TBI and Concussion Flashcards
What is RLA level IV
Confused agitated
describe RLA IV
confused agitated
heightened state of activity
bizarre behavior
patient is unable ot cooperate directly with treatment efforts
confabulation may be present
brief attention to environ,emt
no short or long term recall
What are the PT roles for RLA IV
mobilize with consideration
low stimulation environment with structured times for therapy
assist with sleep wak cycle
short sessions
What is RLA Level V
Confused inappropriate
describe RLA V
confused inappropriate
follows simple commands
gross attenton to the environment but highly distractable
lacks ability to focus on specific task
verbalization is often inappropriate and confabulatory
memory is impaired
difficultly learning new information
What are the PT roles for RLA V
environemental modification
progress mobility
structured short sessions
directed tasks vs automatic tasks
consider implicit learning over explicit
What is focused attention
focus on and respond to a specific stimulus
What is sustained attention
sustain attention over a period of time
What is selective attention
focus attnetion in the presence of distracting stimuli
What is alternating attention
Shift focus of attention from one task to another
What is divided attention
respond simultaneously to multiple tasks
at is RLA Level VI
confused appropriate
Describe RLA Level VI
confused appropriate
goal directed behavior but is dependent on external input for direction
follows simple directions
shows carryover
errorless learning (mmultiple reps and guidance needed)
past memories show more depth
What are the PT roles for RLA VI
prevent learneed non-use
constraint induced therapy may be initiated
BWSTT
incorporate goal directed tasks, ADLs
What is errorless learning (ELL)
cognitive therapy technique for those with sever memory impaitments
use verbal and visual cues
hand over hand assistance
discouragement of guessing
gradual fading of prompts
part task practice of discrete portions of larger skill
immediate timing of FB for correction if an error does occur
What is RLA VII`
automatic
appropriate
MIN A needed
goes through daily routine automatically, but ffreqeuntly robot like with minimal to ansent confusion
has shallow recall of activities
shows carryover for new learning, decreased rate
with structure able to initiate social or recreational activities
What is RLA VIII
purposeful
appropriate
SBA
able to recall and integrate past and recent revents and is aware of and responsive to environment
shows carryover for new learning and needs no supervision once actiities are learned
What is RLA IX/X
purposefuul
appropriate
SBA upon request/ Mod I
What is occupational medicine
adresses the physial, cognitive, psychosocial, sensory, and other aspects of performance in a variety of contexts to support participation in everydat, meaningful life activities
What do OTs focus on?
instumental activities of daily livining
cognition
rest and sleep
education
work
play
leisure
social participation
What does speech language pathology practice include?
includes identification, prevention, assessment, and treatment of disorders of cognition communication, speech, language, voice, and swallowing
what does SLP do for dysphagia?
dysphagia= disordered swallowing
bedside exam
barium swallow exam
fiberoptioc endoscopic evaluation of swallowing (FEES)
assess vocal cord function
SLP also help with speech, language anc voice with…
aphasia
apraxia (oral and verbal planning)
dysarthria (motor function) speech produ tion
What is consciousness?
a state of awareness of self and environment that requires alertness and arousal
What is arousal
arousal is the level of consciousness
What is awareness
awareness is the content of consciousness
What is the goal of a consciousness assessment
goal is to provide accurate diagnosis
develop treatment plan
accurate prognosis
What is the gold standard for consciousness assessment?
behaviorial assessment
What is the coma recovery scaled revised (CSR_R)
standard adminstration and scoring
excellent content validitiy
susbstantial evidence of internal consistency and good inter-rater reliability
contains 23 items that comprise 6 subscales
Who is appropriate for the CSR-R
patients who range from RLA II - V
lvel II= gneralized response
level III= localized response
level IV: confused and agitiated
level V- confused and inappropriate
What are the CRS-R subscales
auditory function scale
vvisual function scale
motor funiton scale
oromotor/verba,, function scale
communication scale
arousal scale
What defines a coma?
no eye opening
absence of sleep/wake cycle
unable to follow instructions
no speech or other forms of communication
no purposeful movement
behavior limited to reflexive activity
What is RLA level I
no reponse– paitnet appears to be a deep sleep and is unresponsive to any stimuli
What are the PT roles for RLA Level I
no response
consult
provide supportive care
bed and mattress
positioning in bed
pulmonary needs
contracture prevention
skin protection
ROM initiated with caregiver education
What is vegetative state?
Return of sleep wake cycle with periodic eye opening and eye closing
may moan or make other sounds
may cry or smile or other facial expression
may briefly move eyes toward person or object
may react ot loud sounds with startle response
unable to follow instructions
no speech or other comunication
no evidence of sustained, reproducible. purposeful or voluntary behavioral responses to stimuli
What is unresponsive wakefulness syndrome?
shift in language ti describe vegetative state
perceived as less lnegative connotation
demonstrates wakefulness (eye opening) but no voluntary motor responses
can be transitory or permanent
what is primitive posturing?
de-corticate posturing== flexion
de-cerebrate posturing== dual extension
What is RLA LEvel II
generalized response
What is the description of RLA Level II
patient reacts inconsistently and non- purposefully to stimui in a nonspecific manner
responses are limited and are often the same regardless of stimulus presented
awake but not following commands
unable to localize voice (often presents with chewing motion, breather heavier, tenses in reposnes )
what are the PT roles for RLA Level II (generalized response)1
consult
provide supportive care
bed and mattress
positioning
pulmonary needs
contracture prevention
skin protection
ROM initiation
coma stimulation
What is a minimally conscious state?
sometimes follows simple instructions
may communicate yes or no by talking or gestures
may speak some understandable words or phrases
may response to people, things, events by
-crying, laughing, smiling
-makign sounds or gesturing
-reaching for or trying to hold/use
-keeping eyes focused on people or things for a sustained period of time
do things inconsistently, which makes it difficult to distiniguish between vegetative state and minimally conscious state
What is RLA LEvel III
localized repsonsed = Level III
Describe RLA Level III
localized response
paitent reacts specifically but inconsistently to stimuli
responses are directly related to the type of stimulus presented
may follow simple commands in an inconsistenct, delayed manner, such as closing eyes or squeezing hand
responses delayed or inconsistent
What are the PT roles for localized response (RLA Level III)
provide an enriched envornment
positioning, ROM, sensory stimulation
mobilization
combine positioning with exercise
What classifies emergence from minimally conscious state
communication
followig instructions consistently
demonstrating functional use of an object
almost always experience confusion
