lecture 7: physical therapy managment of individuals with moderate brain injury Flashcards
will a patient go thru all the levels of rancho los amgios
no
what are the ranchos los amigos levels 4-6
4: confused agitated
5: confused inappropriate
6: confused appropriate
Clinical presentation:
◦ Patient demonstrates bizarre, nonpurposeful behaviors
◦ May overreact to stimuli (cry, scream, hit, abusive language), need to be
restrained
◦ Does not discriminate among people or objects
◦ Exhibits incoherent or inappropriate verbalizations
◦ Brief, nonselective attention
◦ Lacks short- and long-term recall
what ranchos level does this patient present w
IV: confused agitated
_ is A subtype of delirium in which the individual is in the state of post- traumatic amnesia and there are excesses of behavior that include some combination of aggression, akathisia, disinhibition, and emotional lability.
agitation
what is post traumatic amnesia
when a aptient can’t remember things after the injury
Time lapse between the accident and the point at which the functions concerned with memory are restored
what does this describe
post traumatic amnesia
what is the difference between retrograde and anterograde amnesia
retrograde is when a patient can’t remember accident or things before
anterograde is when a patient can’t have ongoing memory after injury
what are 2 outcome measures used to assess progress out of PTA (post traumatic amnesia)
-orientation log
- the galveston orientation and amnesia test (GOAT)
what is the orientation LOG
- measures orientation to time , place and circumstance
- scoring 0-30 (25/30 would be normal)
what the galveston orientation and amnesia test used to determine
to determine length and severity of PTA
evaluates temporal orientation adn estimates the duration of retrograde amnesia and duration of PTA
what is the scoring for the Galveston Orientation and Amnesia Test (GOAT)
0-100 , > 75 on 3 consecutive days indicates clearing of PTA
if a patient has PTA for 1-4 weeks what is the severity of the TBI
very severe
if a patient has PTA for 1-7 days what is the severity of the TBI
severe
if a patient has PTA for 1-24 hours what is the severity of the TBI
moderate
what are outcome measures of ranchos IV for body fucntion and structures
◦ Rancho Los Amigos Level of Cognitive Functioning
◦ O-Log
◦ Agitated Behavior Scale (ABS)
◦ Moss Attention Rating Scale (MARS
what is teh agitated behavior scale developed to assess
the nature and extent of agitation during acute phase of recovery
◦ 21 or below =
◦ 22-28 =
◦ 29-35 =
◦ > 35 =
this is the scoring for agitated behavior scale , what does each mean
◦ 21 or below = behavior WNL
◦ 22-28 = mild occurrence of symptoms of agitation
◦ 29-35 = moderate occurrence of symptoms
◦ > 35 = severe occurrence of symptoms
what is the moss attention rating scale
observational rating scale to measure attention related behavior after TBI
what scale is recommended to sue in acute hospital or inpatient rehab for people with moderate to severe TBI to measure attention related behavior
moss attention rating scale
- Quick verbal response without
awareness of consequences - Quick physical action without safety
awareness
what behavior is this for TBI
impulsivity
what is the behavior in compliance
refusal to participate
what interventions would PT use if a patient was impulsive
-verbalize or rehearse steps prior to starting a task or activity
- provide verbal cues from safety
-safe environment
what interventions would PT use if a patient was noncompliance
- idefeitfy motivators
-give patient choice - set goals
◦ Responds to simple commands fairly
consistently
◦ Gross attention to environment but
highly distractible
◦ Inability to concentrate on task
◦ Verbalizations are inappropriate,
confabulation present
◦ Memory severely impaired
◦ Inappropriate use of objects
◦ Unable to learn new information
what ranchos levels does this describe
V: confused , inappropriate , non-agitated
◦ Goal-directed behavior but dependent on
cuing for direction
◦ Follows simple directions consistently
◦ Little to no carryover for new tasks (can
relearn old skills)
◦ Gives incorrect responses due to memory
problems however appropriate for the
situation
◦ Past memories > recent memory\
what ranchos level does this describe
VI: confused , appropriate
what scale is used to examine participation retristictions for TBI patients
disability rating scale
