TBI Flashcards
Define Polytrauma
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
From Liverpool BIRU, what percentage of people with a TBI had polytrauma
54%
What does PTA stand for? What is its definition
Post traumatic amnesia: Period after TBI when disoriented to time and place and can’t lay down new memories
What’s the measurement method for PTA?
Westmead PTA scale. Out of 12
12/12, 3 days in a row to be deemed out.
What are the measurements to determine the severity of PTA?
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
What is Lifetime Care and Support Scheme (icare NSW)?
Funding scheme that provides treatment, rehab and care for people severely injured in motor accidents in NSW.
What are the conditions that determine care is “reasonable and necessary” in LCAS?
- What are the benefits to the patient
- Appropriate treatment? - evidence?
- Appropriate provider for needs?
- Cost-effective?
- Is it injury related?
What is the eligibility measurements for TBI in the LCAS?
PTA > 1 week
Score = 5 on at least 1 item of Functional independence Measure (FIM) because of brain injury
What is the FIM?
Functional independence measure:
Outcome measures for all rehabilitation services
What is a typical neuro assessment?
Impairments: mobility, ADL, functional, msk
Activity levels
What to assess for when looking at Activity Limitations?
- Bed mobility
- Sitting balance
- Sit to stand
- Standing balance
- Transfers
- Walking
- Reaching and manipulation
- Contracture and Strength
What are the factors to consider with intervention?
Cognition, motivation, pain, priorities, complications
In a TBI patient, how might cognition affect intervention?
- Patients may not have insight into their own injury.
- Memory loss
- Mental fatigue
How might priorities impact intervention?
Consider patient goals
Have definite priorities leading to a global goal
What is collaborative Rehabilitation?
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.
Identify how a multidisciplinary team can collaborate in treatment?
Physio: msk, physical impairments Nurse: ward-care OT- Discharge/home planning Neuropsychologist- cognitive Social work: supports at home Medical teams- relevant body systems
What are some interventions for TBI patients?
- Kinematic analysis and task specific retraining
- Low load prolonged stretches (contracture)
- UL AND LL ROM and strength
- Fitness training
- Education and advice
- Consultations
What are aspects of education and advice during intervention?
- Explanation of injury
- Prognosis and expectations
- Pain management
- Training strategies
- Precautions
- Counselling
What is collaborative goal setting?
Goal setting by different health professionals to achieve global goals
Link short term to long term
What are some benefits of collaborative goal setting?
- Improved client motivation and participation in rehab
- Highly valued by patients
- Higher goal relevance and satisfaction
What are some challenges of collaborative goal setting?
- Some people aren’t goal driven
- Cognitive impairments
- Time consuming - paperwork etc
What is the evidence regarding Goal Setting?
Cochrane SR Levack 2015
- Low quality evidence
Clinical implications
- Person-centred and personally meaningful goals favorable to QoL
- Can serve to improve team cohesion
Why cant evaluations be made for research with TBI?
Not ethical to randomise a person with TBI to a group that does not receive MDT rehab
What are the conclusions about MDT rehabilitation for ABI?
Varied nature of services due to varied needs
- Intervention should be offered as early and intensively as possible
- People require ongoing rehab after discharge
