TBI - 2b Mod-Severe TBI Flashcards
what is the focus of the RLA
general pattern w focus on cog and behavior
what type of responses can be expected from RLA 1-3
no - generalize - localized
what are the 5 main intervention categories to manage RLA 1-3
sensory stim
communcation
cardiopulm
prevention of indirect impairment
family/caregiver ed
how should sensory stim be presented and what should you look for for for RLA 1-3
present in highly structured manner
monitor for:
- subtle response (HR, RR, BP)
- motor response (face, posture, head turn, vocalization)
when can communication as an intervention be introduced and how is it utilized across RLA 1-3
as begins to respond to commands via eye opening, changes in BP/HR/RR w stim
encourage vocalization/verbal
integrate movement w meaning as start to follow commands
what are appropriate cardiopulm interventions for levels 1-3
positioning
bronchopulm hygiene
early mob OOB
what are interventions to prevent indirect impairments in RLA 1-3
positioning
ROM
serial casting
- phenol, botox
what are things to educate the family/caregiver on in RLA 1-3
stages of disability
POC
ROM, positioning, communication, sensory stim
what type of response can be expected from RLA 4-5
confused agitated - confused inappropriate
what are 5 components of managing RLA 4-5
manage agitation
behavior modification technique
consequent control
antecedent control
pt/family ed
what are strategies to manage the agitated pt
MDs - optimize med status and meds
orient - non threatening and provide info to pt
safety, constant supervision
what is consequent control and how can this be utilized in RLA 4-5
consequence immediately following behavior is assumed to have some significant effect on future probability of behavior
- token economy
- positive re-inforcement
- redirection/time out
- shaping
what is antecedent control and how can this be utilized in RLA 4-5
stimulus present prior to and during behavior
- can elicit, maintain, modify behavior
can use environment as stim early in treatment (primary means of control)
- how you deliver stim is important
what are things to educate the pt/family on in RLA 4-5
focus on family
- explain part of recovery
- teach strategies - consistency, calm behavior
what type of responses can be expected from RLA 5-6
confused-inappropriate / confused-appropriate
what are strategies to utilize in managing RLA 5-6 (6)
- frequent re-orientation but try not to cue continuously
- explain what you are doing and why
- establish routine and structure -> memory charts, lists
- environment control
- appropriate amt of supervision vs restraints for safety
- avoid mental and physical fatigue (ie allow for rest breaks)
what are things to educate the family and pt on in RLA 5-6
pt may be moving but lack insight into deficits
- family teaching regarding assisting, wc use, body mechanics (unable to complete tasks (I) w/o cueing)
what are safety considerations when managing RLA 5-6
PT/OT may co-tx (rehab aide)
don’t leave unit/gym
- risk of elopement
what responses can be expected from RLA 7-8
automatic appropriate - purposeful appropriate
what is the emphasis of pt management of RLA 7-8 and what is an important thing to cut back on to encourage this
beginning community re-entry, return to work or school
wean from structure of inpatient rehab
what is the main strategy of pt management of RLA 7-8 and what are examples of this
progressive build up of cog components
- negotiate obstacles
- use environmental cues
- integrate compensatory strategies during “PT” activities
- low to high level of distraction in environment
- decision making
- problem solving
what are things to educate the patient and family on in RLA 7-8
community resources
-support groups
what type of response can be expected from RLA 8-10
purposeful - appropriate
what is an important thing to remember when managing patients RLA 8-10
pts not at baseline
what is the focus of the PT program for RLA 8-10 and what are examples of interventions
work on remaining deficits:
- high level balance and coordination deficits
- endurance/work hardening
- remaining ROM/strength deficits from neuro/ortho injuries
- integrate high level problem solving during tasks (public transport, scavenger hunts, community outings)
what are primary impairments of neuromuscular BSF (5)
abnormal tone
sensory impairments
motor function
- control and learning
postural control (balance)
gait
what are primary impairments of cognitive BSF (7)
altered level of consciousness
memory loss
altered orientation
attention deficits
impaired insight and safety
impaired problem solving/reasoning
impaired executive function
what are primary impairments of behavioral BSF (8)
disinhibition
impulsivity
physical/verbal aggressiveness
apathy
lack of concern
sexual inappropriateness
irritability
egocentricity
what are primary impairments of communication BSF (6)
receptive aphasia
expressive aphasia
dysarthria
auditory deficits
impaired reading comprehension
impaired written expression
what are 7 primary impairments of BSF
neuromuscular
cognitive
visual
perceptual
behavioral
communication
dysphagia
what are 3 secondary BSF impairments
musculoskeletal
cardiopulm/vascular
integ
what are 4 secondary musculoskeletal BSF impairments
soft tissue contractures
heterotrophic ossification
ms atrophy
dec bone density
what are 3 secondary cardiopulm/vascular BSF impairments
dec endurance
pneumonia
DVT
what are 2 secondary integ BSF impairments
skin breakdown (ie decubitus ulcers)
infection
what systems/functions should PT tests and measures assess (11)
circulation/respiratory
integ
MSK
nervous system
reflex integ/ms tone
postural control
vision
perceptual
cognition
behavior
communication
what PT tests and measures are included in a screen of the nervous system
sensory integrity
- light touch
- deep sensation
- proprioception
motor function
- motor control and learning
