Session 16 - TBI, Rancho Los Amigos Levels, Cognitive Rehabilitation FOR Flashcards
injury caused by a direct or indirect force with no resultant penetration into the skull (Ex: external force, rotational or deceleration injuries)
closed head injury
injury caused by an external force with resultant penetration of the skull (Ex: skull fracture)
open head injury
- most common TBI
- Wide range of severity
- direct blow
- whiplash
concussion
- direct blow
- bruise to the brain or bleeding into brain tissue
contusion
bruising at initial site of force or impact and then at back of head
coup-contrecoup injury
- gun shot wound
- Knife wound
- other sharp object
penetrating injury
name 6 secondary health complications of TBI.
- seizures
- hydrocephalus
- infection
- polytrauma
- vascular injuries or internal bleeding
- deep vein thrombosis
a condition resulting in extensive lesions in white matter (Sheering forces) and a major cause of coma or vegetative state
diffuse axonal injury
name the 5 most vulnerable areas for diffuse axonal injury.
- cerebral cortex
- corpus callosum
- cerebral peduncles
- basal ganglia
- thalamus
name 4 common types of occurrences of diffuse axonal injuries.
- MVA, fall or other accident
- strong rotation of head or blow to the head
- shaken baby syndrome
- blast injury (military-related TBI)
- Specific and localized
- Usually more manageable and less impairment level seen
focal injuries
name the 4 anatomical substrates that are important for attention functions.
- brainstem
- thalamus
- limbic system connections
- neurotransmitters
ascending reticular activating system (ARAS) in the reticular formation
brainstem
attends to right and left sides
right hemisphere
mainly attends to right side
left hemisphere
- strong reciprocal connections btwn frontal and parietal lobes for processing of multi-modal stimuli
- connected with heteromodal association cortex (lateral parietal cortex, temporal association cortex, and occipital association cortex)
frontal and parietal association cortex
- role: coordination with parietal, occipital and temporal cortex, and brainstem for processing attention
- role: frontal eye fields direct and initiate eye movements toward target of interest for sustained or directed visual attention
frontal heteromodal association area aka anterior multimodal association area (found in prefrontal cortex)
Degree of generalized readiness to receive information
alertness
Ability to choose specific stimuli while suppressing irrelevant stimuli
attention
Highest level of attention processing used to direct all actions
awareness
Parietal Lesion with resultant Hemi-spatial Neglect Syndrome
right hemisphere stroke
no response
Level 1 - Ranchos Los Amigos Levels of Cognitive Function
generalized response
Level 2 - Ranchos Los Amigos Levels of Cognitive Function
localized response
Level 3 - Ranchos Los Amigos Levels of Cognitive Function
confused - agitated
Level 4 - Ranchos Los Amigos Levels of Cognitive Function
confused - inappropriate
Level 5 - Ranchos Los Amigos Levels of Cognitive Function
confused - appropriate
Level 6 - Ranchos Los Amigos Levels of Cognitive Function
automatic - inappropriate
Level 7 - Ranchos Los Amigos Levels of Cognitive Function
purposeful - appropriate
Level 8, 9, 10 - Ranchos Los Amigos Levels of Cognitive Function
- disorders of consciousness
- coma
- vegetative state
- minimally conscious state
- responses: eye opening, sleep-wake cycles, visual tracking, object recognition, command following, communication
- coma – none
- vegetative state – eye opening, sleep-wake cycles
- minimally conscious state – eye opening, sleep-wake cycles, others inconsistently
- concern with responses to stimuli
- ranges from initially none to inconsistent to non-purposeful
- assessed in highly controlled fashion
- addressing initial sensory inputs: tactile, visual, olfactory, auditory, gustatory, and pain
levels 1 - 4 - Ranchos Los Amigos Levels of Cognitive Function
name 2 general OT interventions for ranchos los amigos levels 1-4.
- introduction to environmental stimuli in a controlled manner
- beginning motor control and address motor impairments - ROM, positioning, muscle tone, mobility in and out of bed
- concern with agitation and aggression as RAS is easily over stimulated and unrelated
- focus on basic attention and vision/perception
- addressing increase in skill with increased normal sensory modulation
rancho los amigos - levels 5-8
name 6 general OT interventions for levels 5-8 of ranchos los amigos.
- introduction to environmental stimuli in a controlled manner
- work on addressing neurobehavioral issues and cognitive deficits
- beginning motor control and address motor impairments
- cognition
- basic ADL functioning
- family and caregiver education and training
- attention, concentration, memory/recall
- awareness, judgment/safety
- organization, problem-solving
- flexibility, self-monitoring
- higher order cognitive skills
- executive functions
- grade skills with demands of task and environment based on individual’s ability
- still needs highly structured tasks (may decrease over time)
- may be independent and functional with structure
levels 8-10 - ranchos los amigos
name 4 aspects of OT interventions for levels 8-10 of ranchos los amigos.
- grade skills with demands of task and environment based on individual’s ability
- still needs highly structured tasks (may decrease over time)
- May be independent and functional with structure
- family and caregiver education and training
