TBI Flashcards
how is TBI different from stroke
similar that it has neuromuscular deficits
diff bcs of cognitive and behavior deficits
neuromuscular
cognitive
behavior
what are the neuromuscular impairments in TBI
abnormal tone and gait - spasticity
sensory impairments
motor function
impaired balance
paresis
secondary impairments of TBI
atrophy
DVT
heterotrophic
ossification
pneumonia
fx
contractures
cognitive impairments of TBI
altered LOC
memory loss
altered orientation
attention deficits
impaired insight and safety
problem solving/reasoning impairments
perseveration
impaired executive functioning
behavioral impairments of TBI
disinhibition
impulsiveness
physical and verbal aggressiveness
apathy
lack of concern
sexual inappropriateness
irritability
egocentricity
impaired drive
dyscontrol
goals of acute care
improve respiratory function and prevent complication
prevent 2° brain damage
preserve MSK integrity
facilitate arousal and active engagement
how does one improve respiratory function
bed mob and GBRE
interventions if pt has hypoventilation and impaired mucociliary clearance
tapping and cupping if s chest tube
ankle pumps
make pt rest
interventions if pt has hyperventilation
brown bag technique to dec CO2
interventions if pt has ventilation/perfusion mismatch
alter position
indications for ventilation
PaO2 < 60 mmHg - hypoxemia
PaCO2 > 45 mmHg - hypercapnia
exp how inc ICP causes 2° brain damage
inc ICP = dec CPP since too much pressure in brain causes dec BF bcs more pressure is needed to supply
hence causing cerebral ischemia
inc ICP also inc BP = dec HR to reduce BP but irregular breathing will occur
dont control ICP padin more dec of BP para pababain = dec CPP = coma
cerebral hypoxia –> cerebral edema
how to control inc ICP
GBRE then monitor vitals
interventions in preventing MSK injury
PROM, stretching
positioning
serial casting
GBRE
sitting and standing
sitting and standing in TBI is only allowed if
voluntary control of breathing
no severe chest injury
no chest tube
no femoral/pelvic fx
benefits of upright position
bowel and bladder emptying
improved ventilation
dec ICP since inc CVR
parameters in facilitating arousal and active engagement
timing - do interv when pt is most awake
family involvement, educ and counseling
limited carry over of training
re-establish: swallowing, breathing, coughing, comms
LOCF 1-3
prevent contractures and tightness
improve arousal through sensory stim - talking, movement
manage spasticity - inhibitory techniques
early sitting - GBREs
educate family
monitor response
early indicators of good prognosis
high GCS score
younger age
PLR
hypotension
CT scan - onti lng damage
LOCF 4
maintain function s triggering patient
can do strengthening pero wag dumbells
use:
- isolation
- calm behavior
- consistency
- negative reinforcement
- flexibility
- safety measures
- fam educ
expect:
- no carry over
- egocentricity
- aggressive and inappropriate actions
LOCF 5-6
rely heavily on routines - OC
- PT should not change; exercise should not change
- change = aggression
maximize functional recovery - compensatory approach or rehab approach
tasks progressed gradually
LOCF 7-8
get them out of routine
community, social and daily living skills
involve pt in decision making and problem solving
more self monitoring
challenging tasks
endurance training
how to manage cognitive and behavioral deficits
dont change environment and dont add stressors
proper positioning
frontal pattern behavior is common in
coup injury
how to manage communication problems
be patient
pertinent cues
focus pt attention
simplify language
isolation
use of natural context cues
redirecting agitated behavior
unable to learn new info
RLA 1-5
carry-over for relearned tasks with little or no carry-over for new tasks
RLA 6
carry-over for new learning but decreased rate
RLA 7
carry-over for new learning and needs no supervision once activities are learned
RLA 8
decision making process in choosing a task
should be suitable
not too complex and not to easy
discuss managing dysfunction
problem in ADLs for RLA 7-8
multiple steps and pwede group sessions
simulation
compare antecedent and consequence focused
antecedent - warn lang of what u do if bad cla
consequence - do the consequence; get out of room gnun
strategies for dec behavior
withhold rewards that maintain bad
withhold positive reinforcement after bad
apply penalty for bad
stim control
systematic desentisization
extincition
strategies for inc behavior
reward good
prompting
chaining
expanding rehearsal
how to manage incontinence
do not make them feel ashamed
pt educ
wiwi na before Tx
how to manage post-traumatic epilepsy
risk w/in 12 mo. post injury
during attack
- floor if exercising
- put rails up onbed and surround c pillows
- pull curtain on ward
after attack
- tell pt what happened
- simple activities
- dont put spoon in mouth
