TBI

Question 1

Rancho Los Amigos scale purpose

Answer 1

Monitors cognitive & behavioral status throughout recovery after TBI.
Considers:
1. State of consciousness.
2. Level of assist required for cognitive & physical tasks.

Question 2

RLA Level 1

Answer 2

Coma; no response to external stimuli.

Question 3

RLA Level 2

Answer 3

Generalized Responses:
-Responds inconsistently & non-purposefully to external stimuli.
-Responses may be similar despite different stimuli.

Question 4

RLA Level 3

Answer 4

Localized Responses:
-Purposeful & specific response, but inconsistent.
-Follows simple commands (e.g., close eyes).

Question 5

RLA Level 4

Answer 5

Confused & Agitated:
-Hyperactivity, non-purposeful behavior.
-Aggression more d/t confusion than external stimuli.
-Does not cooperate, incoherent vocalization, confabulations.

Question 6

RLA Level 5

Answer 6

Confused Inappropriate:
-Consistent response to simple commands.
-Inconsistent response to complex commands.
-Memory severely impaired, cannot learn new tasks.

Question 7

RLA Level 6

Answer 7

Confused Appropriate:
-Consistently follows simple instructions.
-Goal-oriented behavior.
-Increased awareness of self & environment, but unaware of impairments (SAFETY!!)
-Retains memory of familiar tasks (e.g., brush teeth), but difficulty learning new tasks.

Question 8

RLA Level 7

Answer 8

Automatic Appropriate:
-Oriented in familiar environments.
-Able to perform automatic daily routines, but may be robot-like.
-Judgement impaired (SAFETY!)
-Shows interest in social or recreational activity in structured environment.

Question 9

RLA Level 8

Answer 9

Purposeful Appropriate:
-Consistently oriented.
-Memory improvements, can perform familiar tasks in non-distracting environments.
-Aware of impairments, but impaired judgement in emergency situations.
-Reduced tolerance for stress.

Question 10

PT interventions for RLA levels 1-3

Answer 10

-Positioning: preventing ulcers.
-Gentle PROM: maintain joint & skin integrity.
-Respiratory: postural drainage, percussion, vibration.
-Family education.

Question 11

PT interventions for RLA levels 4-6

Answer 11

-Establish consistent routines: same therapist, family introduce themselves daily.
-Orient: calendars, clocks.
-Agitated behaviors: calm, don’t confront.
-Closed environments: to prevent harm to others, & bc complex commands can’t be followed.

Question 12

PT interventions for RLA levels 7-8

Answer 12

-Community re-entry.
-Problem solving, social interactions.
-Adaptations at work/school.

Question 13

GCS categories

Answer 13

1. Eye opening
2. Verbal response
3. Best motor response

Question 14

Mild TBI GCS score

Answer 14

13-15

Question 15

Moderate TBI GCS score

Answer 15

9-12

Question 16

Severe TBI GCS score

Answer 16

3-8

Question 17

GCS eye opening scoring

Answer 17

4 = spontaneous, opens before stimulus.
3 = opens to sound.
2 = opens to fingertip stimulus.
1 = no opening.

Question 18

GCS verbal response scoring

Answer 18

5 = oriented; correctly gives name, place, date.
4 = confused; not oriented but communicates coherently.
3 = single words.
2 = only moans/groans.
1 = no audible response.

Question 19

GCS best motor response scoring

Answer 19

6 = obeys 2-part commands.
5 = brings hand above clavicle to stimulus on head or neck.
4 = normal flexion; bends elbow rapidly, away from body.
3 = abnormal flexion; slow elbow bending, arm across chest, forearm rotates, thumb clenched.
2 = extension; elbow extends.
1 = no movement.

Question 20

GCS best motor response: where to stimulate?

Answer 20

Trapezius pinch
Supraorbital notch (if no response from trap pinch)

Question 21

What are confabulations?

Answer 21

False memories, making up stories.