lecture 7: physical therapy managment of individuals with moderate brain injury

Question 1

will a patient go thru all the levels of rancho los amgios

Answer 1

no

Question 2

what are the ranchos los amigos levels 4-6

Answer 2

4: confused agitated
5: confused inappropriate
6: confused appropriate

Question 3

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

Answer 3

IV: confused agitated

Question 4

_ 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.

Answer 4

agitation

Question 5

what is post traumatic amnesia

Answer 5

when a aptient can’t remember things after the injury

Question 6

Time lapse between the accident and the point at which the functions concerned with memory are restored
what does this describe

Answer 6

post traumatic amnesia

Question 7

what is the difference between retrograde and anterograde amnesia

Answer 7

retrograde is when a patient can’t remember accident or things before

anterograde is when a patient can’t have ongoing memory after injury

Question 8

what are 2 outcome measures used to assess progress out of PTA (post traumatic amnesia)

Answer 8

-orientation log
- the galveston orientation and amnesia test (GOAT)

Question 9

what is the orientation LOG

Answer 9

• measures orientation to time , place and circumstance
• scoring 0-30 (25/30 would be normal)

Question 10

what the galveston orientation and amnesia test used to determine

Answer 10

to determine length and severity of PTA

evaluates temporal orientation adn estimates the duration of retrograde amnesia and duration of PTA

Question 11

what is the scoring for the Galveston Orientation and Amnesia Test (GOAT)

Answer 11

0-100 , > 75 on 3 consecutive days indicates clearing of PTA

Question 12

if a patient has PTA for 1-4 weeks what is the severity of the TBI

Answer 12

very severe

Question 13

if a patient has PTA for 1-7 days what is the severity of the TBI

Answer 13

severe

Question 14

if a patient has PTA for 1-24 hours what is the severity of the TBI

Answer 14

moderate

Question 15

what are outcome measures of ranchos IV for body fucntion and structures

Answer 15

◦ Rancho Los Amigos Level of Cognitive Functioning
◦ O-Log
◦ Agitated Behavior Scale (ABS)
◦ Moss Attention Rating Scale (MARS

Question 16

what is teh agitated behavior scale developed to assess

Answer 16

the nature and extent of agitation during acute phase of recovery

Question 17

◦ 21 or below =
◦ 22-28 =
◦ 29-35 =
◦ > 35 =

this is the scoring for agitated behavior scale , what does each mean

Answer 17

◦ 21 or below = behavior WNL
◦ 22-28 = mild occurrence of symptoms of agitation
◦ 29-35 = moderate occurrence of symptoms
◦ > 35 = severe occurrence of symptoms

Question 18

what is the moss attention rating scale

Answer 18

observational rating scale to measure attention related behavior after TBI

Question 19

what scale is recommended to sue in acute hospital or inpatient rehab for people with moderate to severe TBI to measure attention related behavior

Answer 19

moss attention rating scale

Question 20

• Quick verbal response without
  awareness of consequences
• Quick physical action without safety
  awareness

what behavior is this for TBI

Answer 20

impulsivity

Question 21

what is the behavior in compliance

Answer 21

refusal to participate

Question 22

what interventions would PT use if a patient was impulsive

Answer 22

-verbalize or rehearse steps prior to starting a task or activity

• provide verbal cues from safety

-safe environment

Question 23

what interventions would PT use if a patient was noncompliance

Answer 23

• idefeitfy motivators
  -give patient choice
• set goals

Question 24

◦ 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

Answer 24

V: confused , inappropriate , non-agitated

Question 25

◦ 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

Answer 25

VI: confused , appropriate

Question 26

what scale is used to examine participation retristictions for TBI patients

Answer 26

disability rating scale