Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NPT 1 > TBI > Flashcards

TBI Flashcards

1
Q

The following are all examples of what type of injury?

subarachnoid hemorrhage (SAH)

intraventricular hemorrhage

intracerberal hemorrhage

skull fractrues

epidural hematomas (EDH)

subdural hematomas (SDH)

cerebral contusion => intraparanchymal hemorrhage

focal and diffuse axonal injuries with cerebral edema

A

primary brain injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Secondary Brain Injury and the path to increased ICP

A

Chain of Cellular Events Following Tissue Damage

  • glutamate neurotoxicity => increased swelling, ICP
  • electrolyte imbalances
  • mitocondrial dysfunction
  • inflammatory responses
  • apoptosis (cell death)

All contribute to brain swelling and increased ICP

Lack of oxygenated blood flow to the brain may also be due to

  • systemic hypotension
  • anoxia (seen in drowning victims)/hypoxia (seen in pt’s who have an event where they don’t breathe)
  • vascualr damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the signs and symptoms of Psottraumatic Hydrochephalus?

A
  • obtudation (decreased responsiveness)/decreased consciousness
  • failure to improve or decreaseing status
  • pyschomotor retardation
  • memeory loss
  • gait deterories (may have wide base)
  • intontinence
  • unusal symptoms including emotional disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The following are all examples of what?

  • DVT
  • heterotropic ossification
  • pressure ulcer
  • seizures
  • pnuemoia, respiratory issues
  • chronic pain
  • contractures
  • decreased endurance
  • muscle atrophy
  • GI, GU (feeding tube, PEG)
  • Cardiovascular
A

Secondary impairments and medical complications of brain injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Classificaiton of TBI Severity: Chart Review

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Impairments commonly associated with TBI: chart review

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TBI can result in what type of impairments that include these symptoms

Difficulties with interpretaiton and loss of ability to filter…

  • touch
  • pain
  • Deep pressure
  • temperature
  • limb position
  • fine discrimination
  • visual input (not able to register what they are seeing => slwo to recognize objects => may present as unsteady)
  • smell (cranial nerve dysfunction)
  • auditory input
A

Sensory processing impairments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 8 levels of cognitive funciton for adults in the Ranchos Los Amigos Scale?

A
  1. Level I: No response
  2. Level II: generalized response
  3. level III: localized response
  4. Level IV: confused-agitated
  5. Level V: Confused-inappropriate
  6. Level VI: Confused-appropriate
  7. Level VII: Automatic-appropriate
  8. Level VIII: Purposeful-appropriate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Characteristics of each of the Rancho Levels of Cognitive Funciton

A
  • Levels 1-3: Low level patients -> Stimulation oriented approach
    • stimulation must have structure (include rest periods)
  • Levels 4-5: Agitated-Confused and Confused-Inappropriate => Structure Oriented Approach
    • won’t be teaching anything new => work on keeping the patient calm and from hurting themselves/others
    • if patient get’s worked up, remove the agitating stimulus
  • Levels 6-8: Confused, Automatic, and Purposeful-Appropriate => decreased structure, increase task complexity
    • level 6 = this is often where people are when starting to look at discharge to home setting with supervision
    • as the level increases, you continue decreasing structure while making the tasks more complex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pyramid of Cognitive Recovery: Image review

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Characteristics of RLA scale Level 1 patients

A
  • No response to stimuli: sound, sights, touch, or movement
  • Appears to be in a deep sleep
  • Total assistance
  • Glasgow Coma Scale score: 3 out of 15 (3 is the lowest score on this scale and indicates unresposiveness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The following are characteristics of which level of Rancho Los Amigos?

  • Total assistance
  • Non-purposeful, slow, delayed and inconsistent responses to stimuli
    • may be unable to localize or attend to voice
  • Responses limited, same regardless of stimuli
  • Gross body movements (won’t be able to pull away from painful stimuli)
  • Physiologic changes: increased BP, HR
  • Sweating
  • Vocalization
  • Chewing movements
  • Periods of wakefulness
  • Not following commands
A

Level II: Generalized Response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The following are characteristics of which Rancho Scale Level?

  • Responses are specific but inconsistent, delayed, and directly related to the type of stimuli presented
    • Turns head towards sound
    • Withdraws extremity from painful stimuli
    • May make eye contact, look around
  • May follow simple commands
    • Look at me……Squeeze my hand
    • Open your eyes……Close your eyes
    • Stick out your tongue
  • Does not remember new information
  • Awake intermittently
A

Level III: Localized Response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the biggest difference between Rancho Levels 2 and 3?

A
  • Level 3 = may be able to follow commands
  • even if they aren’t following commands, if you pinch them, they are able to draw their arm away instead of having generalized increased arousal (they have a localized response to stimuli)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does a PT Examine a Low Level Patient?

