Managment of Moderate Brain Injury IV-VI Flashcards
GCS Moderate Brain Injury
9-12
Rancho Los Amigos Level of Cognitive Functioning Scale 4
- Confused, Agitated
-heightened state of activity, confusion, disorientation, aggressive behavior
-internal confusion
-lack short term recall
-perseveration
-violence
Rancho Los Amigos Level of Cognitive Functioning Scale 5
- Confused, Inappropriate, non-agitated
-alert, distractable, verbally or sexually inappropriate
-doesn’t learn new info
-memory impaired
Rancho Los Amigos Level of Cognitive Functioning Scale 6
- Confused, appropriate
-good goal-directed behavior
-needs cueing but can relearn
-memory problems
-little carryover
Agitation
Delirium during PTA and excesses of behavior that include:
-aggression
-akathisia
-disinhibition
-emotional lability
Post Traumatic Amnesia
-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
PT Exam Moderate TBI and Rancho 4
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
Outcome Measures: Rancho 4
-Orientation Log
-Rancho
-Agitated Behavior Scale
-Moss Attention Rating Scale
-FIM
-Disability rating scale
General Goals: Rancho 4
-participation
-decrease confusion
-manage agitation
-increase tolerance
-education
Behavior Management: Rancho 4
-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
Outcome Measure: Rancho 5-6
-Orientation Log
-Rancho
-Agitated Behavior Scale
-Moss Attention Rating Scale
-FIM
-Disability rating scale
-6MWT, 10MWT, BERG, 5STS
General Goals: Rancho 5-6
-increase awareness
-encourage appropriate behavior
-increase functional abilities
-education
PT Intervention: Rancho 5-6
-orientation
-structure
-allow processing time
-challenges but not to agitation
-behavior management
-spasticity
-gait training
-Pt/Family Education