TBI (Part 3)

Question 1

Rancho Level V and VI: Exam

Answer 1

• formalized testing can be started
  
  • keep concise
  • done over several sessions
• frequent re-orientation to situation, place, date, time

Question 2

Moss Attention Rating Scale

Answer 2

• an outcome measure
• observation tool that evaluate attention for TBI
• measures the impact of attentional impairments on ADL and function
• 22 items
  
  • score = 22-110
• rated by multiple team members
• average score is used

Question 3

Treatment Strategies: Levels V/VI

Answer 3

• limit task complexity
• start with short session —> to longer session
• provide structure/routine
• beware of onset of fatigue

Question 4

Treatment Goals: Levels V/VI

Answer 4

• increase safety and independence with mobility and ADLs
• improve postural control, balance, and gait
• improve strength and endurance
• patient and family education

Question 5

Level V: Confused Inappropriate

Answer 5

• easily distractible
• verbalization can be inappropriate and confabulatory
• may become agitated at times
• unable to learn new information

Question 6

Level VI: Confused Appropriate

Answer 6

• Follow simple commands
• follows schedules with structure and reminders
• Severe impaired short-term memory and continues to be unable to learn information
• Poor insight; not as much confabulation

Question 7

Rancho Level VII: Automatic Appropriate

Answer 7

• patient is oriented
• follows a routine, not flexible
• able to learn new things with added time
• may be unable to recall daily events
• safety is still a concern

Question 8

Rancho Level VIII: Purposeful Appropriate

Answer 8

• able to integrate past and present experiences
• aware of environment
• re-integrating into the community
• independent at home

Question 9

Treatment Goals: Rancho Level VII-VIII

Answer 9

• helping the patient function with less structure
• improving patient awareness and insight
• improve efficient and independent decision making

Question 10

Community Balance & Mobility Scale

Answer 10

• high level balance skills
• 13 items
• Scoring = 96 points (low score = greater impairment)
• MDC = 8-10

Question 11

HiMAT

Answer 11

• high level mobility assessment tool
• 13 items (includes: bwd walking, running up and down stairs, single leg hoping, jumping)
• scoring = 54 points

Question 12

Physical Impairments

Answer 12

• gait impairment
• contracture
• dec aerobic capacity
• impaired motor control
• functional mobility skills

Question 13

Rancho Level VII/VIII: Cognitive Interventions

Answer 13

• improve independence
• Taken himself to therapy
• Self-medication programs
• Writing down daily logs in their journal
• Following his or her schedule throughout the day
• Independence with ADLs and grooming
• Provide opportunities for problem-solving (including = prepping and cooking; planning day trips; shopping)
• improve patient awareness (allowing mistakes, minimal cueing, predict performance outcomes)

Question 14

Core Measures: TBI

Answer 14

• 6 minute walk test (MDC 61)
• Berg balance scale (MDC .10 m/s)
• 10 meter walk test (MDC 4)

Question 15

Restorative Approach

Answer 15

• Balance training;
• resistance training;
• Constraint induced movement therapy;
• locomotion training

Question 16

Assessing Aerobic Capacity in TBI

Answer 16

• 6 Minute Walk Test
• timed Treadmill testing
  
  • monitor vitals often

Question 17

Benefits of Aerobic Exercise in TBI

Answer 17

• Improve cardiovascular fitness;
• improve hormone regulation;
• improve mood;
• decreased risk of death by circulatory problem;
• improve sleep better
• improve Cognition;
• improve mental health;
• assist in return to employment;
• decreased decline of mental status at risk of dementia in old age