TBI Flashcards
Glascow Coma Scale
3-8 Severe
9-12 Moderate
13-15 Mild
Post Traumatic Amnesia (PTA)
Inability to remember day to day events after brain injury. The time elapsed from injury to recovery of continuous memory..
- Severe: > 24 hours
- Moderate: 1-24 hours
- Mild: < 1 hour
Rancho Los Amigos
1 - No Response: -Total Assistance
2 - Generalized Response: non-specific/purposeful, inconsistent rxns
3 - Localized Response: inconsistent or delayed, but directly related to stimuli
4 - Confused-Agitated: heightened response, may be aggressive -Max A
5 - Confused-Inappropriate: some simple command response, distractible
6 - Confused-Appropriate: more goal directed responses, needs cues -Mod A
7 - Automatic-Appropriate: robotic responses, lacks judgment, -Min A
8 - Purposeful-Appropriate: adequate w/ familiar tasks, needs cues -Standby Assist
9 - Purposeful-Appropriate: effective response to familiar situations, needs cues for anticipatory & adjustment responses, easily frustrated - Requested Standby A
10 - Purposeful-Appropriate: adequate response to multiple tasks w/ extra time or breaks, utilizes cognitive compensation strategies, self-adjusts PRN - Mod I
Mechanism of Injury
- DIFFUSE
- FOCAL
Diffuse Injury
-Diffuse Axonal Injury
-Axonal damage 2° movements of brain matter & accompanying fast rotational propulsion of the brain in the skull
-Associated with global dysfunction-
-behavior, cognitive & memory prob:
loss of consciousness
mental processing speed
attention
higher level functions
impulsivity
irritability
exaggerated pre-morbid traits
Focal Injury
-Intracranial Hematoma
-Contusion
-Laceration
-Usually anterior/inferior of
frontal/temporal lobes
-Frontal:
-Orbitofrontal
impulsivity
-Frontolateral
hemiparesis
impulsivity
attention
-Temporal:
-Subcortical limbic structures
memory
emotion
drive
Secondary Effects TBI
- Disordered cerebral energy metabolism
- Intracranial hypotension
- Increase in ICP
- Hemorrhage
- Ischemia
- Systemic Reactions
Alterations in Consciousness
- COMA
- Loss of capacity for environ interaction
- Eyes closed
- VEGETATIVE STATE
- Loss of ability to interact with environment despite the capacity for arousal
- After initial phase of coma
- Eyes open
- Behavioral Responses are Reflexive Rxn
- MINIMALLY RESPONSIVE
- Severely disabled, but have the capacity for environmental interaction
- Inconsistent
- Depend on external stimuli
TBI OT INTERVENTION
- Education
- Foster Alertness
- Sensory Stimulation
- ROM
- Prevent Complications
- ROM
- Positioning
- Tone Management
Sensory Stimulation TBI
- Case by Case
- Avoid over-stimulation
- light
- noise
- objects with which you interact
- duration
Positioning TBI
- Side-lying & Supine
- Build-ups
- Encourage/Facilitate neutral
- Pictures & Education
- Family
- Staff
TBI PROM Intervention
-Contraindications Fractures Agitation -Preparatory UE scapular mobilizations
TBI Splinting & Casting
- Splint Wearing Schedule
- Serial
- Bi-valve
- Neurolytics
Inpatient Rehab TBI
-Characteristically, more (& more) acute shorter (& shorter) LOS -More appropriate if ≥ RLA 5 -May or may not be able to formally assess -Treatment focus to: optimize motor, visual-perceptual, & cognitive abilities facilitate self-maintenance support behavioral/emotional adaptation
Post Acute Rehab TBI
-Residential programs can have focus on: Behavior Community re-integration Outpatient programs may focus on: Return to Work Vocational Services Physical, Visual-Percept Deficits Home-based therapy: if the above therapies are N/A typically more severe, or need treatment in home
