TBI after Midterm

Question 1

Severe brain injury

Answer 1

Coma lasting more that 24 hours - sometimes weeks
Glasgow Coma Scale score 3-8
Definite bleeding
LT impairments - home, work or community

Question 2

Coma

Answer 2

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

Question 3

length of Coma

Answer 3

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

Question 4

Minimally conscious

Answer 4

patient must demonstrate at least 1 consistent behavior after stimulus
demonstrate awareness of surroundings
gesture/verbalize yes/no responses

Question 5

marking the end of a minimally conscious state

Answer 5

patient must use functional communication and object use

Question 6

intracranial pressure

Answer 6

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

Question 7

dangerous pressure levels for intracranial pressure are

Answer 7

40 mmHg or higher and can result in neurological dysfunction

Question 8

treatment for altered consicousness

Answer 8

sensory stimulation
prevents sensory deprivation
facilitate recovery and responsiveness
prevent sensory overload
across all disciplines
includes family

Question 9

sensory stimulation can involve

Answer 9

visual components
auditory components
tactile components
olfactory components
kinesthetic componants

Question 10

assessing altered consciousness

Answer 10

we are constantly assessing
by competing sensory stimulation you are assessing for reacting to stimuli
basis for coma assessments

Question 11

coma/near coma scale

Answer 11

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

Question 12

JFK Coma Scale- Revised

Answer 12

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

Question 13

Ongoing care

Answer 13

many life in long term care for years

Question 14

SLP role in long term care

Answer 14

consistent assessment for possible changes
family education and support to continue stimulation
assuring safety and quality of life

Question 15

life support

Answer 15

must make decision to remain on devices

Question 16

DNR

Answer 16

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

Question 17

Ethics

Answer 17

when making decisions all must thin about the patients quality of life

Question 18

Low tech AAC

Answer 18

communication boards
alphabet boards
buzzers

Question 19

High tech AAC

Answer 19

dynavox

proloquo 2 go on iPad

Question 20

Acute hospital SLP

Answer 20

patient might have severe motor, cognitive and/or language deficits
need to establish best means of communication

Question 21

Highest percentage of AAC in an acute hospital

Answer 21

low tech
hand gestures
basic communication - yes/no board
Wong Baker Pain Scale

Question 22

Assessment of AAC in acute hospital

Answer 22

what stimuli is your patient responding to

establish consistency of whatever form of communication is easiest for your patient

Question 23

Acute hospital and tech AAC

Answer 23

patients may have gross motor to follow 1 step commands to hit single buttons or switches
Ex: CD player, light
can promote independence

Question 24

Limitations in acute care hospital

Answer 24

spasticity - limited motor responses
visual deficits - may have to use contrasting color, change size/shape or targets
medications - meds may alter alertness level

Question 25

SLP in rehab

Answer 25

patient may be in the middle of recovery
patients may regain verbalizations
decrease patient’s frustration

Question 26

AAC assessment in rehab

Answer 26

assess for more permanent use
assess - physical limitations, cognition, visual skills, reading comp
usually happen after rehab stay

Question 27

Types of SGDs

Answer 27

static devices, keyboard devices, text-to-speech, dynamic screen devices

Question 28

OT help in rehab

Answer 28

for switch assessment and device establishment

Question 29

Case manager help in rehab

Answer 29

contact insurance companies/assistive technology specialist

the sooner the process begins the sooner the person gets their device

Question 30

SLP post-acute

Answer 30

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

Question 31

Assessment Post-Acute

Answer 31

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

Question 32

Assessment for AAC should include

Answer 32

communication wants/needs
environments for communication
possible communication partners
physical considerations: hearing, visual, motor responses

Question 33

Deciding on a device

Answer 33

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

Question 34

Goals for proficient use of AAC

Answer 34

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