Session 16 - TBI, Rancho Los Amigos Levels, Cognitive Rehabilitation FOR

Question 1

injury caused by a direct or indirect force with no resultant penetration into the skull (Ex: external force, rotational or deceleration injuries)

Answer 1

closed head injury

Question 2

injury caused by an external force with resultant penetration of the skull (Ex: skull fracture)

Answer 2

open head injury

Question 3

• most common TBI
• Wide range of severity
• direct blow
• whiplash

Answer 3

concussion

Question 4

• direct blow

- bruise to the brain or bleeding into brain tissue

Answer 4

contusion

Question 5

bruising at initial site of force or impact and then at back of head

Answer 5

coup-contrecoup injury

Question 6

• gun shot wound
• Knife wound
• other sharp object

Answer 6

penetrating injury

Question 7

name 6 secondary health complications of TBI.

Answer 7

• seizures
• hydrocephalus
• infection
• polytrauma
• vascular injuries or internal bleeding
• deep vein thrombosis

Question 8

a condition resulting in extensive lesions in white matter (Sheering forces) and a major cause of coma or vegetative state

Answer 8

diffuse axonal injury

Question 9

name the 5 most vulnerable areas for diffuse axonal injury.

Answer 9

• cerebral cortex
• corpus callosum
• cerebral peduncles
• basal ganglia
• thalamus

Question 10

name 4 common types of occurrences of diffuse axonal injuries.

Answer 10

• MVA, fall or other accident
• strong rotation of head or blow to the head
• shaken baby syndrome
• blast injury (military-related TBI)

Question 11

• Specific and localized

- Usually more manageable and less impairment level seen

Answer 11

focal injuries

Question 12

name the 4 anatomical substrates that are important for attention functions.

Answer 12

• brainstem
• thalamus
• limbic system connections
• neurotransmitters

Question 13

ascending reticular activating system (ARAS) in the reticular formation

Answer 13

brainstem

Question 14

attends to right and left sides

Answer 14

right hemisphere

Question 15

mainly attends to right side

Answer 15

left hemisphere

Question 16

• 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)

Answer 16

frontal and parietal association cortex

Question 17

• 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

Answer 17

frontal heteromodal association area aka anterior multimodal association area (found in prefrontal cortex)

Question 18

Degree of generalized readiness to receive information

Answer 18

alertness

Question 19

Ability to choose specific stimuli while suppressing irrelevant stimuli

Answer 19

attention

Question 20

Highest level of attention processing used to direct all actions

Answer 20

awareness

Question 21

Parietal Lesion with resultant Hemi-spatial Neglect Syndrome

Answer 21

right hemisphere stroke

Question 22

no response

Answer 22

Level 1 - Ranchos Los Amigos Levels of Cognitive Function

Question 23

generalized response

Answer 23

Level 2 - Ranchos Los Amigos Levels of Cognitive Function

Question 24

localized response

Answer 24

Level 3 - Ranchos Los Amigos Levels of Cognitive Function

Question 25

confused - agitated

Answer 25

Level 4 - Ranchos Los Amigos Levels of Cognitive Function

Question 26

confused - inappropriate

Answer 26

Level 5 - Ranchos Los Amigos Levels of Cognitive Function

Question 27

confused - appropriate

Answer 27

Level 6 - Ranchos Los Amigos Levels of Cognitive Function

Question 28

automatic - inappropriate

Answer 28

Level 7 - Ranchos Los Amigos Levels of Cognitive Function

Question 29

purposeful - appropriate

Answer 29

Level 8, 9, 10 - Ranchos Los Amigos Levels of Cognitive Function

Question 30

- 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

Answer 30

levels 1 - 4 - Ranchos Los Amigos Levels of Cognitive Function

Question 31

name 2 general OT interventions for ranchos los amigos levels 1-4.

Answer 31

- 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

Question 32

- 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

Answer 32

rancho los amigos - levels 5-8

Question 33

name 6 general OT interventions for levels 5-8 of ranchos los amigos.

Answer 33

- 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

Question 34

- 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

Answer 34

levels 8-10 - ranchos los amigos

Question 35

name 4 aspects of OT interventions for levels 8-10 of ranchos los amigos.

Answer 35

- 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