Intervention of TBI Flashcards

Question

What is included in the JFK coma recovery scale (within the CRSR)?

Answer 1

Auditory Visual Motor Oromotor/verbal Communication Arousal

Answer 2

Individualized Quantitative Behavioral Assessment (IQBA)

Answer 3

Applies principles of single-subject experimental design Identify two movements patient may be able to perform Give commands in random order to perform those movements Record movement response (or not) on each trial Use stats to determine if a relationship exists between the command and the patient’s responses

Answer 4

IQBA may actually be able to identify command following earlier and more consistently than the CRSR in some patients. So using both assessment methods is important so that we capture all the ability levels, all the possible awareness that exists across these patients and try to combat the issue of misdiagnosis and discharge to inappropriate places

Answer 5

Initiate early mobilization as soon as possible Increase level of arousal and awareness Increase motor control/postural control Increase activity tolerance Prevent/minimize secondary complications (e.g., joint mobility/contractures, DVTs, decubiti, pneumonia) Family (and patient) education

Answer 6

In every session: Talk to your patient and orient them, even if they do not seem to respond! Ask questions as if you are expecting a conversation

Answer 7

Neutral positioning in recliner wheelchair or tilt in-space chair (pressure-relieving cushion) Positioning in bed (neutral head/neck, hips/knees slightly flexed, PRAFO-type boot, splints) Post positioning signs (include time intervals) near bed as needed for family, nursing, patient care assistants/techs Serial inhibitive casting for excessive tone (ROM maintenance and improvement)

Answer 8

You will need another set of hands General functional mobility (OOB, sitting balance, etc.) Tilt table, standing frame, bodyweight support harness for standing Gait—yes! (e.g., BWS system/Lokomat) Think “outside the box”—safely ROM (Educate family on safe ROM techniques)

Answer 9

Visual, tactile, auditory, etc. Vestibular stim (rocking, rotation) Educate family on strategies to elicit responses/command following Combine strategies (e.g., standing and sensory stim

Answer 10

Overstimulation Closing eyes (appearing to “tune out”) Stops responding to commands which s/he responded to earlier Diaphoresis Flushing of the skin Breathing more quickly Seizure-like activity Abnormal “posturing” or increased muscle tone

Answer 11

"Confused and agitated" Alert and in heightened state of activity Purposeful attempts to remove restraints or tubes or crawl out of bed May perform motor activities such as sitting, reaching, and walking but without any apparent purpose or upon another’s request Very brief and usually nonpurposeful moments of sustained alternatives and divided attention Absent short-term memory May cry out or scream out of proportion to stimulus even after its removal May exhibit aggressive or flight behavior Mood may swing from euphoric to hostile with no apparent relationship to environmental events Unable to cooperate with treatment efforts Verbalizations are frequently incoherent and/or inappropriate to activity or environment

Answer 12

"still confused and inappropriate but not agitated" Alert, not agitated but may wander randomly or with a vague intention of going home May become agitated in response to external stimulation, and/or lack of environmental structure Not oriented to person, place or time Frequent brief periods, nonpurposeful sustained attention Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity Absent goal-directed, problem-solving, self monitoring behavior Often demonstrates inappropriate use of objects without external direction May be able to perform previously learned tasks when structured and cues provided Unable to learn new information Able to respond appropriately to simple commands fairly consistently with external structures and cues Responses to simple commands without external structure are random and nonpurposeful in relation to command

Answer 13

"inconsistently oriented to person, time, and place but more appropriate" Moderate assistance Inconsistently oriented to person, time, and place Able to attend to highly familiar tasks in nondistracting environment for 30 minutes with moderate redirection Remote memory has more depth and detail than recent memory Vague recognition of some staff Able to use assistive memory aide with maximal assistance Emerging awareness of appropriate response to self, family, and basic needs Moderate assist to problem solve barriers to task completion Supervised for old learning (e.g., self-care) Shows carryover for relearned familiar tasks (e.g., self-care) Maximal assistance for new learning with little or no carry over Unaware of impairments, disabilities, and safety risks Consistently follows simple directions Verbal expressions are appropriate in highly familiar and structured situations

