Lecture 7: Moderate Brain Injury Flashcards
patient with moderate brain injury falls under these categories of Rancho
IV - Confused-agintated
V - confused, innapropriate, non-agitated
VI - confused appropriate
what are the secondary impairemnts after brain injury?
MSK
cardiopulmonary
integumentary
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
- nonpurposeful
- stimuli (cry, scream, hit)
- nonselective
- short and long term
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
agitation
time lapse between accident and point at whcih functions concerned with memory are resported
post traumatic amnesia
retrograde amnesia
can’t remember accident
anterograde amnesia
can’t have ongoing memory after
to determine length and severity of PTA
galveston orientation and amnesia test (GOAT)
measurers orientation to time, place and circumstances
O-LOG orientation log
duration of PTA and severity of TBI
<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
test and measures for MOD ABI and TBI Rancho IV
activity domain (funcitonal assessment / movement analysis) and participation domain (prior life roles?)
more info slide 19
what are some outcome measures for body function and strucutres for a rancho level IV ?
-rancho levels
O-log
agitated behavior scale (ABS)
MOSS attention scale
other impairment measures
what outcome measures rancho IV activity
FIM
FAM
what are general goals for patients with moderate ABI and TBI rancho IV?
** 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
Behaviroal issues of a TBI rancho IV
Agitation
aggression
disinhibition
impulsivenes
lack of concern
perseveration
decreased judgment
reduced insight of deficits
sexual inappropriateness
how do you help manage behavioral issues for individuals at Rancho IV?
environmental considerations:
- structure vs distraction
- quiet nonstim
- PT tech
- include family presence
- shorter sessions
- restrains as needed
- determine what triggers agitation
PT considerations rancho lvl IV
- use calm voice, calm body lang
- recognize triggers
- reorient pt
- describe what you are doing
- protect yourself
- use positive reinforcement strategies
tx considerations for managing behavioral issues for individuals at rancho IV?
- high structured sessins, consistent schedule, consistent therapist
- specific otions for activities
- give pt freedom to move….
more on slide31
ways to manage agitation (remove restraints/tubes, crawling, mood swing, screaing, crying and restlessness, pacing and wantering)
- 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
ways to manage aggression (verbal, physical and demanding unreasonable requests)
- 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
read more on slide 34-36
things not to do:
- don’t treat pt like child
- don’t argue with pt
- don’t take things personally
- don’t rush
- don’t show frustration
family education
- 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
rancho lvl V
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
Rancho lvl VI
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
rancho lvl V-VI for body function and structures
orientation, attn, cognition, behavior
sensory integrity
tone
motor funciton
ROM
pain
cranial nerve integrity
outcome measures for body function and structres
rancho levels of cognitive function
modified ashworth scale
O-Log
moss attention rating scale
activity test and measures for rancho lvl V-VI?
6 MWT, 10 MWT, berg, FGA, FIM, 5XSTS, FIM/FAM
participation outcome measure for rancho lvl V-VI
Disability rating scale
what are some general goals for rancho levels V-VI?
- 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
primary focus for rancho levels V-VI PT intervention is
orientation
More PT interventions for rancho V-VI
spasicity
secondary complications
safety awareness
functional training-high strucutre
gait
equipment
family educaton rancho V-VI
- 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
