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NeuroRehab > TBI > Flashcards

TBI Flashcards

1
Q

GCS - best eye response

A

4

  1. No eye opening
  2. Eye open to pain
  3. Eye open to verbal command
  4. Eyes open spontaneously
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2
Q

GCS - best verbal response

A

(5)

  1. No repsonse
  2. Incomprehensible sounds
  3. Inappropriate words
  4. Confused
  5. Oriented
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3
Q

GCS - best motor

A

(6)

  1. No motor reponse
  2. Extension to pain
  3. Flexion to pain
  4. Withdrawal from pain
  5. Localizing pain
  6. Obeys commands
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4
Q

GCS grading

A

> 13, mild
9-12 moderate
8 or less, severe

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5
Q

Rancho 1

A

No repsonse: total assist

Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular, or painful stim

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6
Q

Rancho 2

A

Generalized repsonse: total assist

Demonstrates generalized reflex to painful stim,
Responds to repeated auditory stim w/ increased or dec activity
Responds to external stim w/ PHYSIO changes generalized gross body movements, not purposeful vocaliziation
Response may be same regardless of type/location of stim
Repsonse may be sig delayed

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7
Q

Rancho level 3

A

Localized repsonse: total assist

Withdrawal/focalization to painful stim
Turns toward/away from audio stim
Blinks when strong light crosses visual field
Smooth pursuit
Responds to discomfort by pulling tubes/restraints
Responds inconsistently to simple commands
Responds directly related to type of stim
May respond to some persons but not others

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8
Q

Rancho levels 1-3

A

Just emerging from coma, physically very dep, sleep a lot

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9
Q

Level 4

A

Confused/agitated: max assist

Alert and in highented state of activity
Purposeful attempts to remove restraints/tubes/crawl OOB
Motor activities w/out any apparent purpose or upon another request
Absent short term memory
Aggressive or flight behavior, mood swings
Verbalizations incoherent/inappropriate to activity/enviro

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10
Q

Rancho level 5

A

Confused, inappropriate, non agitated- max assist

Not orientedto PPT
Frequent brief periods, non purposeful sustained attention
Impaired recent memory, confusion of past and present
Absent goal directed, problem solving, self monitoring behavior
Unable to learn new info
Respond appropriately to simple commands fairly consistently w/ external structure and cutes
Need external structures and cues to be appropriate w/ conversation

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11
Q

Rancho level 6

A

Confused, appropriate: mod assist

Unaware of impairments, disability, safety risk
Inconsisten orientated to PPT
Able to attend to highly familiar tasks in non distracting enviro 30 mins
Remote memory has more depth than recent
Vague recognition of some staff
Assistive memory aid w/ max A
Emerging awareness of appropriate response to self, family, basic needs
Carry over for learning familiar tasks
Max A for learning new w/ little to no carryover

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12
Q

Rancho level 7

A

Automatic, appropriate: min A for daily living skills

Unrealistic planning for future, unable to think about consequences, overestimates abilities, unaware of others needs/feelings
Oppositional uncooperative
Unable to recognize inappropriate social interaction behaviors
Min A for new learning, carry over
Initiates ADLS, but shallow recall of what he was doing

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13
Q

Rancho level 8

A

Purposeful and appropriate SBA

I attends to/completes familiar tasks for 1 hour in distracting enviro
Able to recall and integrate recent and past events
Recall daily schedule/to do
Can modify plan w/ min A
Thinks about consequences. Of decision w/ min A
Depressed, irritable, low frustration tol/ easily angered, argumentative, self centered,
Able to recognize/acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action w/ min A

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14
Q

Ranch level 9

A

Purposeful appropriate: SBA on request

Consequences, accurately estimates abilities but SBA to adjust task demands
Acknowledges others needs/feelings, responds appropriately w/ SBA
Self monitory appropriateness of social interactions w/ SBA

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15
Q

Rancho level 10

A

Purposeful, appropriate, mod I

Multiple tasks simultaneously but may require breaks
Able to indep create/maintain own assisted memory device

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16
Q

Level 1 goal

A

Elicit generalized repsonse to any sensory input

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17
Q

Level 1 sensory stim

A 
Always give clear explanation
May affect reticular activating system
1 sense at a time
Don’t allow for accommodation, 
Short, frequent sessions
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18
Q

Types of stim

A 
Gustatory
Olfactory
Auditory 
Visual
Tactile
Vestibular
Noxious
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19
Q

