TBI: Interventions

Question 1

Interventions to promote arousal

Answer 1

Coma stimulation (auditory, visual, somatosensory, kinesthetic, vestibular)
Meaningful multi-sensory stimulation (stimuli must be meaningful)
Hierarchical level of Cueing
Cognitive Behavioral Stimulation (shaping behavior through stimuli: reinforce positive response, eliminate maladaptive responses)

Question 2

How to monitor effectiveness of interventions for arousal

Answer 2

Select stimuli based on interview with family
-introduce stimuli, wait 2-3 minutes for response, based on response continue or remove stimulation
Measure physiological and behavioral response (HR, MAP, Modified Ashworth Scale, Rancho Scale of Cognitive Function)

Question 3

Progression of interventions for arousal

Answer 3

increase the complexity of the response (amplitude or require a decision) or request a different response (motor or verbal rather than visual)

Question 4

Role of PT in identifying cognitive impairment

Role of Neuropsychologist

Answer 4

mini-mental
Galvenston Orientation and Amnesia Test
Children’s Orientation and Amnesia Test

Intellectual function, memory, psychomotor speed, processing speed, attention, language, and executive function

Question 5

Interventions for managing impaired processing speed

Answer 5

tasks requiring decoding of information to perform, and reaction time
i.e.– stepping to a target while matching footstep to an auditory or visual cue, standing while catching scarves of a particular color, path finding
Progression:
increase speed of the response or increase the complexity of the information

Question 6

Interventions for managing impaired executive function

Answer 6

tasks require initiation, planning, monitoring performance, anticipating consequences, and responding and responding flexibly.
i.e.– housecleaning activities and taking transportation to a destination
Progression:
reduce the number of external cues and increase reliance on internalized procedures

Question 7

Interventions for managing impaired problem solving

Answer 7

tasks require brainstorming, comparing ideas, prioritizing ideas, and drawing inferences.
i.e.– novel tasks for the individual where decision making must be made such as planning and implementing a dinner or going on a recreational activity (hiking)
Progression:
increase complexity of the problem

Question 8

Interventions for managing impaired divided attention

Answer 8

tasks require the ability to respond to multiple simultaneously
i.e.– Motor-motor tasks: walking in a figure 8 while carrying different size grocery bags, forward walking while carrying plate or laundry basket, balancing on foam while folding laundry, stepping on targets while tossing bean bags.
Motor-cognitive tasks: tandem walking while adding numbers, backward walking while subtracting numbers, backward walking while spelling, balancing on foam while sorting or categorizing objects, climbing stairs while creating a list.

Progression:

• increase time for sustained attention
• increase distraction for selective attention
• increase choices to select for alternating attention
• increase number of variables for divided attention

Question 9

Interventions for managing impaired memory

Answer 9

restorative memory: list learning, listening, imagery, pneumonic strategies
Strategies: improve attention and working memory, improve prospective memory, improve problem solving skills, facilitate self-awareness
compensatory memory: memory notebooks, assistive technology
strategies: teach pt to use memory aid, teach self-regulatory or metacognitive strategies, improve inhibitory control

Question 10

keys to working with children with brain injuries

Answer 10

develop unique programs
be flexible
measure success in small increments 
communicate with families
develop system for long term monitoring

Question 11

keys to working with families of children with brain injuries

Answer 11

prepare families affectively by providing information on the child’s strengths and concerns
provide multiple opportunities and methods of education
affirm the expertise of parents
refer families to support groups
educate families about the laws regarding individuals with disabilities

Question 12

most common reason for BI in older adults

risk factors:

Answer 12

Falls

previous fall, strength, walking/balance impairments, use of medications

effectiveness of fall prevention programs is unknown

Question 13

Minimal brain injuries in service members

Answer 13

activity tolerance: slow progression for return to duty, rest until symptom free and then daily progression. (exercise within 7 days is detrimental)
vestibular dysfunction: dizziness is common (BPPV or unilateral vestibular hypofunction), dizziness associated with migraine. intervene w/ vestibular interventions
high level balance dysfunction: balance impairment can have multiple origins including dizziness, impaired sensory processing, and/or coordination of balance responses. treatment of balance disorders requires determining origin of the dysfunction.
attention and dual task disorders: intervention strategies should involve dual task conditions incorporating walking, balance, and cognitive tasks.

Question 14

Concussion in athletes: return to play protocol

Answer 14

Recovery stage: rest, limited physical and cognitive activity
initiate light aerobic activity to a moderate intensity
add sport specific exercises (no contact)
progress to non-contact training exercises and resistance training
progress to full-contact practice
return to play