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Phys Dys > TBI > Flashcards

TBI Flashcards

1
Q

Anterograde amnesia

A
  • 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
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2
Q

Retrograde amnesia

A

-Loss of memory before an injury or the onset of a disease.

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3
Q

Working memory

A
  • Holding and processing of new and already stored information
  • Important process for reasoning, comprehension, learning and memory updating.
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4
Q

Explicit memory

A
  • Conscious, intentional recollection of previous experiences and information
  • Ex: remembering appointment
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5
Q

Procedural memory

A

-Part of the long-term memory that is responsible for knowing how to do things (motor skills)

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6
Q

Orientation

A

-Use of memory and attention to identify oneself and to place oneself in time, place, and situation

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7
Q

Confabulation

A
  • Memory disturbance
  • Production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive.
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8
Q

Dyscalculia

A

-Severe difficulty in making arithmetical calculations, as a result of brain disorder

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9
Q

Diffuse axonal injury

A
  • 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
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10
Q

Minimally conscious state

A

-Partial preservation of conscious awareness

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11
Q

Persistent vegetative state

A

-Completely unresponsive to psychological and physical stimuli and displays no sign of higher brain function

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12
Q

What two factors are the best predictors for long-term outcome following brain injury?

A
  • Post-traumatic amnesia (PTA)

- Length of time in a coma

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13
Q

What six areas are typically addressed by OT for patients at Rancho I-III?

A
  • 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
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14
Q

What are the primary strategies used in ICUs for managing intracranial pressure?

A
  • 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
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15
Q

How do OTs utilize procedural memory during inpatient treatment for brain injury?

A

Capitalizing on what they do remember (ADLs)

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16
Q

What is agitation? How does it differ from aggression?

A

-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

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17
Q

Be able to describe strategies for managing agitation

A
  • Consistent routine
  • Calm demeanor/voice
  • Unstimulating environment
18
Q

3 early assessment tools that are typically used with people who have emerged from coma. What do they measure?

A
  • 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
19
Q

Describe the primary behavioral differences among Rancho Levels 4, 5 and 6

A

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)

20
Q

Explain why consistency in treatment is important during inpatient brain injury rehab.

A
  • 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
21
Q

Explain the role of the 4 “S’s” in inpatient rehab

A
  • 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)
22
Q

List several treatment parameters that should be considered when writing TBI treatment goals

A

-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.”

23
Q

What are the components of a memory book?

A
  1. Their name
  2. where they belong
  3. narrative that depicts exactly what happened to them
  4. a list of all people that treat the person
  5. any goals or documentation of previous treatments
  6. hour-by-hour day planner
  7. photos
  8. calendar
24
Q

When can a memory book be used? What is the purpose of a memory book?

A
  • 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
25
Q

What is sun-downing?

A

Primitive fight-or-flight response to evening coming on.

-If not addressed, can lead to sleepless night (also common in elderly w/ dementia)

26
Q

What are some strategies for managing sun-downing?

A
  • treat with meds
  • family at bedside
  • orientation cues
  • gentle reassurance
27
Q

What is the role of “antecedent management” in brain injury rehabilitation?

A

-Arrange situations and organize activities so that triggers for agitation/behaviors are minimized, thus stopping behaviors before they occur; e.g. building therapeutic milieu

28
Q

Describe the Clubhouse model

A
  • 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
29
Q

Describe day rehabilitation centers

A

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.

30
Q

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?

A

-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

31
Q

What are the MOST COMMON FUNCTIONAL IMPAIRMENTS AFTER TBI?

A
  • 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)
32
Q

Describe some strategies for addressing psychosocial deficits after brain injury

A
  • 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
33
Q

List and describe at least 3 ecologically valid community-based cognitive-behavioral assessment tools.

A
  • 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

34
Q

What brain injury related deficits may have an impact on a driving evaluation?

A
  • Slowed cognitive processing
  • Disorientation
  • Poor attention
  • Deficits in decision-making
  • Impaired safety awareness
  • Lack of judgment/awareness of deficits
  • Difficulty in planning, sequencing
35
Q

Describe a strategy for remembering names and faces

A

-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)

36
Q

List at least five concussion symptoms

A
  • Attention difficulties
  • Memory impairment
  • Irritability
  • Anxiety
  • Dizziness
  • Diplopia
  • Insomnia, Hypersomnia
  • SECONDARY symptoms: headache, fatigue, depression, slow cognitive processing, symptoms fluctuate
37
Q

What are the basic return-to-play guidelines for the management of youth sports concussions?

A
  1. No Activity
  2. Light Aerobic Exercise (walking, swimming, stationary cycling)
    HR
38
Q

Following concussion, when should an athlete return to the playing field?

A

After using the Graduated Return to Play Protocol and are symptom free for 24 hours after last step (contact practice).

39
Q

What is the one common cognitive factor among people who have brain injuries?

A

Slow cognitive processing

40
Q

Describe in lay terms what happens to body fluids and the brain in a blast-related concussion

A

-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).

41
Q

List at least 5 symptoms of PTSD

A
  • 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
42
Q

Describe how “graduated exposure” therapy is conducted

A
  • 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.

Phys Dys (17 decks)

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