TBI

Question 1

how is TBI different from stroke

Answer 1

similar that it has neuromuscular deficits

diff bcs of cognitive and behavior deficits

neuromuscular
cognitive
behavior

Question 2

what are the neuromuscular impairments in TBI

Answer 2

abnormal tone and gait - spasticity

sensory impairments

motor function

impaired balance

paresis

Question 3

secondary impairments of TBI

Answer 3

atrophy

DVT

heterotrophic
ossification

pneumonia

fx

contractures

Question 4

cognitive impairments of TBI

Answer 4

altered LOC

memory loss

altered orientation

attention deficits

impaired insight and safety

problem solving/reasoning impairments

perseveration

impaired executive functioning

Question 5

behavioral impairments of TBI

Answer 5

disinhibition

impulsiveness

physical and verbal aggressiveness

apathy

lack of concern

sexual inappropriateness

irritability

egocentricity

impaired drive

dyscontrol

Question 6

goals of acute care

Answer 6

improve respiratory function and prevent complication

prevent 2° brain damage

preserve MSK integrity

facilitate arousal and active engagement

Question 7

how does one improve respiratory function

Answer 7

bed mob and GBRE

Question 8

interventions if pt has hypoventilation and impaired mucociliary clearance

Answer 8

tapping and cupping if s chest tube

ankle pumps

make pt rest

Question 9

interventions if pt has hyperventilation

Answer 9

brown bag technique to dec CO2

Question 10

interventions if pt has ventilation/perfusion mismatch

Answer 10

alter position

Question 11

indications for ventilation

Answer 11

PaO2 < 60 mmHg - hypoxemia

PaCO2 > 45 mmHg - hypercapnia

Question 12

exp how inc ICP causes 2° brain damage

Answer 12

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

Question 13

how to control inc ICP

Answer 13

GBRE then monitor vitals

Question 14

interventions in preventing MSK injury

Answer 14

PROM, stretching

positioning

serial casting

GBRE

sitting and standing

Question 15

sitting and standing in TBI is only allowed if

Answer 15

voluntary control of breathing

no severe chest injury

no chest tube

no femoral/pelvic fx

Question 16

benefits of upright position

Answer 16

bowel and bladder emptying

improved ventilation

dec ICP since inc CVR

Question 17

parameters in facilitating arousal and active engagement

Answer 17

timing - do interv when pt is most awake

family involvement, educ and counseling

limited carry over of training

re-establish: swallowing, breathing, coughing, comms

Question 18

LOCF 1-3

Answer 18

prevent contractures and tightness

improve arousal through sensory stim - talking, movement

manage spasticity - inhibitory techniques

early sitting - GBREs

educate family

monitor response

Question 19

early indicators of good prognosis

Answer 19

high GCS score

younger age

PLR

hypotension

CT scan - onti lng damage

Question 20

LOCF 4

Answer 20

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

Question 21

LOCF 5-6

Answer 21

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

Question 22

LOCF 7-8

Answer 22

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

Question 23

how to manage cognitive and behavioral deficits

Answer 23

dont change environment and dont add stressors

proper positioning

Question 24

frontal pattern behavior is common in

Answer 24

coup injury

Question 25

how to manage communication problems

Answer 25

be patient

pertinent cues

focus pt attention

simplify language

isolation

use of natural context cues

redirecting agitated behavior

Question 26

unable to learn new info

Answer 26

RLA 1-5

Question 27

carry-over for relearned tasks with little or no carry-over for new tasks

Answer 27

RLA 6

Question 28

carry-over for new learning but decreased rate

Answer 28

RLA 7

Question 29

carry-over for new learning and needs no supervision once activities are learned

Answer 29

RLA 8

Question 30

decision making process in choosing a task

Answer 30

should be suitable

not too complex and not to easy

Question 31

discuss managing dysfunction

Answer 31

problem in ADLs for RLA 7-8

multiple steps and pwede group sessions

simulation

Question 32

compare antecedent and consequence focused

Answer 32

antecedent - warn lang of what u do if bad cla

consequence - do the consequence; get out of room gnun

Question 33

strategies for dec behavior

Answer 33

withhold rewards that maintain bad

withhold positive reinforcement after bad

apply penalty for bad

stim control

systematic desentisization

extincition

Question 34

strategies for inc behavior

Answer 34

reward good

prompting

chaining

expanding rehearsal

Question 35

how to manage incontinence

Answer 35

do not make them feel ashamed

pt educ

wiwi na before Tx

Question 36

how to manage post-traumatic epilepsy

Answer 36

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