TBI Flashcards
(42 cards)
Anterograde amnesia
- Loss of the ability to create new memories after the event
- Partial or complete inability to recall the recent past
- Long term memories before accident intact
Retrograde amnesia
-Loss of memory before an injury or the onset of a disease.
Working memory
- Holding and processing of new and already stored information
- Important process for reasoning, comprehension, learning and memory updating.
Explicit memory
- Conscious, intentional recollection of previous experiences and information
- Ex: remembering appointment
Procedural memory
-Part of the long-term memory that is responsible for knowing how to do things (motor skills)
Orientation
-Use of memory and attention to identify oneself and to place oneself in time, place, and situation
Confabulation
- Memory disturbance
- Production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive.
Dyscalculia
-Severe difficulty in making arithmetical calculations, as a result of brain disorder
Diffuse axonal injury
- Extensive lesions in white matter tracts occurs over a widespread area
- Very common TBI
- Major cause of unconsciousness and persistent vegetative state after head trauma
Minimally conscious state
-Partial preservation of conscious awareness
Persistent vegetative state
-Completely unresponsive to psychological and physical stimuli and displays no sign of higher brain function
What two factors are the best predictors for long-term outcome following brain injury?
- Post-traumatic amnesia (PTA)
- Length of time in a coma
What six areas are typically addressed by OT for patients at Rancho I-III?
- sensory stimulation
- bed positioning
- casting and splinting
- wheelchair positioning
- dysphasia management
- family and caregiver education
- GENERAL AIM is to increase individual’s level of response and overall awareness of self and environment
What are the primary strategies used in ICUs for managing intracranial pressure?
- Monitor ICP, must be below 20 mm Hg
- Keep head elevated in bed
- Maintain nutrition
- Skull resection, if necessary
- Barbiturate paralysis, if necessary
- Emergency craniotomy
- Chronic: shunts
How do OTs utilize procedural memory during inpatient treatment for brain injury?
Capitalizing on what they do remember (ADLs)
What is agitation? How does it differ from aggression?
-Agitation: typically Rancho Levels 4-5, confused and adaptive attempt to explore environment, not purposeful
-Aggression: person begins to connect cause-effect,
beginning to make sense of the world.
Usually anything it takes to keep health care team away
-ex: don’t do the behavior they want
Be able to describe strategies for managing agitation
- Consistent routine
- Calm demeanor/voice
- Unstimulating environment
3 early assessment tools that are typically used with people who have emerged from coma. What do they measure?
- Rancho Los Amigos Levels of Cognitive Functioning
- Agitated Behavior Scale
- Orientation Log
- Galveston Orientation & Amnestic Test (GOAT) - not until they can engage, as agitation decreases
Describe the primary behavioral differences among Rancho Levels 4, 5 and 6
Level 4: Non-purposeful, confused, agitated behaviors
OT usually begins inpatient treatment at this level
Level 5: Gross attention, requiring frequent cueing and re-direction for most tasks
Level 6: Independent self-care, but little carryover of new learning
Patient may be able to go home, but still requires supervision (safety concerns)
Explain why consistency in treatment is important during inpatient brain injury rehab.
- Inconsistent situations can increase agitation and quickly lead into recalcitrant negative behaviors/aggressive tendencies
- Consistency helps fuel procedural memory
- Any change can cause a breakdown of function
Explain the role of the 4 “S’s” in inpatient rehab
- Safety: for yourself (having an extra person in room if needed), and for patient
- Stability: posture/movement (vestibular difficulties, put them in their most comfortable positions for ADLs)
- Stimulus: environmental focus (consistency)
- Sequencing: organized step-by-step routine (important for morning routine, ex: brush teeth → wash face → comb hair)
List several treatment parameters that should be considered when writing TBI treatment goals
-Level of cues/hand-over-hand
-Type of environment (ex: low-stim)
-Number of steps completed in task
-Use keywords like “simple,” “moderately complex,” and “familiar”
Ex: “Pt. will complete all steps of tooth-brushing task in low-stim environment with sequential set-up, verbal cues, and HOH guidance.”
Upgrade: “Pt. will complete all steps of tooth-brushing task in low-stim environment with sequential set-up and occasional verbal cues.”
What are the components of a memory book?
- Their name
- where they belong
- narrative that depicts exactly what happened to them
- a list of all people that treat the person
- any goals or documentation of previous treatments
- hour-by-hour day planner
- photos
- calendar
When can a memory book be used? What is the purpose of a memory book?
- When a person is able to read and attend briefly - as soon as they can respond to the GOAT (~Rancho Level 6)
- Professionals cue the person back to the memory book to refer to, usually calms them down and makes them feel less confused
