amnesia

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13
Q

What balance outcome measure is validated for TBI?

A

Berg

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14
Q

What Ranchos Levels are considered to be higher level rehabilitation?

A

Levels VII and VIII

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15
Q

What is the name for Ranchos Level VII?

A

Automatic-Appropriate

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16
Q

Describe an automatic-appropriate pt

A

Pt is oriented to environment, follows daily schedule and routine robotically, unable to recall details of daily events, new learning possible with extra time, safety concerns and impaired judgement

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17
Q

What is the name for Ranchos Level VIII?

A

Purposeful-Appropriate

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18
Q

Describe a purposeful-appropriate pt

A

Able to recall and integrate events, aware of and responds to environment, independent in home, developing community reentry skills, carryover with new skills and no supervision required once skill is learned, stills demonstrate decreased abilities

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19
Q

What are key examination elements for Ranchos Levels VII and VIII?

A

Likely outpatient, examine gait and balance with more detail, new learning is possible at a decreased rate

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20
Q

What are the 5 rehab goals for Ranchos Level VII and VIII?

A
  1. Helping pt function with less structure
  2. Improve problem solving and decision making
  3. Increase safety awareness and insight
  4. Decreasing assistance and supervision
  5. Integrating cognitive, emotional, and social skills needed to function in the community
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21
Q

What are 4 cognitive intervention strategies?

A
  1. High level balance and walking aids
  2. Dual task
  3. Provide opportunities for problem solving
  4. Enhancing social skills
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22
Q

What motor relearning strategies would be important for Ranchos Level IV-VI?

A

Distributed practice and extrinsic feedback

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23
Q

What motor learning strategies would be important for Ranchos Level VII-VIII?

A

Massed practice, self-generated feedback, video self-monitoring

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24
Q

What are cognitive intervention strategies for Ranchos Level VII and VIII?

A

Develop awareness by actively involving pt. Allow them to make mistakes in safe environment to develop self-awareness, predict future performance, self-assessment, cueing and assistance

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25
Q

What is the most important first step to help a pt with anosagnosia?

A
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26
Q

What is the power of prediction?

A
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27
Q

Define the concept permitting errors and safety says

A
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28
Q

What is the self-generation effect?

A
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29
Q

What is the systematic cuing strategy?

A
30
Q

What are signs that your pt is fatigued?

A

Increased irritability, decreased attention and concentration, deteriorated performance, delayed initiation

31
Q

What are strategies to maximize outcomes following TBI?

A

Be aware of overstimulating pt, gradually increase cognitive complexity, structured organizational system

32
Q

What does the Community Balance and Mobility Scale assess?

A

Examines high level balance skills in ambulatory individuals. No device is permitted

33
Q

What items are included in the Community Balance and Mobility Scale?

A

Unilateral stance, tandem walking, hop, run with controlled stop, walk, look and carry grocery bags, stairs, lateral foot scooting

34
Q

What does a low score on the Community Balance and Mobility Scale indicate?

A

Greater impairments

35
Q

What is the HiMAT?

A

High-Level Mobility Assessment Tool, return to sport and physically demanding

36
Q

What items are included on the HiMAT?

A

Run, skip, hop, single leg jump, walk on toes, backward walking, run up and down stairs

37
Q

What outcome measures are useful for higher level examination gait?

A

6MWT, 10MWT, FGA, Rancho Los Amigos Observational Gait Analysis

38
Q

What measures are used to assess QOL in Levels VII and VIII?

A

Quality of Life after Brain Injury and Community Integration Questionnaire

39
Q

What are the 6 subscales of the Quality of Life after Brain Injury measure?

A
  1. Cognition
  2. Self
  3. Daily life and autonomy
  4. Social relationships
  5. Emotions
  6. Physical problems
40
Q

What does the Community Integration Questionnaire assess?

A

Readiness to return to work

41
Q

Wha is the Functional Assessment Measure/Quality Indicators assessment?

A

Focus on community functioning and behavior. Score <65 indicates risk of long-term unemployment

42
Q

What outcome measure is best used for patients at a Ranchos Level IV-VI who are very distractible?

A

MOSS

43
Q

What is the compensatory approach?

A

Improved functional skills by compensating for the lost ability. Brain activation in areas formerly not used for a given task

44
Q

What is the restorative/recovery approach?

