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Neuro Rehab II > TBI (Part 2) > Flashcards

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
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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
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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
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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
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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*
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6
Q

Glasgow Outcome Scale (GOS)

A
  • assessed generalized outcomes
  • interview with patient/family
    • death
    • vegetative
    • severely disabled
    • moderately disabled
    • good recovery
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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
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8
Q

Levels of Consciousness: Coma

A
  • completely unresponsive
  • eyes are typically closed (no sleep cycle)
  • GCS <9; Rancho Level I
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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
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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)
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11
Q

Persist at Vegetative State

A
  • > 12 months post trauma

- >3 months post anoxia (poor px)

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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
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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
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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
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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)
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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

Neuro Rehab II (4 decks)

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