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Neuro PT > Lecture 7: Moderate Brain Injury > Flashcards

Lecture 7: Moderate Brain Injury Flashcards

1
Q

patient with moderate brain injury falls under these categories of Rancho

A

IV - Confused-agintated
V - confused, innapropriate, non-agitated
VI - confused appropriate

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2
Q

what are the secondary impairemnts after brain injury?

A

MSK
cardiopulmonary
integumentary

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3
Q

rahcho lvl IV
- bizarre, ____behavior
- may overract to____, need to be restrained
- does not discriminate amoung people or objects
- exhibits incoherent or inappropriate verbalizaitons
- brief, ____attention
- lack ____and_____term recall

A
  • nonpurposeful
  • stimuli (cry, scream, hit)
  • nonselective
  • short and long term
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4
Q

subtype of delirium in which the individal is in the state of post traumatic amnesia
and there are excesses behavior that include some combinatoin of aggression, akathisia, disinihibitoin and emotial lability
NOTE: hallmark of Rancho 4

A

agitation

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5
Q

time lapse between accident and point at whcih functions concerned with memory are resported

A

post traumatic amnesia

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6
Q

retrograde amnesia

A

can’t remember accident

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7
Q

anterograde amnesia

A

can’t have ongoing memory after

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8
Q

to determine length and severity of PTA

A

galveston orientation and amnesia test (GOAT)

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9
Q

measurers orientation to time, place and circumstances

A

O-LOG orientation log

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10
Q
A
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11
Q

duration of PTA and severity of TBI

A

<5 min = very mild
5-60 min = mild
1-24 hours = moderate
1-7 days = severe
1-4 weeks = very severe
>4 weeks = extremely severe

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12
Q

test and measures for MOD ABI and TBI Rancho IV

A

activity domain (funcitonal assessment / movement analysis) and participation domain (prior life roles?)

more info slide 19

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13
Q

what are some outcome measures for body function and strucutres for a rancho level IV ?

A

-rancho levels
O-log
agitated behavior scale (ABS)
MOSS attention scale
other impairment measures

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14
Q

what outcome measures rancho IV activity

A

FIM
FAM

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15
Q

what are general goals for patients with moderate ABI and TBI rancho IV?

A

** participate in activity**
- decrease confusion by increasing orientatin to self and environment
- manage agitation
**increase attention **to task and activity tolerance, envrionment
- functional mobility
- reduce risk of secondary impairments
- pt/family education

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16
Q

Behaviroal issues of a TBI rancho IV

A

Agitation
aggression
disinhibition
impulsivenes
lack of concern
perseveration
decreased judgment
reduced insight of deficits
sexual inappropriateness

17
Q

how do you help manage behavioral issues for individuals at Rancho IV?

A

environmental considerations:
- structure vs distraction
- quiet nonstim
- PT tech
- include family presence
- shorter sessions
- restrains as needed
- determine what triggers agitation

18
Q

PT considerations rancho lvl IV

A
  • use calm voice, calm body lang
  • recognize triggers
  • reorient pt
  • describe what you are doing
  • protect yourself
  • use positive reinforcement strategies
19
Q

tx considerations for managing behavioral issues for individuals at rancho IV?

A
  • high structured sessins, consistent schedule, consistent therapist
  • specific otions for activities
  • give pt freedom to move….

more on slide31

20
Q

ways to manage agitation (remove restraints/tubes, crawling, mood swing, screaing, crying and restlessness, pacing and wantering)

A
  • stay near exit
  • one to one supervision
  • redirect to task
  • reduce stimulation and triggers
  • stay calm and don’t argue
  • educate on IV and tubes and lines
  • consistent response from team members to undesired behaviors
21
Q

ways to manage aggression (verbal, physical and demanding unreasonable requests)

A
  • removing breakable or sharp objects
  • keep safe distance from pt
  • don’t respond with physical force
  • reduce stim
  • minimize safetly risk (lower the bed and lock brakes)
    -don’t argue and stay calm
  • give pt breaks
22
Q

read more on slide 34-36

A
23
Q

things not to do:

A
  • don’t treat pt like child
  • don’t argue with pt
  • don’t take things personally
  • don’t rush
  • don’t show frustration
24
Q

family education

A
  • behaviors exhibited are a sx of TBI
  • limit visitors to 2-3 per room
  • calm voice
  • limit distraction
  • find activity calming to pt
  • make pt comforatale
  • oreintaiton strategies
  • reassure pt they are safe
25
Q

rancho lvl V

A

confused, inapropriate, non-aggitated
- responding simple command
- gross attention to environment and highly distractible
- can’t concentrate on task
- verbalization inappropriate, confabulation
- memory impaired
- inappropriate use of object
- unable to learn new info

26
Q

Rancho lvl VI

A

confused, non-agitated
- goal directed behavior depending on cuing
- follows simple directions consistently
- can relearn old skills but no carryover for new task
- give incoreect response during memory problems but still appropriate
- past memories>recent memory

27
Q

rancho lvl V-VI for body function and structures

A

orientation, attn, cognition, behavior
sensory integrity
tone
motor funciton
ROM
pain
cranial nerve integrity

28
Q

outcome measures for body function and structres

A

rancho levels of cognitive function
modified ashworth scale
O-Log
moss attention rating scale

29
Q

activity test and measures for rancho lvl V-VI?

A

6 MWT, 10 MWT, berg, FGA, FIM, 5XSTS, FIM/FAM

30
Q

participation outcome measure for rancho lvl V-VI

A

Disability rating scale

31
Q

what are some general goals for rancho levels V-VI?

A
  • increase pt awareness of self and environment and time
  • increase attn span
  • encourage appropriate behavior + reinforcement
  • increase independence with functional activity
  • increase functional strength, endurance
  • patient and family education
32
Q

primary focus for rancho levels V-VI PT intervention is

A

orientation

33
Q

More PT interventions for rancho V-VI

A

spasicity
secondary complications
safety awareness
functional training-high strucutre
gait
equipment

34
Q

family educaton rancho V-VI

A
  • orienting pt
  • repeaing questions/commands as needed
  • short simple convo
  • reorganize pt and have them start activity
  • frequent rest breaks when having difficulty paying attn
  • help pt make connections with family/activity/friends
  • pics
35
Q
A

Neuro PT (8 decks)

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