PT management of MOD/Severe TBI Flashcards
Physical therapy skilled roles in management of tbi
promote functional ability and independence
determine optimal environment/next setting
provide adaptive equipment to aid in the independence and care
provide patient/family education and guidance
TBI edge outcome measures
Agitated behavior scale
moss attention rating scale
functional assessment measure
FIM
TBI edge outcome measure entry level education
community balance and mobility scale
community integration questionaire
high-level mobility assessment
Behavioral challenges during PT examination and intervention
behavioral excesses
-inappropriate abrupt physical action
-verbal interruptions
-in-appropriate topic selection
-sexual inappropriateness
-irritability
-angry transition
Behavioral deficits
-decreased self directed action
-depressed mood
-restricted affect
what are 4 motor learning/cognitive challenges individuals with TBI have
- problem solving deficits
- impaired attention
- impaired abstract reasoning
- impaired short term memory
During what rancho level do patients come out of post traumatic amnesia
VI rancho 6 confused and appropriate
Rancho Level IV confused and agitated PT roles
- mobilize with consideration
- low stimulation environment with structured times for therapy
- assist with sleep wake cycle and appropriate activities
- short session
Rancho Level V confused and inappropriate PT roles
environment modification
progress mobility
structured short sessions
directed task vs automatic tasks
consider implicit learning over explicit
Focused attention
focus on and respond to a specific stimulus
Sustained attention
sustained attention over a period of time
selective attention
focus attention in the presence of distracting stimuli
Alternating attention
shift focus of attention from one task to another
divided attention
respond simultaneously to multiple tasks
Rancho Level VI confused and appropriate PT goals
prevent learned non-use
constraint induced therapy may be initiated
incorporate goal directed task and ADLS
individuals with severe cognitive impairments from brain injuries had improved performance on everyday tasks, increased functional independence, improved cognitive performance and fewer inappropriate social behaviors after the use of _____ learning
Errorless learning
Errorless learning was used to teach patients _____ tasks rather than novel skills
familiar
Involves identification of errors and feedback to correct the performance of movement
errorless learning
examples of errorless learning
use verbal and visual cues
hand over hand assistance
discouragement of guessing
gradual fading prompts
part task practice of discrete portions of a larger skill
retrograde amnesia
partial or total loss of ability to recall events that have occured during the times immediately before the brain injury
anterograde memory
is the ability to form more complete new memories, complicated by decreased attention and perception
post traumatic amnesia
the time between the injury and the point at which functional memory returns
RLA level VII automatic appropriate
PT goals
min A needed for daily living skills
add more complex environmental tasks
community interaction
stimulation and problem solving
more self directed and trial and error learning
the patient predicts how the task will go
if accurate: good
if overestimation: experience failure or see their limits
if underestimation: positive reinforcement and increased confidence after success
awareness training
RLA level VIII purposeful appropriate
PT roles
community reentry
increasing levels of problem solving and stress exposure
increase independence using management skills
CPG for locomotor training
moderate to high intensity walking training
virtual reality coupled with walking training
strength training
cycling or recumbent stepping at higher aerobic intensities
balance training, especially when coupled with VR or augmented visual FB
What doe the CPG not recommend for locomotor training TBI
do not use body weight supported treadmill training
do not use exoskeletal robotics on TM
Goals by stage rancho level II to III
stimulation
goals by stage rancho level IV-V
allowing
encouraging patient to be more active participant in therapy
goals by stage rancho level VI-VIII
initiation, more structure, new learning, gaining independence
goals by stage rancho level IX-X
main goal return to optimal level of function and participation
