Module 7 Flashcards
What are the 3 main components of a comprehensive Plan of Care for Rehabilitation of patients with Acquired Brain Injury (ABI)
CGI
- Coordination/ Communication
- Goals/ Outcomes (Assessment & reassessment)
- Interventions
With whom do PT’s need to coordinate and communicate with during patient rehab? (3)
MFI
Medical team, Family/ Caregivers, Insurance
What are the 3 main types of interventions that PT’s use during patient rehab for ABI?
RCP
-restorative & neural plasticity, compensatory, and preventative
Acute phase: begins once? Usually?
Begins once the patient is medically stable
Usually within 72 hours
Acute phase: Review the _ _ and communicate with _ _. Assist in _ _ of _.
Review the medical record and communicate with medical team. Assist in ongoing monitoring of recovery.
Which vitals might it be necessary to monitor during treatment and mobilization of an ABI patient in the acute phase? (7)
MR. H BOIL
-Mental Status, Respiratory Rate, HR, BP, O2 saturation, Intercranial pressure, Level of Consciousness (LOC)
During the Acute rehab phase early mobilization _ or _ effects of _ _ and _. May increase a patients _ and _.
Early mobilization prevents or minimizes effects of bed rest and deconditioning
May increase a patients LOC (level of consciousness) and orientation
During acute rehab phase early mobilization promotes _ _ and limits _ -. Can foster a _ _.
Early mobilization promotes functional reorganization and limits learned non-use.
Can foster a positive outlook
What are early interventions used in the acute rehab phase (usually in acute care setting)? (7)
PPP SS RB
- positioning
- patient & family education/ Rancho levels
- potentially progress to standing balance/ pre-gait/ gait
- strengthening
- sitting balance/ postural control
- ROM/ contracture prevention
- Bed mobility
Positioning, mobility, ROM, serial casting, dynamic splinting and upright tolerance are all early interventions used to?
Prevent secondary impairments
Acute Inpatient Rehab facilities involve _ _ _ _ of therapy per day, _ days per week, and includes two or more _ _. Time frame? Why?
Involves aggressive 3+ hours of therapy per day, 6 days per week, and includes two or more disciplines.
Shorter period of time to get patients home faster
Skilled Nursing facilities are _ _ than Acute inpatient rehab, _ - _ _ per day, _ days a week. Time frame?
SNF are less intense therapy than acute inpatient rehab, 60-90 minutes per day, 5 days a week.
Offers the ability to stay for a longer time if necessary
Transitional living/ Post acute facilities are often used for / patients. Therapy is integrated _ _ _ _, helps reintegrate patient _ _ _. 2 example facilities.
Often used for TBI/ ABI patients
Therapy is integrated into the living arrangement, helps reintegrate patient into their environment.
Ex: Center for Neuro Skills (CNS) and Casa Colina’s TLC
Comprehensive outpatient therapy is typically - _ per week. Focuses on _ _, and the length of time depends on?
Typically 3-5 times per week
Focuses on community reintegration, and the length of time depends on justification to insurance
Treatment considerations for Rancho levels I-III? (3)
PEA
Prevention of secondary impairments
Early mobility
Arousal
Treatment considerations for Rancho Level IV? (3)
MOP
Mobility
Orientation
Preventing outbursts
Special considerations for Rancho IV: _ is important, expect no _, model _ _, expect _, be _/ have _ for treatment, keep the patient and yourself _.
Consistency is important Expect no carryover Model calm behavior Expect egocentricity Be flexible/ have options for treatment Keep the patient and yourself safe
Treatment considerations for Rancho levels V-VI? (3)
HOB
Higher mobility
Orientation
Behavior modification
Treatment considerations Rancho levels VII-X? (3)
R HS
Regaining independence
High level mobility
Safety
Common ABI interventions: _ _ program, , / _ management, _ (/ progression), _ management, _ mobility, -/ _ training and _ _ & _ assessment.
Behavior modification programs Strengthening ROM/ Spasticity management Balance (Sitting/ standing progression) Vestibular management Functional mobility Pre-gait/ gait training Assistive devices and orthotics assessment
ABI Intervention considerations: incorporate _ & _, start with _ _ and move towards _ _ _ that require _ _.
Incorporate creativity and flexibility
Start with familiar activities and move towards more challenging skills that require new learning.
ABI intervention considerations: add _ _ (_ or _ system), _ and _ training. _ training, to help _ _ _, and to involve _ with _ _.
Add positive reinforcement (point or reward system), redirection, and compliance training.
Family training, to help family understand behaviors, and to involve them with behavioral modification.
4 motor learning strategies to implement with ABI rehab patients?
- Use distributed practice initially with frequent rest breaks to prevent mental fatigue
- Self generation concept
- progress to random practice schedule
- feedback
Feedback for ABI: _ to _, prevent _ the patient
Explicit to implicit
Prevent overwhelming the patient
Patient & family, physician, Nurse, PT, OT, speech and language pathologist (SLP), orthotist/ prosthetist, case manager, social worker, neuropsychologist, and RT’s are all part of?
Rehabilitation team
Sports related _ _ _ _ occur at a rate of 1.6-3.8 million yearly. _ of military report symptoms consistent with _ _ _.
Sports related mild Traumatic Brain Injury (mTBI) 1.6-3.8 million yearly
12% of military report symptoms consistent with blast related mTBI
3 complications associated with mild TBI?
Post-Traumatic amnesia (PTA)
Cumulative trauma encephalopathy (CTE)
Second Impact Syndrome (SIS)
Patient education, activity tolerance, vestibular dsyfunction, high-level balance dsyfunction, post-traumatic headache, attention and dual-task performance and participation in exercise are all areas for _ _ to _ and intervene in patients with _.
All areas for physical therapist to examine and intervene in patients with mild TBI
Documentation: celebrate _ but _ _ _ _.
Celebrate success but clearly spell out needs
What part of a SOAP notes involve: documenting difference from the last treatment, especially note improvements and progress.
Assessment
What part of the SOAP notes involve documenting each activity you performed, and documenting specific evidenced–based tests and measures (TBI EDGE).
Objective
What part of SOAP notes includes clearly spelling out ideas that worked or that you would want to try with the patient.
Plan
What part of SOAP notes involve documenting outbursts, attention, and orientation, and taking note of specific activities or subjects that set the patient off into agitated outburst.
Subjective
Periodic re-evaluations of ABI involve assessing _ of _, and _ towards _. Determine _, and use - _ and _ to justify progress to _. Planning _ to the _ _, and assuring patient _ with the _ _ & _.
Assessing effectiveness of treatment and progress towards goals
Determine necessity, and use evidence-based practice and outcomes to justify progress to insurance
Planning discharge to the next level, and assuring patient engagement with treatment plan & goals.
