TBI Management Flashcards

1
Q

ID all VIII levels of RLA

A

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

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2
Q

Which levels of RLA are in the coma levels?

A

Level I-III

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3
Q

Which levels are post-traumatic cognitive state RLA

A

Levles IV and V

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4
Q

Which levels are appropraite behaviour for RLA

A

Vi- VIII

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5
Q

T or F: RLA LOCF can apply to all brain injuries (acquired and traumatic)

A

FALSE TRAUMATIC ONLY

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6
Q

What is our goal in RLA I-III

A

Increase awareness and alertness
Prevent secondary impairments
Secure appropriate WC

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7
Q

What are treatment strategies in RLA I-III

A
  • Education
  • Positioning and ROM
  • Upright mobility
  • sensory regulation and stimulation
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8
Q

T or F: Sensory stimulation is always safe

A

False - if a patient has elevated ICP you do not want to do sensory stim. Monitor vitals and ICP t/o

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9
Q

What does a sensory stimulation session consist of?

A
  • 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
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10
Q

What are the treatment strategies for RLA IV

A

Focus on behaviour + re-orientation w/short attn spans
Participate in meaningful and familiar tasks
Prevent self-harm + stop is agitation increasing

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11
Q

At which stage of RLA is learning possible?

A

RLA VI

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12
Q

What is the behavioural result of frontal lobe damage

A
  • personality changes w/verbal or physical violence
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13
Q

What is the behavioural result of temporal lobe damage

A
  • frustrated by aphasia and comm deficits
  • inability to regulate emotions
  • impaired memory = frustration
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14
Q

What is the behavioural result of parietal lobe damage

A
  • inability to interact w/environment appropriately leading to undesirable behaviours
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15
Q

What is the behavioural result of occipital lobe damage

A
  • think people/items are present when they are not
  • poor tolerance to task
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16
Q

Keys to success for RLA IV?

A
  • calm controlled environment and consistent
  • flexible in planning & t/o session
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17
Q

What are possible behaviours to manage? (list)

A

Agitation
Confusion
Impulsivity
disinhibition
perseveration
confabulation
decreased insight
apathy/depression
lack of initiation

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18
Q

What can you change in the environment to help w/behaviour management?

A

Lighting
Number of visitors
Sleep amount
electronic use

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19
Q

What can you do for structure for behaviour management?

A
  • schedule rest breaks
  • avoid overload and overstim
  • CONSISTENCY IS KEY
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20
Q

List the types of medications used in behaviour management of TBI

A
  • psychostimulants
  • antidepressants (SSRI)
  • antiparkinsonian (amantadine)
  • anticonvulsants
  • meds for sleep/wake
  • beta blockers for autonomic dysfuntion
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21
Q

What is the goal of psychostimulants for those w/TBI?

A

To improve attn and concentration

22
Q

What is the goal of antiparkinsonian meds for those w/TBI?

A

Increase DA level in brain to help w/agitated behaviours

23
Q

What are treatment strategies for RLA V?

A
  • 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
24
Q

At what RLA LOCF can a pt complete goal directed activities w/cues for safety

A

VI

25
Q

What are treatment strategies at RLA VII and VIII

A
  • Integrate increased cog function into the community
  • encourage independence and progressively remove supervision
26
Q

What physical deficits may your patients w/RLA VII and VIII have?

A
  • paresis
  • unfractionated mvmt
  • sensory deficits
  • perceptual deficits
  • coord deficits
  • vestibular issues (sensory selection and weighting deficits)
27
Q

When would you use the Glasgow Coma Scale?

A

many different patients w/altered consciousness

28
Q

What is the scale for the GCS and what do the numbers indicate?

A

3-15 w/3 = coma and 15 = fully awake

29
Q

What does the glasgow coma scale measure (subscales)?

A
  • eye opening
  • verbal response
  • motor response
30
Q

What is the revised coma recovery scale used for?

A

To assess patients at RLA LOCF I-IV to track consciousness overtime

31
Q

How is the revised coma recovery scale scored?

A
  • lower score = reflexive activity
  • higher score = cognitively mediated behaviours
    Scale 0-23
32
Q

What are the subscales for the revised coma recovery scale?

A
  • auditory
  • visual
  • motor
  • oromotor
  • communication
  • arousal
33
Q

What does the agitated behaviour scale measure?

A

The degree to which a behaviour is present: aggression, disinhibition, and lability

34
Q

How is the agitated behaviour scale scored?

A

1-4
1 = absent
2 = present to a slight degree
3 = present to a moderate degree
4 = present to an extreme degree

35
Q

Which scale is unique in that it looks at an individual over a span of 2-3 days and uses a team approach?

A

Moss Attn Rating Scale

36
Q

What is the moss attention rating scale?

A

A scale that assesses the average attention of a patient over a few days typically in IPR or acute care

37
Q

How is the moss attn rating scale scored/what does a score mean?

A

A higher score reflects better attention

38
Q

What is the high level mobility assessment? (HiMAT)

A

A 13 item assessment of high-level motor performance in TBI patients performed at their max safe speed

39
Q

What is important about the HiMAT?

A

It has a minimum requirement that the patient must be able to independently ambulate over 20 meters

40
Q

What types of movement does the HiMAT asess?

A

Multi-directional walking
Run
Skip
Hop
Bound
Stairs

41
Q

What is the community integration questionnaire?

A

A self-report participation measure for acquired brain injuries that assesses their social role limitations and community interaction (home, social, & productive)

42
Q

List the 4 domains of post-concussive symptoms

A

1 - cervical MSK impairments
2 - vestibulo-oculomotor impairments
3 - autonomic dysfunction and exertional intolerance
4 - motor function impairments

43
Q

List out possible cervical MSK impairments

A

neck pain
H/A
dizziness
dec bal and postural control

44
Q

List out possible vestibulo-oculomotor impairments

A

dizziness
bal prob
vertigo
blurred vision
H/A
Nausea
Sensitivity to sound and light
mental fogginess
difficulty reading and concentrating
anxiety and fatigue

45
Q

List out possible autonomic dysfunction and exertional intolerance impairments

A

OH
Impaired BP or HR responses to exertion

46
Q

List out possible motor function impairments

A
  • static/dynamic bal
  • postural control
  • dual task
  • delayed rxn time
  • impaired coordination
47
Q

What do we educate patients on post concussion?

A
  • activity
  • stress mgt
  • consistent sleep
  • eat and hydrate
48
Q

What should we tell pts post-concussion regarding activity?

A
  • rest first 24-48 hrs
  • then resume basic activities including daily routine (can now resume light exercise per tolerance)
  • eventually add school/work
49
Q

What should we tell pts post-concussion regarding stress?

A
  • perform daily relaxation activity
  • limit screen time
50
Q

What should we tell pts post-concussion regarding sleep?

A
  • maintain a schedule of bedtimes and awake times and try to minimize naps so you can get better quality sleep at night
51
Q

What should we tell pts post-concussion regarding eat and hydrate?

A
  • eat normal diet on a regular schedule
  • drink 2-3 24 oz bottles of water/day
  • do not drink alcohol
52
Q

When should your post-concussion patient seek medical assitance?

A
  • 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