A
  • Observation
  • Determine level of alterness and response to commands
  • assess cranial nerves
  • sensory motor exam
  • assess neruomuscular system
    • try rolling the pt
    • can do some neurodevelopmental training
  • musculoskeletal system exam
  • assess cardiovascular system
  • assess integumentary system
  • evaluate funcitonal abilities
    • try sitting the pt up (can they hold their head up?)
    • check for head-riding (if traciton is applied through the upper trap and the head does not come up => this involves the mid-brainstem and is not good)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

the folllowing are examples of what type of exam?

  • Test each limb for withdrawal from painful stimulus
    • Skin pinch/twist
    • Nail bed pressure
  • Assess response
    • Reflexive (spinal cord level)
      • UE: pinch flexor surface of arm, arm flexes, no abduction
      • L/E: triple flexion (pinch flexor surface of leg and hip, knee flex + ankle DF)
    • Purposeful withdrawal
      • pinch flexor surface, arm flexes and abducts: moves away from stimulus
A

Sensory and Motor Exam

17
Q

the following are examples of what type of exam?

  • Resistance to PROM (spasticity, hypotonicity)
  • Effect of body/head position on tone
  • Presence of Abnormal Primitive Reflexes
    • ATNR, STNR, TLR
    • Babinski
    • DTR’s/clonus
    • Hoffman’s
A

Neuromuscular examination: Muscle Tone

18
Q

The following are examples of what type of exam?

  • Level of assistance provided by PT with mobility tasks
  • Patient’s active participation with mobility
    • Once in a position, do something for treatment!
  • Head/ body righting with rolling
  • Head/trunk control in sitting, standing
A

Functional Exam

19
Q

What are the treatment goals of Ranchos Levels 1-3, Stimulation Orieted Program?

A
  • increase awarness of enviornment/ increase attention span
  • reinforce localized responses to stimuli and repsonse to one step commands
  • maintain or increase joint ROM
  • normalize muscle tone
  • increase active movement
  • achieve proper body alignment while progressing tolerance to upright positioning
  • improve motor control and functional status
  • increase endurance
20
Q

Which Ranchos Level is hallmarked by the following characteristics:

  • heightened state of activity, agitation
  • a response to patient’s internal state of confusion and discomfort
    • decreased ability to process information, distractable, fatigure, sleep distrubances
    • unable to recall new information
    • may recognize family/friends
    • can respond to simple commands with structure
  • Overreacts: hitting behavior, yelling, foul language, restless
  • short attention span, confabulation, no memory
A

Level IV: Confused and Agitated: Maximal Assisstance

  • max assit = for structure and for safety and problem solving and sequencing to finish a task
  • these patients need structure for safety
  • Approach: Structure Oriented Program
21
Q

What are some team goals for treating Ranchos Level IV: confused-agitated?

A
  • Decrease intensity, duration and frequency of agitation
    • goal is basically to get the pt through this stage as quickly and safely as possible without them injurying themselves or anyone else
  • Prevent injury
  • Prevent inappropriate response patterning
  • Increase attending behaviors to environmental stimuli
  • Complete simple tasks with structure (giving the pt verbal cues)
  • Facilitate appropriate behaviors
  • Family education re patient behavior, team goals
  • Facilitate automatic responses in ADL and mobility
22
Q

What are some treatment stratergies to meet goals for Level IV: confused-agitated?

A
  • Decrease agitation, prevent injury
  • Prevent inappropriate response patterning
  • Improve ability to pay attention
    • ID and remove sources of agitation
    • Structure environment: consistent PT, schedule, treatment session structure, private room
    • Reality orientation (where are you? what day is it? who is the president? Why are you here? what happened? => you are in the hospital, you have had an accident, you are here to get better)
    • Have help readily available
    • Calm with slow rocking, neutral warmth, etc.
    • Fatigue hyperactive patients with gait, w/c mobility, ADL’s, etc.
  • reassure the pt they are safe
  • allow as much movement as is safe
  • facilitate automatic, overlearned responses in ADL’s and mobility (i.e., repeated sit-to-stand, walking, washing hands, rolling, sitting up => consider using mobility and things the person has to do every day of their life)
23
Q

what are intervention stratergies that can be used when treating ranchos level IV: confused-agitated?

A

Structure, re-direction

  • Skills should be directed to level of function and focus on cognitive endurance rather than progressing to new skills
    • Consistency is very important
    • Teaching new skills is unrealistic at this level
    • Patient is likely to model the behavior of the caregiver
    • Therapist must be flexible with treatment activities
  • Family education regarding patient behavior and team goals is critical!
  • Don’t reinforce inappropriate behaviors
  • Consider how you might do the same task but work on the pt’s cognitive endurance (i.e., more repititions)
24
Q

Which rancho level is characterized by the following characteristics?

