TBI Flashcards
Coup and…
Contracoup
Classification of head injuries based on
Open or closed
Penetrating or blunt
Depressed or no depressed skull fracture
Shearing causes
Diffuse atonal injury
Contusion
Hemorrhages
PTA with concussion
Transient, acute
Range of mild to severe based on
Degree of force
Multiple trauma
Neurological complications
Speed of assistance
Mild TBI
13-15 GCS
Less than 1 hour loss of consciousness
Less than 24 hours PTA
Moderate TBI
9-12 GCS
1-24 hours LOC
1-7days PTA
Severe TBI
3-8 GCS
Over 24 hours LOC
More than 7 days PTA
Greatest degree of recovery occurs within
6 months
Rancho Los amigos scale
1-3 beginning stages of recovery
4-6 middle
7-8 later
9-10 new recovery stages
Persistent vegetative state when…
12 months post trauma
Or
3 months post anoxic incident
Rancho level 1
No response
Give stimulation
Speak as if they understand
Rancho level 2
Generalized response
Reacts inconsistently, non purposeful, nonspecific to the stimuli.
Limited, repeated responses
Facilitate purposeful movement
Stimulate sensory, increase rate, variety, quality of pt response
Rancho level 3
Localized response
Pt reacts specifically but not consistently
May follow specific commands , ie open your eyes
Inconsistent, delayed
Maintain attention Establish means of communication Matching objects Sensory stimulation Use of objects Common commands
Rancho level 4
Confused, agitated Heightened activity, low processing of info Non purposeful behavior May overreact to stimuli Aggression Confabulations, hostile Inappropriate verbal Brief gross attn, needs help w activities Automatic motor tasks but not purposeful or on request
Establish Comm system Increase attn to environment Decrease agitation Improve orientation Sequencing and temporal tasks Discrimination of pics and objects Expression and comprehension , yes-no questions Set up routine, structure. Avoid touch and restraint if possible.
Rancho level 5
Confused, inappropriate Looks alert Responds consistently w simple commands but more complex ones w less structure get answers that are non purposeful, fragmented Gross attn to environment Lack of initiation Inappropriate use of objects Verbal inappropriate, confabulations Needs supervision for tasks Out of proportion agitation to stimuli
Compensate for memory deficits Increase attn, orientation, cognitive fx Problem solving, judgment Increase Awareness of inappropriate behaviors Enhance communication Memory notebook Calendars and clocks Maintain topic Sequence Reading and writing tasks Association and categorization
Rancho level 6
Confused, appropriate
Goal directed behavior but needs outside direction
Able to tolerate unpleasant stimuli
Consistently follows commands
Carry over for learned tasks
Memory deficit but answers questions appropriately
Inconsistently oriented to time and place
Memory is better than before,deeper
Selective attn impaired
Better self awareness and recognition of others
Cognitive linguistics Word retrieval Community reentry Address memory Thought formulation Processing, reasoning, executive fx
Rancho level 7
Automatic, appropriate Minimal to absent confusion Oriented, appropriate Automatic with daily tasks Doesn't fully understand his condition Decreased judgement and problem solving Lack realistic planning Carryover present but slow
Increase insight Maximize community functioning Sequential thought processing Organization, planning Memory long and short term Social skills Decrease dependence Abstract thinking Role playing
Rancho level 8
Purposeful, appropriate
Alert, able to recall past events
Doesn’t need supervision
May still have trouble with processing speed, abstracts, stress, and judgement in an emergency
Attention
Memory devices
Social
Rancho level 9
Aware of deficits Able to think of consequences with assistance Can acknowledge others feelings w help Easily frustrated Depression Can self monitor socially
Memory devices
Social interaction
Divided, alternating, sustained attn
Rancho level 10
Can multitask in all environments but may need breaks
May need more time for activities
Aware of deficits impact and can compensate
Periodic depression
Independently gets others emotions and consequences to actions
No therapy
Response hierarchy
Response
Consistent response
Accurate response
For arousal, consider…
Medications and pain level
