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Neuro Rehab Test 2 > Rehab Guidelines for TBI pt 2 > Flashcards

Rehab Guidelines for TBI pt 2 Flashcards

1
Q

what is ideal management of spasticity in TBI?

A

There is very low quality and limited evidence to manage spasticity conservatively in TBI - pharmacotherapy recommended

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2
Q

why would you put a TBI patient in a multipodus boot?

A

to position someone at rest; however, these boots have been anecdotally contributing to increased tone

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3
Q

why would you choose a dynasplint for a TBI patient

A

low load and long duration stretch to a muscle to prevent development of contracture

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4
Q

what does the literature say about serial casting?

A

not supported strongly in the literature

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5
Q

Though serial casting requires special training, why would you choose to do it?

A

to improve the range of motion in a joint

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6
Q

T/F: patients respond poorly to being serial casted

A

false: patients typically respond well to serial casting

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7
Q

T/F: serial casting leads to short term changes in joint ROM

A

true: long term effects are typically not seen in serial casting

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8
Q

T/F: serial casting effects tone

A

false

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9
Q

T/F: botox + casting is more effective than casting alone

A

false

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10
Q

What are the 3 low level RLA levels

A
  1. no response
  2. generalized response
  3. localized response
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11
Q

5 examination points for low level RLA patients

A
  1. ROM
  2. spontaneous activity observation
  3. tone & reflexes
  4. postural reactions observation
  5. primitive reflexes observation
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12
Q

how long should treatment sessions for low level TBI patients last

A

10-15 minutes

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13
Q

What are you looking for (goal) when managing a low level TBI patient

A

response to stimulation

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14
Q

possible responses to stimulation

A 
HR/BP/RR
arousal
movement
posturing
facial expressions
vocalization
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15
Q

What is the number 1 thing you should do (treatment) with low level TBI patients

A

sit them up

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16
Q

T/F: decreased arousal is a contraindication for sitting

A

false

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17
Q

What is responsible (usually) for changes in arousal when bringing a low level TBI patient from supine to sit

A

Reticular activating system - regulates consciousness

18
Q

How should you characterize a response to stimulation in low level coma patients

A

latency, consistency, intensity, and duration of the response

19
Q

what is the goal of a coma stimulation program

A

develop a consistent and reliable response with minimal latency

20
Q

T/F: coma stimulation for TBI is supported by strong evidence

A

false: mixed evidence for impact of coma stim on TBI

21
Q

Families are typically overwhelmed when a loved one is in a coma, what are two things you can do to educate the family

A
  1. allow the patient time to respond and expect processing delays
  2. be mindful of overstimulation - structure their stimulation
22
Q

what is an RLA 4 patient

A

confused and agitated

23
Q

T/F: RLA 4 patients are capable of formal exam

A

false

24
Q

what are four intervention strategies for RLA 4 patients

A
  1. structure/consistency
  2. prevent overstimulation
  3. manage agitation
  4. high success activities
25
Q

describe how you would orient a RLA 4 patient to their environment

A

“you are in hospital” is favorable to “do you know where you are?”

26
Q

do you expect carryover in RLA 4 patients

A

no

27
Q

what is the best piece of education you can give family members for RLA 4

A

behavior is due to the brain injury

28
Q

what are 4 strategies for working with RLA 5-6 patients

A
  1. be consistent
  2. be simple
  3. re-orient the patient
  4. calm and don’t overstimulate
29
Q

how do you address attention issues with RLA 5-6 patients

A
  1. give the command only when attention is assured
  2. ask pt to repeat the command
  3. use positive reinforcement
  4. utilize cognitive rest breaks if commands are failing
30
Q

At which RLA level can you begin a formal exam

A

RLA 5

31
Q

At what RLA level can re-learning occur?

A

RLA 5

32
Q

What RLA levels would benefit most from memory aids? (timers, reminders, memory books)

A

RLA 5 and above

33
Q

When (which RLA level) does discharge from inpatient rehab occur for TBI?

A

RLA 6

34
Q

what should be the emphasis of interventions for RLA 5-6 patients

A

safety with activity/movement

35
Q

What typically happens when patients are discharged from the inpatient setting?

A

the loss of structure can result in setbacks

36
Q

What is the name of an outcome that is useful to gauge readiness for RLA 7+ patients to return to normal activities?

A

community integration questionnaire

37
Q

what is a notable challenge with treating RLA 7-8 patients and how does it impact your plan of care

A

they rely heavily on structure and therefore structure should wean as their function improves during the POC

38
Q

what are the two goals of RLA 7-8 patients

A

wean structure and community reintegration

39
Q

when does new learning occur in TBI patients

A

RLA 7+

40
Q

what does the evidence say for TBI/ABI rehabilitation

A

early neurorehab (trauma center) and intensive neurorehab (rehab facility) promote functional recovery in patients with mod-severe TBI

Neuro Rehab Test 2 (11 decks)

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