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NMR II > TBI: Physical Therapy Management > Flashcards

TBI: Physical Therapy Management Flashcards

1
Q

Describe a typical course of rehab for a patient with TBI

A
  • ICU to acute care to inpatient to longterm care facility to outpatient rehab to community based programs to vocational re entry to exercise programs
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2
Q

When should TBI rehab therapy be started?

A
  • No set standard patient/provider dependent
  • Team decision
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3
Q

What are the 2 primary reasons for starting TBI rehab therapy?

A
  • Normalize of ICP ( less than 20mmHg, patient dependent)
  • Hemodynamic stability
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4
Q

Name some neuromuscular impairments after TBI

A
  • Impaired motor control
  • Impaired coordination
  • Hemiparesis
  • Hypertonicity (abnormal postural reflexes)
  • Somatosensory impairment
  • Impaired postural control
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5
Q

Name some behavioral impairments after TBI

A
  • Easily frustrated
  • Agitation
  • Mental inflexibility
  • Impulsivity
  • Disinhibition
  • Emotional lability
  • Irritability
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6
Q

Name some cognitive impairments

A
  • Arousal/ Disorder of consciousness
  • Attention
  • Concentration
  • Memory
  • Learning
  • Executive functions
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7
Q

What is the patient unable to do if they have Post Traumatic Amnesia (PTA)?

A

Unable to form new memories

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8
Q

How does a neuropsychologist determine the patients length of PTA?

A

Reassessing cognitive status and ability to form new memories daily

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9
Q

What must a patient be able to do in order to demonstrate they are out of a state of confusion?

A

Must be able to identify specifics of date, time, place, and situation consistently

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10
Q

T/F: Patients will typically have aphasia after TBI

A

false- they will have communication/language (dysphagia) impairments but not typically aphasia

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11
Q

T/F: A patient after TBI may have visual and perceptual deficits

A

True

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12
Q

Name some medication used in post-acute phase to address tone

A
  • baclofen
  • diazepam
  • dantrolene
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13
Q

Name some medication used in post-acute phase to address seizure control

A
  • Anti epileptics
  • Depakote
  • Keppra (Levitiracetam)
  • Dilantin (phenytoin)
  • Cerebyx (fosphenytoin)
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14
Q

Name some medication used in post-acute phase to address attention

A
  • Neurostimulants
  • Dopamine
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15
Q

Name some medication used in post-acute phase to address arousal

A
  • Amantadine (4-16 wks after dx)**
  • Methylphenidate
  • Bromocriptine
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16
Q

Name some medication used in post-acute phase to address depression

A

Nontricyclic meds are most effective

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17
Q

What are some activity limitations a patient may exhibit post TBI?

A
  • Ambulation
  • Basic mobility
  • ADLs
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18
Q

What are some participation restrictions a patient may exhibit post TBI?

A
  • Return to employment
  • Family role
  • Community/social role
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19
Q

Knowledge Checkpoint question: When do we start PT rehab for a patient after brain injury?

A

Vitals & ICP stability

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20
Q

Knowledge Checkpoint question:
Which of the following impairments is common after brain injury?
- Amnesia
- Apathy
- Aphasia
- Hypotoncity

A

Amnesia

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21
Q

Knowledge Checkpoint question:
Which of the following medications has been shown to address a secondary complication of seizures?
- Amantadine
- Baclofen
- Dopamine
- Keppra

A

Keppra

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22
Q

What Rancho is a low level patient?

A

Rancho I-III

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23
Q

What are the PT goals for patients in levels I-III?

A
  • Consistently assess level of consciousness & track progress
  • Increase arousal & functional mobility
  • Improve tolerance to upright
  • Reduce risk of secondary impairments
  • Improve or retain joint integrity & ROM
  • Educate family & caregivers
  • Maintain coordinated care among all team member
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24
Q

What impacts a patient’s ability to respond to stimuli & commands?

