Managment of Moderate Brain Injury IV-VI

Question 1

GCS Moderate Brain Injury

Answer 1

9-12

Question 2

Rancho Los Amigos Level of Cognitive Functioning Scale 4

Answer 2

4. Confused, Agitated
   -heightened state of activity, confusion, disorientation, aggressive behavior
   -internal confusion
   -lack short term recall
   -perseveration
   -violence

Question 3

Rancho Los Amigos Level of Cognitive Functioning Scale 5

Answer 3

5. Confused, Inappropriate, non-agitated
   -alert, distractable, verbally or sexually inappropriate
   -doesn’t learn new info
   -memory impaired

Question 4

Rancho Los Amigos Level of Cognitive Functioning Scale 6

Answer 4

6. Confused, appropriate
   -good goal-directed behavior
   -needs cueing but can relearn
   -memory problems
   -little carryover

Question 5

Agitation

Answer 5

Delirium during PTA and excesses of behavior that include:
-aggression
-akathisia
-disinhibition
-emotional lability

Question 6

Post Traumatic Amnesia

Answer 6

-time lapse between the accident and point of memory restoration
-GOAT test (<75) and Orientation Log

<5 min: very mild
5-60 min: mild
1-24h: Moderate
1-7 days: Severe
1-4 Week: Very Severe
>4 Week: Extremely Severe

Question 7

PT Exam Moderate TBI and Rancho 4

Answer 7

Chart Review:
-vitals, Hx, Prior PT, Meds

Systems Review:
-skin, CV, neuro

Subjective:
-How long is PTA
-Culture
-Family support
-Prior function and participation
-activity limitations

Question 8

Outcome Measures: Rancho 4

Answer 8

-Orientation Log
-Rancho
-Agitated Behavior Scale
-Moss Attention Rating Scale
-FIM
-Disability rating scale

Question 9

General Goals: Rancho 4

Answer 9

-participation
-decrease confusion
-manage agitation
-increase tolerance
-education

Question 10

Behavior Management: Rancho 4

Answer 10

-distraction
-increase structure
-decrease stimuli
-tech
-include family
-determine triggers
-reorient patient
-calm voice and body

Treatment:
-precise instructions
-patient control
-high structure
-freedom to move

Question 11

Outcome Measure: Rancho 5-6

Answer 11

-Orientation Log
-Rancho
-Agitated Behavior Scale
-Moss Attention Rating Scale
-FIM
-Disability rating scale
-6MWT, 10MWT, BERG, 5STS

Question 12

General Goals: Rancho 5-6

Answer 12

-increase awareness
-encourage appropriate behavior
-increase functional abilities
-education

Question 13

PT Intervention: Rancho 5-6

Answer 13

-orientation
-structure
-allow processing time
-challenges but not to agitation
-behavior management
-spasticity
-gait training
-Pt/Family Education