Module 7

Question 1

What are the 3 main components of a comprehensive Plan of Care for Rehabilitation of patients with Acquired Brain Injury (ABI)

Answer 1

CGI

• Coordination/ Communication
• Goals/ Outcomes (Assessment & reassessment)
• Interventions

Question 2

With whom do PT’s need to coordinate and communicate with during patient rehab? (3)

Answer 2

MFI

Medical team, Family/ Caregivers, Insurance

Question 3

What are the 3 main types of interventions that PT’s use during patient rehab for ABI?

Answer 3

RCP

-restorative & neural plasticity, compensatory, and preventative

Question 4

Acute phase: begins once? Usually?

Answer 4

Begins once the patient is medically stable

Usually within 72 hours

Question 5

Acute phase: Review the _ _ and communicate with _ _. Assist in _ _ of _.

Answer 5

Review the medical record and communicate with medical team. Assist in ongoing monitoring of recovery.

Question 6

Which vitals might it be necessary to monitor during treatment and mobilization of an ABI patient in the acute phase? (7)

Answer 6

MR. H BOIL

-Mental Status, Respiratory Rate, HR, BP, O2 saturation, Intercranial pressure, Level of Consciousness (LOC)

Question 7

During the Acute rehab phase early mobilization _ or _ effects of _ _ and _. May increase a patients _ and _.

Answer 7

Early mobilization prevents or minimizes effects of bed rest and deconditioning

May increase a patients LOC (level of consciousness) and orientation

Question 8

During acute rehab phase early mobilization promotes _ _ and limits _ -. Can foster a _ _.

Answer 8

Early mobilization promotes functional reorganization and limits learned non-use.

Can foster a positive outlook

Question 9

What are early interventions used in the acute rehab phase (usually in acute care setting)? (7)

Answer 9

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

Question 10

Positioning, mobility, ROM, serial casting, dynamic splinting and upright tolerance are all early interventions used to?

Answer 10

Prevent secondary impairments

Question 11

Acute Inpatient Rehab facilities involve _ _ _ _ of therapy per day, _ days per week, and includes two or more _ _. Time frame? Why?

Answer 11

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

Question 12

Skilled Nursing facilities are _ _ than Acute inpatient rehab, _ - _ _ per day, _ days a week. Time frame?

Answer 12

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

Question 13

Transitional living/ Post acute facilities are often used for / patients. Therapy is integrated _ _ _ _, helps reintegrate patient _ _ _. 2 example facilities.

Answer 13

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

Question 14

Comprehensive outpatient therapy is typically - _ per week. Focuses on _ _, and the length of time depends on?

Answer 14

Typically 3-5 times per week

Focuses on community reintegration, and the length of time depends on justification to insurance

Question 15

Treatment considerations for Rancho levels I-III? (3)

Answer 15

PEA

Prevention of secondary impairments
Early mobility
Arousal

Question 16

Treatment considerations for Rancho Level IV? (3)

Answer 16

MOP

Mobility
Orientation
Preventing outbursts

Question 17

Special considerations for Rancho IV: _ is important, expect no _, model _ _, expect _, be _/ have _ for treatment, keep the patient and yourself _.

Answer 17

Consistency is important
Expect no carryover
Model calm behavior
Expect egocentricity
Be flexible/ have options for treatment
Keep the patient and yourself safe

Question 18

Treatment considerations for Rancho levels V-VI? (3)

Answer 18

HOB

Higher mobility
Orientation
Behavior modification

Question 19

Treatment considerations Rancho levels VII-X? (3)

Answer 19

R HS

Regaining independence
High level mobility
Safety

Question 20

Common ABI interventions: _ _ program, , / _ management, _ (/ progression), _ management, _ mobility, -/ _ training and _ _ & _ assessment.

Answer 20

Behavior modification programs
Strengthening
ROM/ Spasticity management 
Balance (Sitting/ standing progression)
Vestibular management 
Functional mobility
Pre-gait/ gait training
Assistive devices and orthotics assessment

Question 21

ABI Intervention considerations: incorporate _ & _, start with _ _ and move towards _ _ _ that require _ _.

Answer 21

Incorporate creativity and flexibility

Start with familiar activities and move towards more challenging skills that require new learning.

Question 22

ABI intervention considerations: add _ _ (_ or _ system), _ and _ training. _ training, to help _ _ _, and to involve _ with _ _.

Answer 22

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.

Question 23

4 motor learning strategies to implement with ABI rehab patients?

Answer 23

• Use distributed practice initially with frequent rest breaks to prevent mental fatigue
• Self generation concept
• progress to random practice schedule
• feedback

Question 24

Feedback for ABI: _ to _, prevent _ the patient

Answer 24

Explicit to implicit

Prevent overwhelming the patient

Question 25

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?

Answer 25

Rehabilitation team

Question 26

Sports related _ _ _ _ occur at a rate of 1.6-3.8 million yearly. _ of military report symptoms consistent with _ _ _.

Answer 26

Sports related mild Traumatic Brain Injury (mTBI) 1.6-3.8 million yearly

12% of military report symptoms consistent with blast related mTBI

Question 27

3 complications associated with mild TBI?

Answer 27

Post-Traumatic amnesia (PTA)
Cumulative trauma encephalopathy (CTE)
Second Impact Syndrome (SIS)

Question 28

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 _.

Answer 28

All areas for physical therapist to examine and intervene in patients with mild TBI

Question 29

Documentation: celebrate _ but _ _ _ _.

Answer 29

Celebrate success but clearly spell out needs

Question 30

What part of a SOAP notes involve: documenting difference from the last treatment, especially note improvements and progress.

Answer 30

Assessment

Question 31

What part of the SOAP notes involve documenting each activity you performed, and documenting specific evidenced–based tests and measures (TBI EDGE).

Answer 31

Objective

Question 32

What part of SOAP notes includes clearly spelling out ideas that worked or that you would want to try with the patient.

Answer 32

Plan

Question 33

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.

Answer 33

Subjective

Question 34

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 _ _ & _.

Answer 34

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.