L15 TBI Cont Flashcards

1
Q

PT Exam at Rancho 5-6

A
  1. level of consciousness/alertness. Most pts alert for most day at this level, needs breaks
  2. Attention. Assessed by documenting the length of time a pt can attend to task before fatigue
  3. Cognition and executive function
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2
Q

Cognition definition

A

higher level processes that allows the ability to think and process information. termed as mental status testing

related to attention, problem-solving, critical thinking, judgement, thought organization, sequencing, math sense, executive function, self-regulation

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3
Q

Executive Function

A

mental processes that enable humans to plan, focus attention, remember and perform complex multi-step tasks

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4
Q

Impairments in cognition result in

A

inappropriate behaviors and social responses

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5
Q

Test of Vigilance/A-test

A

part of montreal cognitive assessment

useful if pt has aphasia or tubes that prevent talking

“i will read long list of letters, every time you hear A, I want you to tap your hand on the table”

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6
Q

Divided Attention

A

rancho 7 or higher

dual task assessments such as cognitive/motor tasks like walking while talking test or TUG with cognitive

fall risk increases in pts who are unable to perform cognitive and motor task

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7
Q

Orientation

A

used for Rancho 4 to 6

most common is patient name, place, date, situation

document as alert and oriented x 4 (name, place, year, situation)

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8
Q

Cognition Screen

A
  1. Alert and Oriented
    better to document which questions they answer correctly first
  2. montreal cognitive assessment as outcome measure

these assessments can make people feel uncomfortable or anxious

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9
Q

Remote memory

A

distant past, typically intact after TBI

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10
Q

Recent Memory

A

more recent acquired memories
highly vulnerable to loss after TBI

may not recall therapy from one day to next, may repeat self frequently

should document amount of time pt can retain information

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11
Q

Prospective Memory

A

deficits present as forgetting future medical appts

patients will benefit from reminder calls and keeping memory logs

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12
Q

Procedural memory

A

type of long-term memory that is responsible for performing tasks without conscious awareness like tying shoes, eating, walking

often intact after TBI and seen in pt as early as Rancho 3

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13
Q

Declarative Memory

A

type of long-term memory that involves conscious recollection of facts and events

often impaired after TBI

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14
Q

Montreal Cognitive Assessment

A

training and certification is required to perform this tool

assesses broad range of cognitive function such as short term memory, executive function, attention, concentration, working memory

lower score indicates worse performance

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15
Q

MoCA Scores

A

18-25 = mild cognitive impairment
10-17 = moderate cognitive impairment
< 10 = severe cognitive impairment

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16
Q

Multidisciplinary Care for TBI

A

MD
SLP
OT
Neuropsychologists
Social Work

17
Q

Rancho 5-6 Mobility

A

can now begin feeding self, bed mobility, transfer, toileting, gait

patient will not be safe with mobility and will need close physical assistance for safety and biomechanical assistance

functional training can be more purposeful to address neuromotor and cognitive impairments

attention begins to improve, allowing for longer treatment sessions

18
Q

Disrupted Attention

A

contributes to confusion and disorientation, leading to agitation

causes a safety risk because or restlessness and unpredictable behavior

also causes difficulty in reaching therapy targets/goals in patients who attend for only brief periods

19
Q

Normal Behaviors in Cognition

A

rambling
unorganized reply to questions
abrupt interruptions

20
Q

Strategies to enhance interactions with patients after TBI

A
  1. structure and routine
  2. interaction strategies
  3. environmental modifications to decrease distraction
  4. external aids and compensatory strategies
  5. aid in memory
21
Q

Structure and Routine for TBI

A
  1. consistent wording
  2. add nonverbal communication to add redundancy
  3. verbal or tactile cues to increase attention
  4. Use procedural learning and procedural memory
  5. maximum continuity and consistency
  6. calm demeanor throughout
  7. redirect with agitation
  8. don’t leave pt unattended
22
Q

Procedural learning and procedural memory

A

break the task into its component parts, model target behavior, fade feedback

has evidence of success even in pt with impaired declarative memory

23
Q

Environmental Modifications

A

non-distracting physical environment
eliminate other sources like TV, phones
optimize visual cues with room light
turn pt away from visual stimulus

24
Q

Organize Patient’s physical space

A

helps to reduce the cognitive load
physically locate important info
consistent placement of objects

25
Q

External Aids and Compensatory Strategies

A

-clocks, calendars, name tags to help with orientation
-organizer, daily schedule to provide structure
-memory book to recall what they ahve done
-written list of task in checklist form
-reminder notes
-give info in small chunks
-store items in same location

26
Q

Ranch 8 to 10 PT

A

sessions will be longer
fewer rest breaks
should focus on recovery of mobility with more advanced skills

ex: assessing risk of situations, incorporate visuospatial skills, incoporate IADLS, reintro to social situations, leisure activities

driving is not safe until cleared by team