A
  • Limited motor function
  • Communication impairments
  • Sedating meds
  • Impaired sensation
  • Impaired cognition
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25
Q

Describe Coma Rancho Level I

A
  • Unresponsive to any stimuli
  • Arousal system not functioning
  • Eyes closed, often ventilator dependent
  • No auditory, visual, cognitive, communication function
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26
Q

Describe Unresponsive Wakefulness Rancho Level II

A
  • Awake but not aware
  • Able to respond to external & internal stimuli
  • Basic brainstem functions only
  • Minimal communication w/ cortex
  • Spontaneous eye opening
  • Restoration of sleep/wake cycles
  • Differentiate from locked in syndrome
  • May startle to visual or auditory stimuli (or inconsistently localize sound)
  • Not able to follow commands or communicate
  • Reflexive smiling/crying/yawning, chewing may be present
  • Withdraw/posture to noxious stimuli
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27
Q

Describe minimally conscious state Rancho Level III

A
  • Awake & partially aware
  • Inconsistent cognitively mediated behavior, different from reflexes
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28
Q

To be in a minimally conscious state Rancho Level III a patient needs to be able to do one or more of what tasks?

A
  • Follow simple commands
  • Gestural or verbal (“yes/no”) responses
  • Intelligible verbalization
  • Movement or emotional behavior that occur in relation to relevant stimuli, not attributable to reflexive activity
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29
Q

What are some of examples of minimally conscious state?

A
  • Smiling or crying in response to verbal or visual emotional content
  • Vocalization or gestures that occur in direct response to verbal comments or question
  • Reaching for objects that demonstrates a clear relationship between location & direction of reach
  • Touching or holding objects in a manner that accommodates the size/shape of the object
  • Visual fixation & tracking
  • Inconsistently following commands
  • Unable to functionally communicate thoughts/feelings
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30
Q

To emerge from minimally conscious state a patient must demonstrate reliable & consistent demonstration of one or both of what actions?

A
  • Accurate yes/no responses to 6/6 situational questions on 2 consecutive examination
  • Functional use of a least 2 different objects
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31
Q

What is the gold standard outcome measure for assessing levels of consciousness?

A

Coma Recovery Scale Revised (CRS-R)

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32
Q

Name the SOMs that can be used to assess levels of consciousness

A
  • Coma Recovery Scale Revised
  • Disorders of Consciousness Scale
  • Rancho Los Amigos Levels of Cognitive Functioning
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33
Q

How is Multi-Modal Sensory Stimulation programs implemented?

A
  • Controlled & structured manner
  • Multi-sensory
  • Balance of stimulation & rest
  • Monitor patient response
  • Use outcome measure to assess change
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34
Q

How is Familiar Auditory stimulation training performed?

A

5 minute story telling by patient relatives that involve autobiographical events

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35
Q

What does Familiar Auditory stimulation improve?

A

Improvement in CRS & increased activation of language areas on functional MRI

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36
Q

What are the benefits of Music Therapy in MCS?

A
  • Behavioral improvement (more eye contact & smiles)
  • Improved BP in MCS
  • Greater activation of auditory network & physical responses (possible enhancement in attention)
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37
Q

Which is better music alone or movement with music interventions?

A

Supported sitting on trampoline with vertical motions & listening to music (3x/d x 7 min) > music alone

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38
Q

When is multimodal stimulation more effective MCS or VS/UWS?

A

MCS > VS/UWS

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39
Q

How should Multi- Modal Sensory Stimulation Programs be implemented?

A
  • Tailor to client tolerance & preference
  • Begin early & perform frequently (3-5x/d, 7-20 min, for at least 2 wks)
  • Avoid overstimulating
  • Non distracting environment
  • Give pt time to respond
  • Use until more complex activity is possible
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40
Q

What does bi-modal and multi- modal mean?

A
  • Bi Modal: Auditory & tactile
  • Multi Modal: All 5 senses
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41
Q

Why should early mobilization be implemented?

A
  • Shorter length of stay
  • Increase chance of d/c to home
  • Decreased secondary complications
  • Improved outcomes (neuroplastic changes)
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42
Q

What are the contraindications to early mobilization?

A
  • Unstable Spine
  • Increased (ing) ICP
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43
Q

What are the precautions to early mobilization?

A
  • WB restriction
  • Skin/Joint integrity
  • Autonomic instability
  • CV status
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44
Q

How should early mobilization be implemented?

A
  • Mobility to varied positions relative to gravity
  • Monitor vitals closely
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45
Q

What is the goal of early mobility?

A
  • Increase alertness with stimulation in different positions/ environment
  • Improve level of consciousness
  • Improve GI motility, ROM, CV response
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46
Q

What are some secondary impairments that can be prevented with early mobility?

A
  • Contractures
  • Pressure sores
  • Pneumonia
  • DVT
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47
Q

How often should a patient weight shift when in a wheelchair?

