PT Management of Traumatic Brain Injury

Question 1

Classification of TBI

Glasgow Coma Scale of 13 - 15

Answer 1

< 20 min coma duration

Question 2

Classification of TBI

Glasgow Coma Scale of 9 -12

Answer 2

moderate: up to 6 hours coma duration

Question 3

TBI classification

Glasgow Coma Scale of ≤ 8

Answer 3

Severe: more than 6 hours of coma duration

Question 4

TBI

Ranchos Los Amigos Levels I – III

Intervention:

(No Response, Generalized Response, Localized Response)

Answer 4

• Sensory Stimulation
• Prevention of secondary impairments
• Mgmt tone/spasticity
• Early mobilization (when stable)

Question 5

TBI

Ranchos Los Amigos Level IV (Confused- Agitated)

What type of examination may be the best form of assessment?

Answer 5

Observation

Question 6

Ranchos Los Amigos Level IV (Confused- Agitated)

Examination:

Answer 6

• Functional mobility
• Cognitive assessment: orientation, memory, etc.

Question 7

Ranchos Los Amigos Level IV (Confused- Agitated)

Intervention:

Answer 7

• endurance in functional activities
• control behavior
• stable closed environment
• daily routine

Question 8

TBI

Should the therapist teach new skills to Ranchos Los Amigos Level IV (Confused- Agitated) patient?

Answer 8

NO!

Question 9

Should you expect carry over in the intervention to a Ranchos Los Amigos Level IV (Confused- Agitated) pt?

Answer 9

No

Question 10

Ranchos Los Amigos Level V & VI
(Confused-Inappropriate, Confused- Appropriate)
Is the pt able to follow simple commands?

Answer 10

yes, can perform more formal and accurate PT

Question 11

at what level of Rancho Los Amigos pt can perform more formal & accurate P. T. exam but may need to modify some exam procedures?

Answer 11

Level V & VI

Question 12

Ranchos Los Amigos Level V & VI

(Confused-Inappropriate, Confused- Appropriate)

Intervention:

Answer 12

• Maximize functional skills and motor learning capabilities
• Safety skills education

Question 13

TBI Patient usually discharged from inpatient rehab late in level

Answer 13

VI or early level VII

Question 14

Ranchos Los Amigos Levels VII & VIII
(Automatic-Appropriate, Purposeful- Appropriate)
Intervention:

Answer 14

• function in “real world”
• problem solving
• community skills
• regular exercise program

Question 15

Standardized Outcome Measures for TBI

Answer 15

1. Glasgow Coma Scale: 3-15, less than 8 is more than 6h coma, 15 is Les than 20min coma.
2. Glasgow Outcome Scale (1 is dead, 5 is good recovery. Not much clinical use)
3. Functional Independence Measure plus Functional Assessment Measure – FIM + FAM
4. Disability Rating Scale
5. High-Level Mobility Assessment Tool
   (HiMAT)

Question 16

FAM uses ____ point rating scale modeled after FIM rating scale

Answer 16

7

(Functional Assessment Measure)

Question 17

Disability Rating Scale (DRS) scoring

Answer 17

0 (no disability) to 29 (extreme vegetative state)

(Intended to accurately measure general functional changes over the course of recovery)

Question 18

High-Level Mobility Assessment Tool (HiMAT) scoring

(Developed to measure high-level mobility outcomes in individuals with TBI)

Answer 18

• Maximum score = 54
• Minimum mobility requirement: Indep walking without device over 20 m
• 13 items: walking forward, backward, on toes, over obstacle, run, hop, skip, bound, stairclimbing