A

Restore the normal use of the movement pattern. Reactive areas of the brain typically responsible for task

45
Q

What are considerations for the compensatory approach?

A

Safety, impairments, cognitive and behavioral barriers, financial resources, discharge destination

46
Q

What are the 10 principles of neuroplasticity?

A
  1. Use it or lose it
  2. Use it and improve it
  3. Specificity
  4. Repetition matters
  5. Intensity matters
  6. Time matters
  7. Salience matters
  8. Age matters
  9. Transference
  10. Interference
47
Q

What are examples of intensive, challenging, meaningful, and task specific interventions to promote motor cortex changes and functional recovery?

A

Constraint induced movement therapy, locomotion training, aerobic conditioning, strengthening, balance

48
Q

What are the parameters for Constraint Induced Movement Therapy?

A

6 hrs/day, 2-3x/week

49
Q

What are the results of locomotor training with BWS?

A

Increased gait speed, endurance, QOL

50
Q

Is locomotor training with BWS more effective than conventional gait training?

A

No

51
Q

What are the components of the CPG for improving walking in CNS dysfunction?

A
  1. Task specificity at a high intensity
  2. High intensity aerobic activity and strengthening
  3. No robotic assisted
52
Q

What are the effects of severe deconditioning following TBI?

A

Following period of bed rest and immobility, more likely to have a sedentary lifestyle, decreased aerobic capacity, VO2 will peak at 75% of typical

53
Q

What are the consequences of aerobic deconditioning?

A

Shorter life expectancy (7 years), 3x more likely to die of CV disease, increased risk of Alzheimers, early onset dementia, PD, mental health, fatigue, sleep

54
Q

What are the benefits of aerobic conditioning?

A

Reduce long term CV risks, improve aerobic capacity, improve sleep, decrease fatigue, decreased depression and anxiety

55
Q

What are the neuroprotective benefits that result from aerobic conditioning?

A

Stimulate the production of brain derived neurotropic factors that support existing neurons and encourage neurogenesis in CNS and PNS

56
Q

What is the dosage for aerobic conditioning?

A

60-90% of HR max, 12-16 RPE, 20-40 min sessions, 3-4/week

57
Q

What is the benefit of circuit training following TBI?

A

Improved power output and aerobic capacity

58
Q

What are the negative prognostic indications for TBI?

A

Low initial GCS score, no pupillary response, age, low educational level, hypoxia, coma for more than two weeks, high ICP, hyperthermia within 72 hrs, brain bleed, obliteration of third ventricle, midline shift

59
Q

What are the positive prognostic indications for TBI?

A

Multidisciplinary intensive rehab

60
Q

What outcome is associated with PTA that is < 48.5 days?

A

Higher RIM score at discharge from inpatient rehab

61
Q

What outcome is associated with PTA that is < 27 days?

A

More likely to be employed

62
Q

What outcome is associated with PTA that is < 34 days?

A

Good overall recovery

63
Q

What outcome is associated with PTA that is < 53 days?

A

Live without assistance

64
Q

What pt population is more likely to die sooner following TBI?

A

Older adults, men, unemployed, not married, less education, more severe TBI, fall-related TBI

65
Q

What specific benefits are associated with going through inpatient rehab when there is a disorder of consciousness?

A
  1. Increase chance of independence at 5 years
  2. Increased likelihood of regaining consciousness
  3. Improved caregiver education
  4. Reduced secondary complications
66
Q

What effect does age have on prognosis?

A

Longer stay, slower functional recovery, greater cognitive impairment at discharge, greater chance of nursing home placement

67
Q

Why does age have an effect on prognosis?

A
  1. Brain has a decreased capacity for repair as it ages
  2. Increased frequency of systemic complications
  3. Comorbidities
68
Q

With young TBI pt’s, when can cognitive deficits manifest?

A

Attention and increased processing time in school

69
Q

What is the life expectancy following TBI?

A

7-9 years less

70
Q

What % of TBI patients are unemployed 5 years after their injury?

A

55%

71
Q

What are TBI patients at a higher risk of developing?

A

Depression, anxiety, PD, Alzheimer’s, dementia, CTE

72
Q

What are long term negative effects following TBI?

A

Seizures, accidental drug poisoning, infections, pneumonia

NMR II (27 decks)

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