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PT 10117 - Neuro Eval and Interv > TBI > Flashcards

TBI Flashcards

1
Q

how is TBI different from stroke

A

similar that it has neuromuscular deficits

diff bcs of cognitive and behavior deficits

neuromuscular
cognitive
behavior

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2
Q

what are the neuromuscular impairments in TBI

A

abnormal tone and gait - spasticity

sensory impairments

motor function

impaired balance

paresis

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3
Q

secondary impairments of TBI

A

atrophy

DVT

heterotrophic
ossification

pneumonia

fx

contractures

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4
Q

cognitive impairments of TBI

A

altered LOC

memory loss

altered orientation

attention deficits

impaired insight and safety

problem solving/reasoning impairments

perseveration

impaired executive functioning

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5
Q

behavioral impairments of TBI

A

disinhibition

impulsiveness

physical and verbal aggressiveness

apathy

lack of concern

sexual inappropriateness

irritability

egocentricity

impaired drive

dyscontrol

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6
Q

goals of acute care

A

improve respiratory function and prevent complication

prevent 2° brain damage

preserve MSK integrity

facilitate arousal and active engagement

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7
Q

how does one improve respiratory function

A

bed mob and GBRE

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8
Q

interventions if pt has hypoventilation and impaired mucociliary clearance

A

tapping and cupping if s chest tube

ankle pumps

make pt rest

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9
Q

interventions if pt has hyperventilation

A

brown bag technique to dec CO2

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10
Q

interventions if pt has ventilation/perfusion mismatch

A

alter position

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11
Q

indications for ventilation

A

PaO2 < 60 mmHg - hypoxemia

PaCO2 > 45 mmHg - hypercapnia

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12
Q

exp how inc ICP causes 2° brain damage

A

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

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13
Q

how to control inc ICP

A

GBRE then monitor vitals

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14
Q

interventions in preventing MSK injury

A

PROM, stretching

positioning

serial casting

GBRE

sitting and standing

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15
Q

sitting and standing in TBI is only allowed if

A

voluntary control of breathing

no severe chest injury

no chest tube

no femoral/pelvic fx

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16
Q

benefits of upright position

A

bowel and bladder emptying

improved ventilation

dec ICP since inc CVR

17
Q

parameters in facilitating arousal and active engagement

A

timing - do interv when pt is most awake

family involvement, educ and counseling

limited carry over of training

re-establish: swallowing, breathing, coughing, comms

18
Q

LOCF 1-3

A

prevent contractures and tightness

improve arousal through sensory stim - talking, movement

manage spasticity - inhibitory techniques

early sitting - GBREs

educate family

monitor response

19
Q

early indicators of good prognosis

A

high GCS score

younger age

PLR

hypotension

CT scan - onti lng damage

20
Q

LOCF 4

A

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

21
Q

LOCF 5-6

A

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

22
Q

LOCF 7-8

A

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

23
Q

how to manage cognitive and behavioral deficits

A

dont change environment and dont add stressors

proper positioning

24
Q

frontal pattern behavior is common in

A

coup injury

25
Q

how to manage communication problems

A

be patient

pertinent cues

focus pt attention

simplify language

isolation

use of natural context cues

redirecting agitated behavior

26
Q

unable to learn new info

A

RLA 1-5

27
Q

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

A

RLA 6

28
Q

carry-over for new learning but decreased rate

A

RLA 7

29
Q

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

A

RLA 8

30
Q

decision making process in choosing a task

A

should be suitable

not too complex and not to easy

31
Q

discuss managing dysfunction

A

problem in ADLs for RLA 7-8

multiple steps and pwede group sessions

simulation

32
Q

compare antecedent and consequence focused

A

antecedent - warn lang of what u do if bad cla

consequence - do the consequence; get out of room gnun

33
Q

strategies for dec behavior

A

withhold rewards that maintain bad

withhold positive reinforcement after bad

apply penalty for bad

stim control

systematic desentisization

extincition

34
Q

strategies for inc behavior

A

reward good

prompting

chaining

expanding rehearsal

35
Q

how to manage incontinence

A

do not make them feel ashamed

pt educ

wiwi na before Tx

36
Q

how to manage post-traumatic epilepsy

A

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

PT 10117 - Neuro Eval and Interv (12 decks)

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