TBI after Midterm Flashcards
Severe brain injury
Coma lasting more that 24 hours - sometimes weeks
Glasgow Coma Scale score 3-8
Definite bleeding
LT impairments - home, work or community
Coma
state of impaired consciousness following an acquired brain injury
may have reflexive responses
patient may have sucking pattern or flex a muscle in response to pain
length of Coma
can last 2-3 weeks
if person is still unresponsive they are in a persistent vegetative state
spontaneous sleep/wake cycle
can remain for up to 12 months
after 12 months person is in permanent vegetative state
Minimally conscious
patient must demonstrate at least 1 consistent behavior after stimulus
demonstrate awareness of surroundings
gesture/verbalize yes/no responses
marking the end of a minimally conscious state
patient must use functional communication and object use
intracranial pressure
to decrease pressure while in coma doctors can:
drill a burr ole and insert an intraventricular catheter
insert a bolt into the subarachnoid space
insert an epidural sensor to monitor pressure
dangerous pressure levels for intracranial pressure are
40 mmHg or higher and can result in neurological dysfunction
treatment for altered consicousness
sensory stimulation prevents sensory deprivation facilitate recovery and responsiveness prevent sensory overload across all disciplines includes family
sensory stimulation can involve
visual components auditory components tactile components olfactory components kinesthetic componants
assessing altered consciousness
we are constantly assessing
by competing sensory stimulation you are assessing for reacting to stimuli
basis for coma assessments
coma/near coma scale
monitors for spontaneous verbalizations, motor responses and behavioral responses administered first 3 days after injury then 1 x week for next 3 weeks then 1 x week every 2 weeks after that second clinician scores after the first
JFK Coma Scale- Revised
scale from 0-24
6 subtests - auditory, visual, motor, oromotor, communication, arousal
first items = reflexive in nature, later items are more purposeful
clinicians are given treatment options for sensory stim
Ongoing care
many life in long term care for years
SLP role in long term care
consistent assessment for possible changes
family education and support to continue stimulation
assuring safety and quality of life
life support
must make decision to remain on devices
DNR
can choose to have a family member labeled DNR or “Do not resuscitate”
patients can also institute a living will so their wishes are known and met
Ethics
when making decisions all must thin about the patients quality of life
Low tech AAC
communication boards
alphabet boards
buzzers
High tech AAC
dynavox
proloquo 2 go on iPad
Acute hospital SLP
patient might have severe motor, cognitive and/or language deficits
need to establish best means of communication
Highest percentage of AAC in an acute hospital
low tech
hand gestures
basic communication - yes/no board
Wong Baker Pain Scale
Assessment of AAC in acute hospital
what stimuli is your patient responding to
establish consistency of whatever form of communication is easiest for your patient
Acute hospital and tech AAC
patients may have gross motor to follow 1 step commands to hit single buttons or switches
Ex: CD player, light
can promote independence
Limitations in acute care hospital
spasticity - limited motor responses
visual deficits - may have to use contrasting color, change size/shape or targets
medications - meds may alter alertness level
SLP in rehab
patient may be in the middle of recovery
patients may regain verbalizations
decrease patient’s frustration
AAC assessment in rehab
assess for more permanent use
assess - physical limitations, cognition, visual skills, reading comp
usually happen after rehab stay
Types of SGDs
static devices, keyboard devices, text-to-speech, dynamic screen devices
OT help in rehab
for switch assessment and device establishment
Case manager help in rehab
contact insurance companies/assistive technology specialist
the sooner the process begins the sooner the person gets their device
SLP post-acute
may be working with patient’s at home or at outpatient setting
continue to have patient use strategies previously established
continue the evaluation process for AAC
Assessment Post-Acute
must be thorough, will be submitted for approval to insurance companies
include: interview, formal assessment, informal assessment
match a person’s strength to appropriate device
Assessment for AAC should include
communication wants/needs
environments for communication
possible communication partners
physical considerations: hearing, visual, motor responses
Deciding on a device
do not select a device the person will not use
seek assistance from Assistive Technology Specialists for funding and/or consult the state for the TBI waiver for funding
Goals for proficient use of AAC
help patient improve their comfort
have patient train/practice in different environments
have them use their device in different social situations
have them try to re-establish social networks