A

Every 30 min for 2 min

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48
Q

What is the positioning in bed and how often should the patient be turned?

A
  • Hips/knees slightly flexed
  • Turn every 2 hours
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49
Q

What should be prioritized when positioning?

A
  • Management of mm tightness & joint stiffness
  • Stretching
  • WB
  • Splinting
  • Serial Casting
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50
Q

What is a risk factor if patients aren’t properly positioned?

A

Neurogenic Heterotrophic Ossification

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51
Q

What are the clinical consideration of serial casting?

A
  • Help to improve PROM
  • Used in various neurologic conditions including pediatrics
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52
Q

What is serial casting proven to improve?

A

PROM

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53
Q

What are the 4 main ideas of family education & support?

A
  • Maintain open communication
  • Involve the family in POC & decisions
  • Educate on current evidence when appropriate
  • Provide realistic & consistent messages
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54
Q

What is the practice guidelines for patients in Severe Disorder of Consciousness

A
  • Multidisciplinary Rehab
  • Use SOM
  • Can use electrophysiological tests for dx when in doubt
  • Prognosis may still be favorable >28days
  • Be aware & treat confounding medical complications
  • MD prescribe Amantadine to increase arousal at 4 weeks
  • Counsel families
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55
Q

What are the tips for patient interaction in Rancho Levels I-III?

A
  • Treat the patient with respect & dignity
  • Explain what you are doing & why
  • avoid stimulation
  • Allow time for responses
    -Model behavior for the family’s interaction with the patient
  • Frequently re orient the patient
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56
Q

Patients who are in what stage? at 1 month after TBI have a 50% chance of regaining consciousness

A

UWS

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57
Q

20% recovery in VS or MCS to full consciousness within 6 weeks of discharge from inpatient rehab. What did all the patients have in common?

A
  • Initial GCS average was a 9
  • 3-8x more likely to recover target behavior on CRS if in MCS
  • Preserved language function had best prognosis
  • 20% of VS was able to consistently follow commands
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58
Q

How long do patients need to be in Chronic (Persistent) Vegetative State/Unresponsive Wakefulness before there is a minimal chance of waking up?

A
  • > 12 months in traumatic injury
  • > 3 months in non traumatic injury
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59
Q

The more time of altered consciousness the (worse or better) the outcome

A

Worse

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60
Q

Describe Level IV: Confused- Agitated

A
  • Heightened state of activity
  • Behavior is not purposeful & bizarre relevant to environment
  • Patient is driven by confusion
  • Attention is extremely brief
  • Memory, both long term & short term are impaired
  • Patient may be aggressive
  • Unable to cooperate directly with treatment effects
  • Unable to learn new info
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61
Q

T/F: Patients in level IV are mean and intending to hurt others

A

False

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62
Q

T/F: Patient in LOCF IV does not need a lot of people to manage their safety

A

True - myth that you need a lot of people to manage the patient safely

63
Q

T/F: Medication is required to calm the patient down if they are in LOCF IV

64
Q

T/F: The patient is not deliberately not cooperating with therapist in LOCF IV

65
Q

T/F: In LOCF IV the way the patient acts is not who they are as a person

66
Q

T/F: When a patient is in LOCF IV you should educate the patient that aggressive behavior last for the rest of their life

A

False- Educate that aggressive behavior typically occurs only for a few weeks at most

67
Q

What is the primary examination goal of a patient in LOCF IV Confused and Agitated?

A
  • Identify behavioral & cognitive concerns
  • Ability to sustain attention & Distractibility
  • Identify impairments & activity limitation to determine overall function
68
Q

T/F: The primary goal when a patient is in LOCF IV is to progress function

A

False- Not necessarily the primary goal

69
Q

What should be focused on when working with a patient in LOCF IV?

A
  • Use familiar activities & focus on participation & tolerance to session
  • May need to end early if agitation is too great
70
Q

What are some challenges when working with a patient in LOCF IV Confused & agitated?

A
  • Amnesia
  • Confused
  • Decrease attention
  • Distracted
  • Uncooperative
  • Agitation
  • Agression
  • Impaired insight into deficits
71
Q

What type of environment should a patient in LOCF IV Confused & agitated be in?

A
  • Closed
  • Freedom to move
  • Low distraction
  • Dim lighting
  • Choose when to have family present (one at a time)
72
Q

How can you practice consistency with a patient in LOCF IV Confused & agitated?

