lecture 8: PT management of individuals with mild brain injury Flashcards
what is ranchos levels VII-VIII
VII – Automatic-appropriate
VIII – Purposeful-appropriate
*Appropriate and oriented
*Robot-like
*Minimal confusion
*Shallow recall of activities
*Poor insight into condition
*Carryover for new learning but decreased rate
*Initiates social activities with structure
*Poor judgment, problem-solving, and planning skills
what ranchos level does this describe
VII: automatic appropriate
*Alert and oriented
*Recalls and integrates past and recent events
*Aware of and responsive to environment
*Carryover for new learning
*Decreased level of abstract reasoning, tolerance for stress, and judgment
what ranchos level does this describe
purposeful appropriate
what is the clinical presentation for a mild brain injury for the integumentary system
ulcers , incisions
after a mild brain injury deficits may increase with what 4 things
faitgue
stress
illness
heat
what are the activity limitation after a mild brain injury
*Activity limitations
◦ Bed mobility
◦ Transfers
◦ Wheelchair mobility and management
◦ Gait/stairs
what is apart of the participation outcome measures for a mild brain injury
- Craig Handicap Assessment and Reporting
Technique (CHART) - Community Integration Questionnaire (CIQ)
- DRS (BS&F, activity, and participation)
what is apart of the body functions and structures outcome measures for a mild brain injury
- Rancho Levels of Cognitive Function
- Modified Ashworth Scale
- MMSE
- Montreal Cognitive Assessment
- Patient Health Questionnaire
what is apart of the activity outcome measures for a mild brain injury
- FIM/FAM
- High Level Mobility Assessment Tool (HiMAT)
- 6MWT, 10mWT
- Berg Balance Scale (BBS)
- Functional Gait Assessment (FGA)
- 5 Time Sit to Stand (5TSTS
what is apart of the environment outcome measures for a mild brain injury
- Craig Hospital Inventory of Environmental
Factors (CHIEF
what is the description for the High Level Mobility Assessment Tool (HiMAT)
Description
◦ Assess high level mobility in individuals with TBI
◦ No use of assistive devices but orthotics permitted
◦ Must walk without assistance x 20 meters
how can u prioritize PT goals
Participation restrictions → Activity limitations → Impairments
what 3 things go into motor control
-task
individual
-environment
what are some of the communication deficits one will present w after a mild brain injury
◦ Dysarthria
◦ Aphasia
◦ Impaired reading/writing
◦ Auditory deficits
why is awareness important
-leads to improved attention , memory , and problem soling
- ability to analyzer own performance
what are the 4 different attention types
-sustained
-selective
-alternating
-divided
what is sustained attention
Ability to maintain focus on a continuous, repetitive activity
what is selective attention
Focus on a particular task or activity in the presence of distractors
what is alternating attention
Switching between tasks
what is divided attention
Performance of multiple tasks simultaneously
how can u integrate attention into ur PT sessions
- modification of treatment environment
-Begin in environment which allows optimal function
Ultimate goal is function in high distraction with low structure
what is the stroop test
have the pt say word not the color of the word
what is the The ability to organize sensory input into meaningful patterns that emerge from increasingly integrated levels of processing that form a perceptual whole
perception
Body image and unilateral spatial inattention/neglect
Unilateral spatial inattention/neglect with homonymous hemianopsia
Visual agnosia
Visual-spatial disorders
these are all examples of what kind of deficits
visual
what is unilateral spatial in attention/hemisphere in attention/neglect
- failure to orient toward, respond to, or report stimuli on the side contralateral to the cerebral lesion
◦ Inability to integrate and use perceptions from one side of body
what is visual agnosia
failure to recognize visual stimuli
unable to name objects due to having no concept of what the object is
basically they can see the object but can tell u what it is but they could feel it and know it is a spon
what attention does the right adn left hemisphere pay attention to
R hemi: explores left and right attention
L hemi: pays attention just to the righ
so if u have a deficit on the R hemisphere that would lead to L side neglect bc there would be no attention to the L side bc the R explores teh L and R
what is Topographic disorientation:
Difficulty way finding in a familiar environment
if a patient after a TBI can not remeber how to get home form store evne tho they liveed in same home for 60 yrs
what is Figure ground perception
inability to distinguish foreground from background (poor depth percpetion) so not being able to see the difference between the wheelchair break and the ground
◦ Midline orientation deficits
◦ Pusher’s syndrome
these are what kind of visual spatial disorders
position in space
what are tips to integrate during PT session for addressing executive functions
- ask pt to predict performance before they begin a task to max their attention to the task
- ask pt for feedback about their performance
- allow error to occur bc it helps pt self monitor to look for errors and prevent them from next time
if a pt has a L hemispheric lesion waht are their communicant deficits
◦ Aphasia (can’t understand or express speech)
◦ Apraxia ( can’t person purposeful actions)
◦ Alexia (cant read)
◦ Agraphia (cant write letters )
◦ Anomia (cant recall names of an object)
if a pt has a R hemispheric lesion what will their communication deficits be
◦ Deficits in abstract verbal
tasks like ….
-Storytelling and
interpretation
- Integration of emotional
elements
-Sense of humor
what are the dominant hemisphere language deficits
Wernicke’s (receptive) aphasia
Broca’s (expressive) aphasia
Global aphasia
for brocas (expressive) aphasia …
Word comprehension ___-
Syntax and fluid speech ____
____ fluency
Prosody is lacking
____ of grammatical structure
Aware of deficits
Word comprehension retained
Syntax and fluid speech lost
Decreased fluency
Prosody is lacking
Lack of grammatical structure
Aware of deficits
WERNICKE’S (RECEPTIVE) APHASIA
____ comprehension
Speech is fluent, but paraphasic errors, jargon,
empty, meaningless speech
Basic intonation and syntax maintained, word
meaning _____
Patients ____ of their deficits
(anosognosia)
WERNICKE’S (RECEPTIVE) APHASIA
Impaired comprehension
Speech is fluent, but paraphasic errors, jargon,
empty, meaningless speech
Basic intonation and syntax maintained, word
meaning inaccessible
Patients unaware of their deficits
(anosognosia)
what is apraxia
inability to perform certain skilled purposeful movements in the absence of any loss of motor power, sensation or coordination
what is Alexia and agraphia
inability to read/write
what is Lack of recognition of familiar objects
agonsia
what kind of gait is present for gait apraxia
magnetic gait
what is verbal apraxia called
aphemia (basically mute) but they can write
what are positive factors to return to work for pt’s
◦ Previous employment
◦ Shorter length of time since injury
◦ < 40 years old
◦ Greater cognitive abilities
◦ Lack of behavioral problems
how can u incorporate principles of motor control/learning/neuroplasticity
- Treadmill training, high intensity gait training (Hornby et al, 2020)
- Virtual reality
- Dual-task training
- Aerobic exercise
- Vestibular rehab
what is limb ideational
purposeful movement no possible on command or automatically
what is ideomotor apraxia
inability to formulate correct movement sequence in response to a command
ex if u tell a pateint to pick up the spoon and feed themselves they wouldn’t be able to do it