Level 2 pts react

A

Inconsistently and non purposefully to stim in a nonspecific manner

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20
Q

Level 2 to priorities

A
  1. Continue bed positioning as needed. Introduce wheelchair positioning program.
  2. Communication of positioning changes with interdisciplinary team/goals
  3. ROM: Maintain joint mobility and muscle flexibility. Inhibitory casts or splints if needed.
  4. Closely monitor for changes in status
21
Q

Level 2 tx goals

A
  1. Elicit localized repsonse
  2. Increase non reflexive repsonses
  3. Begin to introduce appropriate postural set for functional activities, as tolerated
22
Q

Level 2 application of stim

A

Sit pt up

Use stim that most consistently elicits a desired response

23
Q

Level 2 light touch

A

Midline perioral area facilitates UE flexion

To dermatome of t10 facilitates LE flexion

24
Q

Level 3 response

A

Specifically but inconsistently

25
Q

Level 3 tx priorities

A
  1. Maintain joint mobility and flexibility
  2. Comm of postural and mobility goals
  3. Structure tx to encourage functional activities
26
Q

Level 3 goals

A

Increase repsonse consistency

Channel repsonses into functional activities

27
Q

Level 3 posture

A

Provide correct postural set to give pt optimal chance to repsond motorically

28
Q

Level 4

A

Alert and in heightened state of activity, purposeful attempt to remove restraints or tubes/crawl out of bed
May perform motor activities
Aggressive or flight behavior

29
Q

Level 4 tx goals

A
  1. Consistent ID comm, manage and avoid escalation of inappropriate behavior
  2. Decrease intensity, duration, frequency of agitated repsonses.
    Increase attention, orientation, and repsonse to specific stim
30
Q

Level 4 tx strategy

A

Non threatening and calming
Elim noxious stim
Never approach/startle

Use automatic repsonses/movements incorporated into therapy

31
Q

Level 4 consistency

A

Physical exercise or recreation activities to channel restless behavior
Safe area to move
Set boundaries for safe release

32
Q

Family instructions for level 4

A

Don’t force pt to do things
Give breaks and change activities frequently
Keep room quiet and calm
Limit visitors to 2-3 at a time

33
Q

One to one supervision

A

Highest level 24 hour supervision

34
Q

Bracelet

A

whoever has the key or bracelet is responsible for the patient the entire time that they have it. Must be passed on to the next staff member with patient

35
Q

Eyes on

A

everyone in immediate area keeps an eye out for this patient.
– No single person responsible
– May have specific rooms

36
Q

Restraints

A

any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the patient’s ability to move his or her arms, legs, body, or head freely

Last resort, requires ongoing documentation and justification

37
Q

Level 5 tx goals

A
  1. Dec confusion, improve orientation
  2. Decrease inappropriate behavior
  3. Increase approp behavior
  4. Increase attention
  5. Improve memory
  6. Improve functional ability
38
Q

Level 6 tx goal

A
  1. Improve orientation and deficit awareness
  2. Improve selective attention
  3. Increase initiation
  4. Improve planning and sequencing
    abilities
  5. Increase functional ability
39
Q

Level 6 tx strategy

A

• Begin to add variation into daily routines
• Participate in a verbal logic and problem-
solving group
• Use safety drills for fire, earthquake, child
emergencies
• Give the patient small responsibilities • Gradually increase steps to your
instructions

40
Q

Level 7 tx goal

A
  1. Increase memory
  2. Increase safety judgment and problem-
    solving abilities
  3. Improve learning
41
Q

Level 8 goals

A
  1. Determine ability to return to school or job
  2. Improve reasoning, tolerance to high
    stress, and high-level problem solving 3. Improve ability to function in unfamiliar
    settings and situations
42
Q

Level 8 strategies

A

• Focus on community mobility and
navigation
• Referral to transitional living center
• Referral to pre-vocational or vocational
program
• Referral to community re-entry program

43
Q

Level 9 and 10 tx goal

A
  1. Focus on appropriate social behavior
  2. Community reintegration in school, job,
    recreation
  3. Independent/supervised living
44
Q

MDC: Minimal Detectable Change

A

Statistical estimate of the minimum amount of

change in a score required to ensure that the change isn’t the result of a measurement error

45
Q

MCID: Minimal Clinically Important

Difference

A

Published value that indicates the minimum

amount of change required for your patient to feel a difference in the variable you are measuring.

46
Q

dual-task effect

DTE

A

relative change in performance

associated with dual-tasking

47
Q

Dual task TUG cut off in community elderly for increased fall risk

A

TUG(Cognitive): >15 seconds

48
Q

If gait speed improves, but the cognitive task

worsens

A

this is only a trade-off in attention, not a true

improvement in dual-task gait performance

NeuroRehab (33 decks)

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