L15 TBI Cont Flashcards
PT Exam at Rancho 5-6
- level of consciousness/alertness. Most pts alert for most day at this level, needs breaks
- Attention. Assessed by documenting the length of time a pt can attend to task before fatigue
- Cognition and executive function
Cognition definition
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
Executive Function
mental processes that enable humans to plan, focus attention, remember and perform complex multi-step tasks
Impairments in cognition result in
inappropriate behaviors and social responses
Test of Vigilance/A-test
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”
Divided Attention
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
Orientation
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)
Cognition Screen
- Alert and Oriented
better to document which questions they answer correctly first - montreal cognitive assessment as outcome measure
these assessments can make people feel uncomfortable or anxious
Remote memory
distant past, typically intact after TBI
Recent Memory
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
Prospective Memory
deficits present as forgetting future medical appts
patients will benefit from reminder calls and keeping memory logs
Procedural memory
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
Declarative Memory
type of long-term memory that involves conscious recollection of facts and events
often impaired after TBI
Montreal Cognitive Assessment
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
MoCA Scores
18-25 = mild cognitive impairment
10-17 = moderate cognitive impairment
< 10 = severe cognitive impairment
Multidisciplinary Care for TBI
MD
SLP
OT
Neuropsychologists
Social Work
Rancho 5-6 Mobility
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
Disrupted Attention
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
Normal Behaviors in Cognition
rambling
unorganized reply to questions
abrupt interruptions
Strategies to enhance interactions with patients after TBI
- structure and routine
- interaction strategies
- environmental modifications to decrease distraction
- external aids and compensatory strategies
- aid in memory
Structure and Routine for TBI
- consistent wording
- add nonverbal communication to add redundancy
- verbal or tactile cues to increase attention
- Use procedural learning and procedural memory
- maximum continuity and consistency
- calm demeanor throughout
- redirect with agitation
- don’t leave pt unattended
Procedural learning and procedural memory
break the task into its component parts, model target behavior, fade feedback
has evidence of success even in pt with impaired declarative memory
Environmental Modifications
non-distracting physical environment
eliminate other sources like TV, phones
optimize visual cues with room light
turn pt away from visual stimulus
Organize Patient’s physical space
helps to reduce the cognitive load
physically locate important info
consistent placement of objects
External Aids and Compensatory Strategies
-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
Ranch 8 to 10 PT
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
