TBI

Question 1

Define Polytrauma

Answer 1

Two or more injuries, one which are sustained in the same incident that affect multiple body parts or organ systems
- can result in physical, cognitive, psychological, pyschosocial impairments and functional disabilities

Question 2

From Liverpool BIRU, what percentage of people with a TBI had polytrauma

Answer 2

54%

Question 3

What does PTA stand for? What is its definition

Answer 3

Post traumatic amnesia: Period after TBI when disoriented to time and place and can’t lay down new memories

Question 4

What’s the measurement method for PTA?

Answer 4

Westmead PTA scale. Out of 12

12/12, 3 days in a row to be deemed out.

Question 5

What are the measurements to determine the severity of PTA?

Answer 5

Very mild - <5 min
Mild - 5-60min
Moderate - 1-24hours
Severe - 1-7 days
Very severe - 7-28 days 
Extremely severe- >28 days
globally amnesic - >6 months

Question 6

What is Lifetime Care and Support Scheme (icare NSW)?

Answer 6

Funding scheme that provides treatment, rehab and care for people severely injured in motor accidents in NSW.

Question 7

What are the conditions that determine care is “reasonable and necessary” in LCAS?

Answer 7

• What are the benefits to the patient
• Appropriate treatment? - evidence?
• Appropriate provider for needs?
• Cost-effective?
• Is it injury related?

Question 8

What is the eligibility measurements for TBI in the LCAS?

Answer 8

PTA > 1 week

Score = 5 on at least 1 item of Functional independence Measure (FIM) because of brain injury

Question 9

What is the FIM?

Answer 9

Functional independence measure:

Outcome measures for all rehabilitation services

Question 10

What is a typical neuro assessment?

Answer 10

Impairments: mobility, ADL, functional, msk

Activity levels

Question 11

What to assess for when looking at Activity Limitations?

Answer 11

• Bed mobility
• Sitting balance
• Sit to stand
• Standing balance
• Transfers
• Walking
• Reaching and manipulation
• Contracture and Strength

Question 12

What are the factors to consider with intervention?

Answer 12

Cognition, motivation, pain, priorities, complications

Question 13

In a TBI patient, how might cognition affect intervention?

Answer 13

• Patients may not have insight into their own injury.
• Memory loss
• Mental fatigue

Question 14

How might priorities impact intervention?

Answer 14

Consider patient goals

Have definite priorities leading to a global goal

Question 15

What is collaborative Rehabilitation?

Answer 15

Healthcare professionals with different areas of expertise working together and with the patient and their family to solve problems and make decisions related to planning and implementing care.

Question 16

Identify how a multidisciplinary team can collaborate in treatment?

Answer 16

Physio: msk, physical impairments
Nurse: ward-care
OT- Discharge/home planning
Neuropsychologist- cognitive
Social work: supports at home
Medical teams- relevant body systems

Question 17

What are some interventions for TBI patients?

Answer 17

• Kinematic analysis and task specific retraining
• Low load prolonged stretches (contracture)
• UL AND LL ROM and strength
• Fitness training
• Education and advice
• Consultations

Question 18

What are aspects of education and advice during intervention?

Answer 18

• Explanation of injury
• Prognosis and expectations
• Pain management
• Training strategies
• Precautions
• Counselling

Question 19

What is collaborative goal setting?

Answer 19

Goal setting by different health professionals to achieve global goals
Link short term to long term

Question 20

What are some benefits of collaborative goal setting?

Answer 20

• Improved client motivation and participation in rehab
• Highly valued by patients
• Higher goal relevance and satisfaction

Question 21

What are some challenges of collaborative goal setting?

Answer 21

• Some people aren’t goal driven
• Cognitive impairments
• Time consuming - paperwork etc

Question 22

What is the evidence regarding Goal Setting?

Answer 22

Cochrane SR Levack 2015
- Low quality evidence

Clinical implications

• Person-centred and personally meaningful goals favorable to QoL
• Can serve to improve team cohesion

Question 23

Why cant evaluations be made for research with TBI?

Answer 23

Not ethical to randomise a person with TBI to a group that does not receive MDT rehab

Question 24

What are the conclusions about MDT rehabilitation for ABI?

Answer 24

Varied nature of services due to varied needs

• Intervention should be offered as early and intensively as possible
• People require ongoing rehab after discharge

Question 25

What are the long -term outcomes following multidisciplinary rehab for TBI?

Answer 25

• changes in cognitive, communication and emotional function - 60% of all time
• 40% more support than preinjury
• 50% returned to previous leisure
• <50% returned to work/study
• 30% reported difficulties in personal relationships

Question 26

Compare PA levels between groups with/without disabilities.

Answer 26

Excluding 18-19y/o, people with disability had a lower percentage of meeting PA guidelines compared to without disability.

Question 27

What is the main barrier to PA for people with disabilities?

Answer 27

• Belief of poor health or injury

Question 28

What is the main exercise for people with disability?

Answer 28

Walking - 43%

Question 29

What makes the inclusion spectrum for participation in sport?

Answer 29

Sports with:

• no modification
• minor modifications
• major modifications
• Primarily for people with disability
• Non-playing role
• only for disabled people