TBI (Part 2) Flashcards
1
Q
TBI Rehab Team
A
- Medical team = physician, resident, physicians assistant, nurse practitioner, nurse, nursing assistant
- neuropsychologist
- Therapy team = OT, COTA, PT, PTA, SLP
- Social worker/case manager
- recreational therapist
- respiratory therapist
2
Q
Course of Rehab
A
- ICU/acute care;
- inpatient rehab program (May depend on cognitive recovery)
- Patient receive services from a multi-disciplinary team
- three hours of therapy each day
- Long-term care facility
- After acute care; before inpatient rehab; or skip inpatient rehab
- Outpatient rehab
- Community-based programs
- Vocational re-entry; exercise programs
3
Q
When to start therapy
A
- No set standard (patient dependent)
- Team decision
- Two primary reasons
- Normalization of ICP (< 20 mmHg, patient dependent)
- hemodynamic stability
4
Q
Strategies to Maximize Outcomes
A
- Structured organizational system
- Daily log/journal;
- calendar;
- areas for important documentation (HEP, medication list)
- at higher RLFCS levels, patient can fill it out on their own
5
Q
Galveston Orientation and Amnesia Test (GOAT)
A
- Formally assesses PTA
- memories before and after the injury
- 100 points
- 76-100 = normal
- <76 = still in PTA
- Pediatric version: Children’s Orientation and Amnesia Test (COAT)
- rarely assessed by PT*
6
Q
Glasgow Outcome Scale (GOS)
A
- assessed generalized outcomes
- interview with patient/family
- death
- vegetative
- severely disabled
- moderately disabled
- good recovery
7
Q
Rancho Level I-III: Chart Review
A
- ventilator
- ICP monitoring
- WTB restrictions
- ROM restrictions
- Open Wounds
- External fixations
- presence of other external supports
8
Q
Levels of Consciousness: Coma
A
- completely unresponsive
- eyes are typically closed (no sleep cycle)
- GCS <9; Rancho Level I
9
Q
Levels of Consciousness: Vegetative State
A
- patient is awake, but not aware
- spontaneous eye opening
- restoration of sleep/wake cycle
- lack of awareness of self and environment
- Rancho I or II
10
Q
Vegetative State: Characteristics
A
- may startle to visual or auditory stimuli (inconsistently)
- not able to follow commands or communicate
- reflexive smiling, yawning, crying, chewing
- MAY demonstrate generalized response to stimuli (Rancho Level II)
11
Q
Persist at Vegetative State
A
- > 12 months post trauma
- >3 months post anoxia (poor px)
12
Q
Minimally Conscious State (MCS)
A
- awake and partially aware
- be able to do one of the following
- follow commands
- communicates yes/no
- verbalize intellectually
- demonstrate purposeful behavior
- Rancho level II or III
13
Q
Emergence from MCS
A
- demonstrate one or both of the following
- and yes/no to 6/6 situational questions on 2 seperate occasions
- functional object use for 2 different objects
14
Q
Assessing Levels of Consciousness: Levels I-III
A
- distraction free environment
- motor movements that aren’t reflexive (blinking, open/close hand)
- movements have to be within patient’s ability
15
Q
JFK Coma Recovery Scale-Revised (CRS-R)
A
- assess people in a coma or coma emergent
- 23 items: 6 subgroups
- audio, oromotor, visual, motor, communication, and arousal
- 23 points
- differentiates between levels of coma (VS, MCS)
16
Q
Rehab Goals: Levels I-III
A
- increase alertness and level of function
- minimize risk of secondary impairments
- manage abnormal tone
- tolerate upright positions
- improve motor control
- improve or retain joint integrity and ROM
- provide education to family and caregiver
17
Q
Early Mobility
A
- monitor vitals closely
- getting them to different positions
- sitting on edge of bed, sitting up, getting into chair, standing frame
- goal = increase alertness with stimuli in different environment
18
Q
Sensory Stimulation Program
A
- goal: increase level of alertness, arousal, and awareness
- informal or formal
- nondistracting environment
- give patient time to respond
- olfactory ad gustatory are first triggered
- document environment include patient position
19
Q
Informal Sensory Stimulation Program
A
- for patients making changes readily
- different therapists provide different stimuli
20
Q
Formalized Sensory Stimulation Program
A
- each team member provides consistent sensory stimuli
- results are docmented
- used to track progress, update insurance companies, help support families
- 4-6x/day
- discontinued once patient shows consistent responses (emergence from MCS)
21
Q
Skin Management
A
- beware of ulcers
- prevent skin issues
- turning schedule
- speciality bed
- wheelchair seating and positioning
- provide family education
22
Q
ROM/Tone
A
- ROM should be assessed at IE
- prevent any ROM deficits
- address ROM impairments first
23
Q
Contracture Prevention/Management
A
- position devices
- educate patient and family
- stretching/WTB
- serial casting
24
Q
Serial Casting
A
- most common areas
- prevent elbow flexion contracture
- prevent ankle PF contracture
- improves transient ROM
25
Q
Rancho Levels I-III interactions
A
- treat with respect
- explain what and why you are doing something
- frequently orient patient
- give time to respond
- PT model behavior for patient and family
- dont overstimulate
26
Q
Rancho Level IV: Optimizing the Environment
A
- allow freedom of movement
- floor bed; padded walls
- non-distracting environment
- helmets, abdominal binders, G-tube
- carefully choose when family members can watch tx session
- have help easily available
27
Q
Rancho Level IV: Activity Selection
A
- shorter tx sessions
- provide a lot of rest breaks
- activities that allow the patient to move
- repetitive and automatic task can help ease agitation
- have many activities
- change activity often
28
Q
Rancho Level IV: Patient Interaction
A
- be careful of nonverbal communication
- be respectful
- be flexible and let the patient have control
- provide frequent re-orientation
29
Q
Rancho Level IV: Medical Management
A
- behavioral intervention first
- medication are last resort and used if PT, other team members, and/or family isn’t safe
30
Q
Rancho Level IV: Patient Exam
A
- frequent observation based
- functional skills; use of UE and LE
- can’t formally assess using:
- outcome measures for balance/gait
- thorough impairment testing
- document:
- command following
- attention to the environment
- ability to recognize familiar people, objects, photos to help with orientation
31
Q
Agitated Behavior Scale
A
- 14 items
- scoring = 14-56 (higher score = more impaired)
32
Q
Rancho Level IV: Goals
A
- no functional goals
- no new learning
- improve endurance
- improve activity tolerance
- decrease agitation
- family edu and support
- help patient learn to control his/her own behavior
- prevent agitation through environmental modification and graded stimuli
33
Q
Rancho Level IV: interactions
A
- redirect patient to ew task, or face
- show verbal and nonverbal communication that you support
- use team members to help with behavior
- behavioral modification plan can be help is in level IV for a while
