TBI

Question 1

Closed head injury

Answer 1

Motor Vehicle accidents

Contusions, bruises, DAI, Bilateral Asymmetrical injuries, skull fractures, subdural and epidural hemorrhage, tentorial herniation, coma, brief loss of consciousness

*most common, wide range of damage

Question 2

Open Head injury

Answer 2

Gun shot wounds, fragments from exploding objects, FALLS

Focal neurological symptoms and post traumatic seizures, localized areas of damage

Question 3

Glasgow Coma Scale

Answer 3

• quantifies severity of TBI
• establish a baseline
• predicts the outcome for the patient

Assesses: motor, verbal responses and eye opening

Question 4

Decorticate Posturing

Answer 4

results from damage to corticospinal tracts - arms ADD and Flexed, wrist and fingers flexed, legs are stiffly extended and internally rotated with plantar flexion of the feet

Question 5

Decerebrate posturing

Answer 5

results from damage to the upper brain stem - arms are abducted and Extended, wrist pronated and fingers flexed, legs are stiffly extended with plantar flexion of the feet

Question 6

Method used to categorize level of consciousness after TBI

Answer 6

Glasgow Coma Scale:
1) motor responses,
2) verbal responses,
3) eye opening

Question 7

Criteria to determine the severity of TBI

Answer 7

length of amnesia, depth and duration of coma

Question 8

Ranchos Los Amigos Scale of Cognitive Functioning

Answer 8

used to determine effective intervention for Cognitive and BEHAVORIAL ASPECTS of recovery

Question 9

the medical and OT interventions that are necessary during the emergency & acute phases of TBI

Answer 9

• Glasgow Coma Scale, BP, HR, temperature, ICP
• Rehab begins when vital signs are stable
  -positioning for contracture prevention, and bed sore prevention, monitoring of HR/BP OX sat, ICP PROM, sensory stim program.

Question 10

Ranchos Los Amigos Scale Level I.

Answer 10

No response - deep sleep, completely unresponsive to any stimuli

Question 11

Ranchos Los Amigos Scale Level II

Answer 11

Generalized response - reacts inconsistently and non purposefully to a stimuli in a non-specific manner - may be delayed

Question 12

OT Tx in Level 2

Answer 12

Stim program with olfactory enhancement - really strong scent, and PROM

Question 13

Ranchos Los Amigos Scale Level III

Answer 13

Localized response - reacts specifically but inconsistently to stimuli - follow simple commands in an inconsistent and delayed manner

Question 14

OT Tx in Level 3

Answer 14

Continue stim program, simple gross motor actions, one step commands with no choice, basic self care, simple reality orientation (In front of mirror)

Question 15

Ranchos Los Amigos Scale Level IV

Answer 15

Confused Agitated - a heightened state of activity with severely decreased ability to process information, not able to cooperate directly with treatment efforts, gross attention to environment for a very short duration, confabulation may be present, ST recall is lacking, behavior is bizarre and non-purposeful relative to the environment

Question 16

OT Tx in Level 4

Answer 16

simple gross motor skills, vanilla room (non threatening and predictable, familiar and automatic tasks

Question 17

Ranchos Los Amigos Scale Level V

Answer 17

Confused Inappropriate Non Agitated - with structure, may be able to converse on a social automatic level for short periods of time

Question 18

OT Tx in Level 5

Answer 18

evaluate visual perception, provide redundancy and repetition, review biographical info, play simple games, go fish, war etc.

Question 19

Ranchos Los Amigos Scale Level VI

Answer 19

Confused Appropriate - goal directed but dependent on external input for direction , shows appropriate responses to discomfort and shows carry over of new learning

Question 20

OT Tx in Level 6

Answer 20

gradually decrease structure, work on ADLs less assistance, do simple math drills (single digit), sequencing cards, make simple treats, follow written directions, start with cooperation with others, start to put things away

Question 21

Ranchos Los Amigos Scale Level VII

Answer 21

Automatic Appropriate - oriented to familiar settings, goes through daily routines automatically but robot like with minimal to absent confusion, has superficial awareness but lack insight into own condition with decrease judgement and problem solving, unrealistic planning for future

Question 22

OT Tx in Level 7

Answer 22

focusing on community reentry skills, use phone, checkbook, money exchange, cross streets signs and grocery shop

Question 23

Ranchos Los Amigos Scale Level VIII

Answer 23

Purposeful Appropriate - alert and oriented and able to recall integrate past and recent events, responsive to own culture and shows carry over for new learning and no longer requires supervision once the activity is learned, can make STG and LTG for future, driving can occur (do 1 step of activity)

Question 24

OT Tx in Level 8

Answer 24

Home safety, ID dangerous situations in non predictable settings, (do full activity)

Question 25

Ranchos Los Amigos Scale Level IX

Answer 25

Purposeful Appropriate with Stand by Assistance on request

Question 26

Ranchos Los Amigos Scale Level X

Answer 26

Purposeful Appropriate with Modified Independent

Question 27

what group/s of individuals are at greater risk for TBI?

Answer 27

• children 4 to 5 years old
• men in 15 to 24 years old
• elderly
• previous brain injured individuals

Question 28

TBI precautions

Answer 28

avoid over stimulation *

wear protective devices *

disinfect treatment areas

observe for seizure occurrence *

avoid inversion or weight bearing for unresolved FX *

avoid aggressive ROM *

monitor skin breakdown

keep tubes and lines untwisted *

avoid pain and discomfort *

avoid rapid rotary movements *

maintain airway passage *

observe tracheostomy care *

observe, avoid and protect

avoid and prevent pressure sores

monitor HR and BP during facilitation – especially after bed rest

avoid circulatory disorders

avoid damage from sensory impairment

avoid resistance in the presence of spasticity

observe safety of/for the patient *

avoid falls

observe for aspiration precautions and risk

prevent/control edema

monitor ICP *

Question 29

Diffuse Axonal Injury (DAI)

Answer 29

Shearing of the white fibers of the brain

Question 30

Hematoma

Answer 30

blood clot

Question 31

Concussions

Answer 31

mild injury to the brain, often resulting from a blow to the head, that can cause temporary disorientation, memory loss and unconsiousness