TBI - 3 Flashcards
ranchos los amigos cognitive scale revised
examines changes in behavior after brain injury
ranchos los amigos has
10 stages (3 of which are related to coma)
ranchos los amigos –> stages
usually pts follow these stages
2 or more stages may be seen at one time
length of each stage varies
level 1
no response
total assistance
level 1 is
complete absence of observable change in behavior
when presented w/ visual, auditory, tactile, proprioceptive, vestibular or painful stimuli
what does level 1 need
regular stimulation
do not shout at pt
level 2
generalized response
total assistance
what does level 2 demonstrate
generalized reflex response to painful stimuli
what does a level 2 respond to
external stimuli w/ physiological changes
generalized gross body movement
not purposeful vocalization
what may a level 2 do
be awake for brief periods
need to stimulate the pt
allow plenty of time for rxn
level 3
localized response
total assistance
what does a level 3 do
reacts more but not all the time
what does a level 3 demonstrate
w/drawal or vocalization to painful stimuli
pt is more aware of their body
what does level 3 respond to
discomfort
inconsistently follows 1 step commands
may respond to some people but not others
goals of level 3
increase attention to task
follow commands
use objects in a simple way
problem of levels 1-3
decreased response to the environment
goals of levels 1-3
prevent sensory deprivation
prevent contractures, decubiti, DVTs and pneumonia
elicit responses to sensory stimuli
increase frequency, rate, duration, quality of responses
what do we provide w/ levels 1-3
family education
level 4
confused/agitated
maximal assistance
what is level 4
severe internal confusion and inability to filter out external stimuli
what does level 4 result in
pt’s disruptive exaggerated behavior
how is the pt at level 4
alert
becomes more active (heightened state)
safety is a concern
restless
what may we perform with a level 4
motor activities w/o apparent purpose
sitting, reaching, walking
the pt is unable to –> level 4
focus
process
interpret
how long does level 4 last
2-4 weeks
goals of level 4
decrease agitation
assist pt to control behavior
keep pt safe
increase attention to the environment
strategies for level 4
use a quiet room
be consistent
model calm behavior
be reassuring
allow freedom of movement
structured setting w/ little demands
medications sparingly
what do we provide w/ level 4
pt and family education
level 5
confused, inappropriate, non-agitated
maximal assistance
how is the pt in level 5
may still become agitated in response to external stimulation &/or lack of environmental structure
what will the pt do at level 5
follow simple commands
attention span–> level 5
decreased
speech –> level 5
tangential
use of jargon
memory –> level 5
severely impaired
level 5 pt is unable to
learn new info
level 5 pt has decreased
initiation of tasks
level 5 pt may
wander
objects –> level 5
misuse of objects
level 6
confused, appropriate
moderate assistance
how is a level 6 pt oriented
inconsistently oriented to person, place, time
still has memory deficits
what does a level 6 pt consistently do
follow simple commands
what is a level 6 pt able to do
attend to highly familiar tasks in non-distracting environment for 30 minutes w/ moderate redirection
decreased –> level 6
problem solving or planning
has increased initiation
what is a level 6 pt able to use
assistive memory aide w/ max assist
emerging –> level 6
awareness of appropriate response to self, family and basic needs
goals for levels 5&6
decrease confusion
increase frequency, rate, duration, quality of appropriate interactions w/ environment
incorporate increased cognitive fxn into fxnal activities
provide pt and family education
level 7
automatic, appropriate
min assist for daily living skills
how is a level 7 pt
consistently oriented to person and place
w/in highly familiar environments
needs moderate assistance for orientation to time
what is a level 7 pt able to attend to
highly familiar tasks in a non-distracting environment for at least 30 mins w/ min assist
new learning –> –> level 7
minimal supervision
awareness of problems –> level 7
increased
judgement –> level 7
still poor
driving –> level 7
no
in a structured environment –> level 7
pt seems goal directed and purposeful
level 8
purposeful, appropriate
SBA
level 8 pt
consistently oriented to person, place, time
how does a level 8 pt attend to tasks
completes familiar tasks for 1 hr in distracting environments
new learning –> level 8
retained better
memory and concentration –> level 8
continues to improve
when may a problem emerge –> level 8
new or hard tasks
goals for 7&8
increased ability to respond to minimally structured environment
integrated increased cognitive fxn into fxnal activity w/in the community
provide pt education
level 9
purposeful, appropriate
SBA on request
tasks –> level 9
independently shifts b/w tasks and completes accurately for at least 2 hours
assistive memory device –> level 9
uses w/ assistance when requested
what do level 9 pts initiate and complete
familiar tasks independently and unfamiliar tasks with assistance when requested
what does a level 9 pt require
SBA to adjust to task demands, acknowledging others needs and feelings
what is a level 9 pt able to think about
consequences of decisions/actions w/ assistance on request
what could continue –> level 9
depression
easy irritation
low frustration tolerance
what is a level 9 pt able to do
self monitor appropriateness of social interaction w/ SBA
goals for level 9
pts typically seen in outpatient PT/home care
increase pt problem solving skills
increase pt higher level of cognitive fxning
increase pt and family awareness
increase pt and family awareness –> level 9
recognition of stressors, strategies to minimize impact of stressors
level 10
purposeful, appropriate
modified independence
what is a level 10 pt able to handle
multiple tasks simultaneously in all environments
may require periodic breaks
what can a level 10 pt independently do
procure
create
maintain own AD
task completion –> level 10
independently initiates and carries out steps to complete familiar and unfamiliar tasks
may require more time/compensatory strategies to complete
anticipates –> level 10
impact of impairments/disabilities on ability of ADLs/tasks
takes action to avoid problems before they occur but may need increased time/compensatory strategies
consequences –> level 10
independently think of consequences
may need increased time and compensatory strategies to select appropriate decision/action
accurately –> level 10
estimates abilities and independently adjusts to task demands
recognizes –> level 10
needs and feelings of others w/ appropriate response
what may occur –> level 10
periodic periods of depression
irritability and low frustration –> level 10
tolerance when sick, fatigued &/or under emotional stress
social interaction –> level 10
consistently appropriate
where will a level 10 pt be seen
outpatient/home care
goals for level 10
minimize pt breakdown when stressors occur
increase pt/family awareness for recognition of stressors/strategies to minimize impact of those stressors
pt to independently recognize difficulty
decrease time/compensation for pt to initiate/carry out familiar and unfamiliar tasks