  • Non-agitated
  • Agitation and confused are now in response to EXTERNAL stimuli
    • Responds to simple commands consistently with assistance
    • Performs self-care/ ADL’s with MAXIMAL supervision/ step by step instruction and assist (STRUCTURE)
    • Distractible, lacks ability to focus attention (minutes)
    • Cannot learn new information
    • Memory severely impaired, some immediate memory
    • Verbalizations: confabulatory, inappropriate
    • Perseverates on basic needs; hunger, thirst, sleep, going home
A

Level V: Confused-Inappropriate

  • Approach: Structure Oriented Program
  • pt’s can still get agitated if you overstimulate them and irritate and/or challening them too much
  • when doing a transfer with this level of pt, they will need maximum supervision and step by step instruction from a cognitive standpoint
25
Q

Which ranchos level has the following characteristics?

  • Awake and aware! Now emerges from PTA (post traumatic amnesia), has some day to day recall.
  • Goal Directed Behavior
  • Moderate assistance/cues to structure tasks, ADL’s
  • Purposeful interactions, converses on a simple, social level
  • Carry-over with simple tasks
  • Can remember main points but will confuse the details
  • Can follow a schedule
  • Knows month, year, and place
  • Can pay attention for about 30 minutes but is easily distracted, difficulty multitasking
  • Manage own bathroom needs (with supervison if they are safe enough with their mobility)
  • More aware of physical problems than cognitive problems
  • Focal injuries more apparent
A

Level VI: Confused Appropriate

  • Approach: Structure Oriented Program
  • oftentimes, this is the level that someone can go home from an acute care inpatient rehab into an outpatient program
26
Q

The following are appropraite PT goals for which ranchos level?

  • Decrease confusion from environment
  • Increase cognitive abilities (i.e., tell the pt a short story and have them try to re-tell it to you)
  • Increase frequency, rate, duration & quality of appropriate interactions with environment
  • Incorporate increasing cognitive function into functional activity (i.e., when walking, tell a patient their room #, then have them stop and read room #’s on the way back)
A

Level V: Confused Inappropriate

27
Q

The following are appropriate PT goals for which ranchos level?

  • The goal is to maximize functional recovery & prepare the patient for discharge to home & the community
A

Level VI: Confused Appropriate

28
Q

What are some intervention strategies for Levels V and VI?

A
  • The same strategies as level IV should be considered
  • Continue reality orientation
  • Repetition
  • Memory planner
  • Use re-direction if patient gets argumentative
  • Patient & family education
  • Developmental, functional postures (i.e., with pt in prone on elbows, have them flip the pages of a book)
  • Balance, coordination, strength, endurance, mobility
  • Locomotor training (gait training, wheelchair mobility)
29
Q

What are stratergies applied to the environment for Level V?

A
  • Consistent (as you can’t assume the pt being able to get out of bed at the hospital means they can do the same thing at home, you have to perform a home evaluation and structure your environment accordingly to make it consistent)
  • Memory aids in visual range (i.e., a sign that says “paper towel” on a paper towel dispenser)
  • Minimize distractions (as a treatment, you can vary the amount of distractions from none to increasing them)
  • Same therapy staff
  • Everyone orients patient to time, place, activity and staff names
  • Bring in family pictures & other personal items
  • Limit to 2-3 visitors at a time
30
Q

The following are treatment interventions for which ranchos level?

  • Pre-functional skills
    • Head/neck/trunk control
    • Balance
  • Strengthening
    • Simple, repetitive exercises
    • Progress to more complex as ability to participate improves
  • Early Functional Training
    • 1 step activity
    • Verbal, visual, tactile cues
    • Do not anticipate carry-over of learning to new situations, practice in specific situation
    • can perform activities in devlopmental postures (i.e., tall kneeling on a pad while boxing = function + head/neck/trunk control)
A

Level V: Confused Inappropriate

31
Q

What are some guidelines for treating patients who are confused?

A
  • Structure: repetition of relevant functional activity
    • doing the same thing,…
    • at the same time, in the same place,…
    • with the same person, in the same way
  • Increase complexity
    • increase number of steps
    • decrease cues
    • practice with increased distractions
  • Physical Therapy Treatments
    • incorporate attention, orientation, and memory
    • simple reason and problem solving
32
Q

Which ranchos level has the following characteristics?

  • Minimal assistance for daily living skills
    • Appropriate and oriented
    • Shallow recall
    • Goes through daily routine “robot-like” with minimal to no confusion
    • New learning is slow
    • Impaired judgement, problem-solving and realistic planning for the future
    • Needs assistance in decision making, encouragement to use compensatory strategies set up by ST and OT
A

Level VII: Automatic and Appropriate

  • RX: Decrease structure, Increase challenge
33
Q

Which ranchos level has the following characteristics?

  • Stand-by assistance for daily living skills, reminders
  • Recalls and integrates past and recent events
  • Carry-over for new learning
  • Independent function in home setting within constraints of focal deficits
  • Low frustration and stress tolerance
  • Impaired judgment in new situations
  • Social, emotional, intellectual deficits may persist but functional for society
  • School, Vocational Rehabilitation
A

Level VIII: Purposeful and Appropriate

  • before this point, pt’s were re-learning things they used to know and now they are learning new things (i.e., they can go to college)
34
Q

Can you recall the ranchos levels, their recovery phase, and treatment approach?

A

NPT 1 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions