PT management of MOD/Severe TBI

Question 1

Physical therapy skilled roles in management of tbi

Answer 1

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

Question 2

TBI edge outcome measures

Answer 2

Agitated behavior scale
moss attention rating scale

functional assessment measure
FIM

Question 3

TBI edge outcome measure entry level education

Answer 3

community balance and mobility scale
community integration questionaire
high-level mobility assessment

Question 4

Behavioral challenges during PT examination and intervention

Answer 4

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

Question 5

what are 4 motor learning/cognitive challenges individuals with TBI have

Answer 5

1. problem solving deficits
2. impaired attention
3. impaired abstract reasoning
4. impaired short term memory

Question 6

During what rancho level do patients come out of post traumatic amnesia

Answer 6

VI rancho 6 confused and appropriate

Question 7

Rancho Level IV confused and agitated PT roles

Answer 7

1. mobilize with consideration
2. low stimulation environment with structured times for therapy
3. assist with sleep wake cycle and appropriate activities
4. short session

Question 8

Rancho Level V confused and inappropriate PT roles

Answer 8

environment modification
progress mobility
structured short sessions
directed task vs automatic tasks
consider implicit learning over explicit

Question 9

Focused attention

Answer 9

focus on and respond to a specific stimulus

Question 10

Sustained attention

Answer 10

sustained attention over a period of time

Question 11

selective attention

Answer 11

focus attention in the presence of distracting stimuli

Question 12

Alternating attention

Answer 12

shift focus of attention from one task to another

Question 13

divided attention

Answer 13

respond simultaneously to multiple tasks

Question 14

Rancho Level VI confused and appropriate PT goals

Answer 14

prevent learned non-use
constraint induced therapy may be initiated

incorporate goal directed task and ADLS

Question 15

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

Answer 15

Errorless learning

Question 16

Errorless learning was used to teach patients _____ tasks rather than novel skills

Answer 16

familiar

Question 17

Involves identification of errors and feedback to correct the performance of movement

Answer 17

errorless learning

Question 18

examples of errorless learning

Answer 18

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

Question 19

retrograde amnesia

Answer 19

partial or total loss of ability to recall events that have occured during the times immediately before the brain injury

Question 20

anterograde memory

Answer 20

is the ability to form more complete new memories, complicated by decreased attention and perception

Question 21

post traumatic amnesia

Answer 21

the time between the injury and the point at which functional memory returns

Question 22

RLA level VII automatic appropriate

PT goals

Answer 22

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

Question 23

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

Answer 23

awareness training

Question 24

RLA level VIII purposeful appropriate
PT roles

Answer 24

community reentry
increasing levels of problem solving and stress exposure
increase independence using management skills

Question 25

CPG for locomotor training

Answer 25

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

Question 26

What doe the CPG not recommend for locomotor training TBI

Answer 26

do not use body weight supported treadmill training
do not use exoskeletal robotics on TM

Question 27

Goals by stage rancho level II to III

Answer 27

stimulation

Question 28

goals by stage rancho level IV-V

Answer 28

allowing
encouraging patient to be more active participant in therapy

Question 29

goals by stage rancho level VI-VIII

Answer 29

initiation, more structure, new learning, gaining independence

Question 30

goals by stage rancho level IX-X

Answer 30

main goal return to optimal level of function and participation