TBI Flashcards
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
What is sun-downing?
Primitive fight-or-flight response to evening coming on.
-If not addressed, can lead to sleepless night (also common in elderly w/ dementia)
What are some strategies for managing sun-downing?
- treat with meds
- family at bedside
- orientation cues
- gentle reassurance
What is the role of “antecedent management” in brain injury rehabilitation?
-Arrange situations and organize activities so that triggers for agitation/behaviors are minimized, thus stopping behaviors before they occur; e.g. building therapeutic milieu
Describe the Clubhouse model
- Members work together to support each other in the pursuit of personal goals
- Encourages community re-entry, the rebuilding of social relationships and the training of skills required to return to productive activity
- Divided into four main areas: Work Ordered Day, (which consists of Units such as Kitchen and Business), Employment, Education and Evening/Weekend activities
Describe day rehabilitation centers
Full-day therapy program that is structured like a regular school day. It is available from 9 a.m. to 3 p.m. Monday through Friday. The focus of the program is the return of the functional skills necessary for continuing recovery and school re-entry.
What home management recommendations would you make to family caregivers as they prepare for a loved one with a brain injury to return home from hospital?
-Learning how to manage environment, tasks, memory issues, and behaviors
De-clutter/manage environmental stim
Allow extra rest time
Ensure maintenance of sleep routine
Limit caffeine intake
Keep grooming & bedside materials in same place
Maintain daily routine
Provide adequate lighting
Avoid unnecessary trips to unfamiliar surroundings
Avoid ambiguity, don’t present too many choices
Just-right challenge :)
-Home visits with & w/o patients to assist with mods and adaptations
What are the MOST COMMON FUNCTIONAL IMPAIRMENTS AFTER TBI?
- Slowed cognitive processing (brain processes slower than actions → impulsive)
- Transfer of learning to varied tasks and settings (generalizing)
- Insight, judgment, and denial (of need for rehab)
Describe some strategies for addressing psychosocial deficits after brain injury
- relaxation techniques/stress training, anger diary
- family counseling group, individualized therapies; group cognitive-behavioral modules
- BIP (school)
- teach communication alternatives
- focus on antecedents, not consequences
List and describe at least 3 ecologically valid community-based cognitive-behavioral assessment tools.
- Rivermead Behavioral Memory Test - predict everyday memory problems in people with acquired, nonprogressive brain injury and to monitor their change over time
- Test of Everyday Attention - Measure selective attention, sustained attention and attentional switching
Multiple Errands Test - evaluates the effect of executive function deficits on everyday functioning through a number of real-world tasks
-Cambridge Test of Prospective Memory - assesses deficits of prospective memory
What brain injury related deficits may have an impact on a driving evaluation?
- Slowed cognitive processing
- Disorientation
- Poor attention
- Deficits in decision-making
- Impaired safety awareness
- Lack of judgment/awareness of deficits
- Difficulty in planning, sequencing
Describe a strategy for remembering names and faces
-Make positive, can exaggerate, use humor, rude is funny, vivid and colorful images are good, use all sense to code information (e.g., sounds, smell), bring movement into it
Ex: George is a ginger. (similar sounds)
List at least five concussion symptoms
- Attention difficulties
- Memory impairment
- Irritability
- Anxiety
- Dizziness
- Diplopia
- Insomnia, Hypersomnia
- SECONDARY symptoms: headache, fatigue, depression, slow cognitive processing, symptoms fluctuate
What are the basic return-to-play guidelines for the management of youth sports concussions?
- No Activity
- Light Aerobic Exercise (walking, swimming, stationary cycling)
HR
Following concussion, when should an athlete return to the playing field?
After using the Graduated Return to Play Protocol and are symptom free for 24 hours after last step (contact practice).
What is the one common cognitive factor among people who have brain injuries?
Slow cognitive processing
Describe in lay terms what happens to body fluids and the brain in a blast-related concussion
-Blast-Related Concussion: All of the following 3 can occur together
Can have a direct blow to the head, brain bounces inside skull (looks like a concussion)
Penetrating head injury: the brain doesn’t like to be exposed to the world, get infected
Shock wave blasts through whole body, including the brain. Your cells in your body fluid & brain are moved out of the way (compression), then they bounce back (vacuum wave).
List at least 5 symptoms of PTSD
- Upset thoughts or images about traumatic event when you did not want them
- being overly alert
- bad dreams about traumatic event
- feeling distant or cut off from people around you
- feeling emotionally numb
- having trouble falling or staying asleep
- feeling irritable or having fits of anger
Describe how “graduated exposure” therapy is conducted
- Identify personal tolerance (with regard to time and intensity) for self-selected activities pertinent for role function and functional goals for social interaction and community reentry.
- Create a schedule of gradually increased engagement in assigned activities.
- Client self-assesses exposure using SUDS (subjective units of disturbance scale).
- Grade up to next step. Review and collaborate on supports needed.
