TBI Management Flashcards
ID all VIII levels of RLA
I: No response
II: Generalized response
III: Localized response
IV: confused, agitated response
V: confused, inappropriate, non-agitated response
VI: confused, appropriate response
VII: automatic appropriate response
VIII: purposeful, appropriate response
Which levels of RLA are in the coma levels?
Level I-III
Which levels are post-traumatic cognitive state RLA
Levles IV and V
Which levels are appropraite behaviour for RLA
Vi- VIII
T or F: RLA LOCF can apply to all brain injuries (acquired and traumatic)
FALSE TRAUMATIC ONLY
What is our goal in RLA I-III
Increase awareness and alertness
Prevent secondary impairments
Secure appropriate WC
What are treatment strategies in RLA I-III
- Education
- Positioning and ROM
- Upright mobility
- sensory regulation and stimulation
T or F: Sensory stimulation is always safe
False - if a patient has elevated ICP you do not want to do sensory stim. Monitor vitals and ICP t/o
What does a sensory stimulation session consist of?
- explanation w/ time to respond
- 1-2 mins b/t stim pres for a total of 15-30 min multiple times a day
- aud, olfactory, gustatory, visual, tactile, kinesthetic, vestibular
What are the treatment strategies for RLA IV
Focus on behaviour + re-orientation w/short attn spans
Participate in meaningful and familiar tasks
Prevent self-harm + stop is agitation increasing
At which stage of RLA is learning possible?
RLA VI
What is the behavioural result of frontal lobe damage
- personality changes w/verbal or physical violence
What is the behavioural result of temporal lobe damage
- frustrated by aphasia and comm deficits
- inability to regulate emotions
- impaired memory = frustration
What is the behavioural result of parietal lobe damage
- inability to interact w/environment appropriately leading to undesirable behaviours
What is the behavioural result of occipital lobe damage
- think people/items are present when they are not
- poor tolerance to task
Keys to success for RLA IV?
- calm controlled environment and consistent
- flexible in planning & t/o session
What are possible behaviours to manage? (list)
Agitation
Confusion
Impulsivity
disinhibition
perseveration
confabulation
decreased insight
apathy/depression
lack of initiation
What can you change in the environment to help w/behaviour management?
Lighting
Number of visitors
Sleep amount
electronic use
What can you do for structure for behaviour management?
- schedule rest breaks
- avoid overload and overstim
- CONSISTENCY IS KEY
List the types of medications used in behaviour management of TBI
- psychostimulants
- antidepressants (SSRI)
- antiparkinsonian (amantadine)
- anticonvulsants
- meds for sleep/wake
- beta blockers for autonomic dysfuntion
What is the goal of psychostimulants for those w/TBI?
To improve attn and concentration
What is the goal of antiparkinsonian meds for those w/TBI?
Increase DA level in brain to help w/agitated behaviours
What are treatment strategies for RLA V?
- Structure that progressively decreases
- Allow Pt to choose (not yes or no)
- Choose activities w/high rate of success since pt may be resistant to treatment
At what RLA LOCF can a pt complete goal directed activities w/cues for safety
VI
What are treatment strategies at RLA VII and VIII
- Integrate increased cog function into the community
- encourage independence and progressively remove supervision
What physical deficits may your patients w/RLA VII and VIII have?
- paresis
- unfractionated mvmt
- sensory deficits
- perceptual deficits
- coord deficits
- vestibular issues (sensory selection and weighting deficits)
When would you use the Glasgow Coma Scale?
many different patients w/altered consciousness
What is the scale for the GCS and what do the numbers indicate?
3-15 w/3 = coma and 15 = fully awake
What does the glasgow coma scale measure (subscales)?
- eye opening
- verbal response
- motor response
What is the revised coma recovery scale used for?
To assess patients at RLA LOCF I-IV to track consciousness overtime
How is the revised coma recovery scale scored?
- lower score = reflexive activity
- higher score = cognitively mediated behaviours
Scale 0-23
What are the subscales for the revised coma recovery scale?
- auditory
- visual
- motor
- oromotor
- communication
- arousal
What does the agitated behaviour scale measure?
The degree to which a behaviour is present: aggression, disinhibition, and lability
How is the agitated behaviour scale scored?
1-4
1 = absent
2 = present to a slight degree
3 = present to a moderate degree
4 = present to an extreme degree
Which scale is unique in that it looks at an individual over a span of 2-3 days and uses a team approach?
Moss Attn Rating Scale
What is the moss attention rating scale?
A scale that assesses the average attention of a patient over a few days typically in IPR or acute care
How is the moss attn rating scale scored/what does a score mean?
A higher score reflects better attention
What is the high level mobility assessment? (HiMAT)
A 13 item assessment of high-level motor performance in TBI patients performed at their max safe speed
What is important about the HiMAT?
It has a minimum requirement that the patient must be able to independently ambulate over 20 meters
What types of movement does the HiMAT asess?
Multi-directional walking
Run
Skip
Hop
Bound
Stairs
What is the community integration questionnaire?
A self-report participation measure for acquired brain injuries that assesses their social role limitations and community interaction (home, social, & productive)
List the 4 domains of post-concussive symptoms
1 - cervical MSK impairments
2 - vestibulo-oculomotor impairments
3 - autonomic dysfunction and exertional intolerance
4 - motor function impairments
List out possible cervical MSK impairments
neck pain
H/A
dizziness
dec bal and postural control
List out possible vestibulo-oculomotor impairments
dizziness
bal prob
vertigo
blurred vision
H/A
Nausea
Sensitivity to sound and light
mental fogginess
difficulty reading and concentrating
anxiety and fatigue
List out possible autonomic dysfunction and exertional intolerance impairments
OH
Impaired BP or HR responses to exertion
List out possible motor function impairments
- static/dynamic bal
- postural control
- dual task
- delayed rxn time
- impaired coordination
What do we educate patients on post concussion?
- activity
- stress mgt
- consistent sleep
- eat and hydrate
What should we tell pts post-concussion regarding activity?
- rest first 24-48 hrs
- then resume basic activities including daily routine (can now resume light exercise per tolerance)
- eventually add school/work
What should we tell pts post-concussion regarding stress?
- perform daily relaxation activity
- limit screen time
What should we tell pts post-concussion regarding sleep?
- maintain a schedule of bedtimes and awake times and try to minimize naps so you can get better quality sleep at night
What should we tell pts post-concussion regarding eat and hydrate?
- eat normal diet on a regular schedule
- drink 2-3 24 oz bottles of water/day
- do not drink alcohol
When should your post-concussion patient seek medical assitance?
- H/A that worsens significantly
- slurred speech
- seizures or LOC
- inc. confusion
- inability to waken
- severe neck pain
- weakness/numbness in arms/leg
- repeated vomiting
- unusual behaviour change