Answer 14

Levels I-IV

Answer 15

Important to avoid overstimulation and to maximize functional performance in the physical rehab interventions that follow Consider who is in the room, noise level, visual distractions, need for private space Your calm demeanor, and redirection at times, can make all the difference, especially in RLA IV

Answer 16

Stretching program Consider serial/delta casting Static positioning for prolonged stretch - Prone lying for hip flexors - Passive standing for plantar flexors - Leg extended on bolster with weight for hamstrings Phenol blocks, Botox

Answer 17

Functional strengthening - Body weight vs. resisted - Cuff weights on limbs during mobility - Thera-band resistance during swing phase Address focal strength deficits - Outside of functional mobility Bilateral vs. unilateral tasks - Moveo Table

Answer 18

Tall kneeling: Mini-squats, forward or lateral walking Half kneeling Quadruped: Single limb, alternate UE/LE Add dynamic UE activity: Bean bag toss, balloon taps, Reaching

Answer 19

Unlike severe TBI, not generally passive Same devices, different settings/clinician assist levels: Lite Gait, Rifton, Lokomat, GEO, Ekso Body weight support: Intensity, Decreased demands on therapist Robotics as adjunct to traditional treatment Consider 2020 CPG recommendations if higher gait capacity

Answer 20

"automatic and appropriate in their responses - consistently oriented" Minimal Assistance for Daily Living Skills Consistently oriented to person and place within highly familiar environments Moderate assistance for orientation to time Able to attend to highly familiar tasks in a nondistraction environment for at least 30 minutes with minimal assist to complete tasks Minimal supervision for new learning Demonstrates carry over of new learning Initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what they have been doing Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance Superficial awareness of his/her condition but unaware of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely carry out his/her household, community, work, and leisure ADLs Minimal supervision for safety in routine home and community activities Unrealistic planning for the future Unable to think about consequences of a decision or action Overestimates abilities Unaware of others’ needs and feelings Oppositional/uncooperative

Answer 21

Standby Assistance Consistently oriented to person, place, and time Independently attends to and completes familiar tasks for one hour in distracting environments Able to recall and integrate past and recent events Uses assistive memory devices to recall daily schedule, “to do” lists, and record critical information for later use with standby assistance Initiates and carries out steps to complete familiar personal, household, community, work, and leisure routines with standby assistance and can modify the plan when needed with minimal assistance Requires no assistance once new tasks/activities are learned Aware of and acknowledges impairments and disabilities when they interfere with task completion but requires standby assistance to take appropriate corrective action Thinks about consequences of a decision or action with minimal assistance Overestimates or underestimates abilities

Answer 22

Level IX: Standby Assistance on Request Level X: Modified Independent

Answer 23

Cognitive deficits can outweigh physical deficits Keep the patient’s goals in mind Hold the patient accountable Consider insight and ability to safely execute their program at home Be creative! You will wear many hats

Answer 24

Challenge patients with no risk of fall Solo-Step: static SafeGait: dynamic Overground vs. treadmill Allows error correction with therapist hands off Ambulation with/without AD Progress dynamic balance

Answer 25

Initiate new movement patterns—the list is endless! - Agility ladder - Line jumps - Heel/toe walking - Walking lunges Mimic community environment Challenge limits of stability Anticipatory and reactionary balance - Anticipatory: throw bean bags or balls onto treadmill - Reactionary: perturbations Vary surfaces and visual input - Obstacle course

Answer 26

Promote force production and muscular endurance Closed chain vs. open chain Circuit training: emphasize core, UE, LE Quadruped, tall kneel, half kneel for core stability Increased repetition, progressive resistance, timed intervals Transition to community gym program

Answer 27

Patients with varied abilities/limitations (UE, LE) Optimize motor learning Change speed, direction, incline, variable stepping over obstacles How do we monitor? HR, Borg

Answer 28

Dual tasking - Cognitive and physical duals tasks - Progress complexity of secondary task Route finding - To familiar and unfamiliar locations - Problem-solving using environmental cues Scavenger hunts - Working memory - Environmental attention - Executive function