Rehab Guidelines for TBI pt 2

Question 1

what is ideal management of spasticity in TBI?

Answer 1

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

Question 2

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

Answer 2

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

Question 3

why would you choose a dynasplint for a TBI patient

Answer 3

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

Question 4

what does the literature say about serial casting?

Answer 4

not supported strongly in the literature

Question 5

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

Answer 5

to improve the range of motion in a joint

Question 6

T/F: patients respond poorly to being serial casted

Answer 6

false: patients typically respond well to serial casting

Question 7

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

Answer 7

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

Question 8

T/F: serial casting effects tone

Answer 8

false

Question 9

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

Answer 9

false

Question 10

What are the 3 low level RLA levels

Answer 10

1. no response
2. generalized response
3. localized response

Question 11

5 examination points for low level RLA patients

Answer 11

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

Question 12

how long should treatment sessions for low level TBI patients last

Answer 12

10-15 minutes

Question 13

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

Answer 13

response to stimulation

Question 14

possible responses to stimulation

Answer 14

HR/BP/RR
arousal
movement
posturing
facial expressions
vocalization

Question 15

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

Answer 15

sit them up

Question 16

T/F: decreased arousal is a contraindication for sitting

Answer 16

false

Question 17

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

Answer 17

Reticular activating system - regulates consciousness

Question 18

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

Answer 18

latency, consistency, intensity, and duration of the response

Question 19

what is the goal of a coma stimulation program

Answer 19

develop a consistent and reliable response with minimal latency

Question 20

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

Answer 20

false: mixed evidence for impact of coma stim on TBI

Question 21

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

Answer 21

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

Question 22

what is an RLA 4 patient

Answer 22

confused and agitated

Question 23

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

Answer 23

false

Question 24

what are four intervention strategies for RLA 4 patients

Answer 24

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

Question 25

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

Answer 25

"you are in hospital" is favorable to "do you know where you are?"

Question 26

do you expect carryover in RLA 4 patients

Answer 26

no

Question 27

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

Answer 27

behavior is due to the brain injury

Question 28

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

Answer 28

1. be consistent 2. be simple 3. re-orient the patient 4. calm and don't overstimulate

Question 29

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

Answer 29

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

Question 30

At which RLA level can you begin a formal exam

Answer 30

RLA 5

Question 31

At what RLA level can re-learning occur?

Answer 31

RLA 5

Question 32

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

Answer 32

RLA 5 and above

Question 33

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

Answer 33

RLA 6

Question 34

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

Answer 34

safety with activity/movement

Question 35

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

Answer 35

the loss of structure can result in setbacks

Question 36

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

Answer 36

community integration questionnaire

Question 37

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

Answer 37

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

Question 38

what are the two goals of RLA 7-8 patients

Answer 38

wean structure and community reintegration

Question 39

when does new learning occur in TBI patients

Answer 39

RLA 7+

Question 40

what does the evidence say for TBI/ABI rehabilitation

Answer 40

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