A
  • Address inappropriate behaviors in a consistent manner
  • Re orient frequently
  • Follow consistent schedule
  • Use daily charts, graphs or logs
73
Q

When a patient is in LOCF IV Confused & agitated will there be carry over of newly taught tasks?

A
  • No carry over over of non-automatic tasks
  • No new learning
74
Q

T/F: When choosing activities for patient in LOCF IV Confused & agitated you should not change up the exercise and get them to do the planned activities.

A

False - Change activities frequently and do not force them to do things because this will increase agitation

75
Q

What type of practice is best for a patient in LOCF IV Confused & agitated ?

A

Distributed because they need rest time

76
Q

T/F: Longer treatment session are beneficial for patients in LOCF IV Confused & agitated

77
Q

What activities should be chosen when working with a patient in LOCF IV Confused & agitated ?

A

Functional tasks whenever possible that are near the patient’s physical level

78
Q

What type of activities can help diffuse agitation for a patient in LOCF IV Confused & agitated ?

A

Repetitive and automatic

79
Q

How can you model calm behavior for a patient in LOCF IV Confused & agitated ?

A
  • Be in control of your emotion
  • Use calm, slower tone
  • Get on patient level
  • Re direct patient if needed
80
Q

How should you communicate with a patient in LOCF IV Confused & agitated ?

A
  • Be clear & concise
  • Be mindful of your nonverbal communication
  • Start with simple questions/commands
81
Q

T/F: Expect egocentricity from patients in LOCF IV Confused & agitated

A

True - Patient doesn’t see your POV they can only think of themself

82
Q

What are some things you can do to promote safety of the patient when they are in LOCF IV Confused & agitated ?

A
  • Helment
  • G Tube/Trach
  • Craniectomy
  • Locked unit
  • Posey mitt when not with you
83
Q

What are some ways a PT can maintain safety of themselves when working with a patient in LOCF IV Confused & agitated ?

A
  • look out for signs of increasing agitation/aggression
  • Get help when needed (Behavior response team)
  • Maintain access route out of room (keep self closest to door)
  • Be aware of clothing/jewerly
84
Q

Describe the Behavior Modification Program

A
  • Positive reinforcement (reward system)
  • Re direction
  • Structure w/ consistent responses to inappropriate behavior
  • All team members on board (including family)
85
Q

Which management approach should be first when working with a patient in LOCF IV Confused & agitated (Behavior or medical) ?

A

Behavioral

86
Q

When and what types of medications should be used with a patient in LOCF IV Confused & agitated ?

A
  • At times required to maintain safety of patient, family or staff
  • Try to minimize use
  • propranolol, trazadine, SSRIs, Tegretol, Seroquel
  • Ativan (benzodiazepines) only in severe agitation
87
Q

What type of learning is possible for patient in LOCF IV Confused & agitated ?

A
  • Motor relearning
  • Formerly learned skills that were practices a lot can be regrained (ie walking or reaching)
88
Q

What are some appropriate goals for patients in LOCF IV Confused & agitated ?

A
  • Improve endurance
  • Improve activity tolerance
  • Improve attention to task
  • Family education & support
  • Prevent agitation through environmental medication & graded stimuli
  • Help patient learn to control their behavior
89
Q

Describe LOCF Level V: Confused- Inappropriate

A
  • Patient is now able to follow simple commands fairly consistently
  • If environment/ task is more complex the patient’s responses are more non-purposeful & random
  • W/ structured environment may be able to socialize on an automative level for short periods
  • Extremely distractible
  • Verbalizations, inappropriate, confabulatory
  • Memory is severely impaired
  • Unable to learn new info
  • Poor safety awareness
90
Q

Describe LOCF Level VI: Confused- Appropriate

A
  • Goal directed behavior w/ external input
  • Recognizes basic needs & performs automatic tasks (Continent & Able to help w/ ADLs)
  • Shows carryover of re-learned tasks
  • Follows simple commands consistently
  • Able to follow a schedule with structure
  • Memory problems
  • Poor insight into cognitive deficits
91
Q

What LOCF level will show carryover of relearned tasks?

A

Level VI Confused-Appropriate

92
Q

What memory problems do patients in LOCF VI Confused- Appropriate have?

A

Long term memory is better than short term

93
Q

What are the treatment goals for Levels V & VI?

A
  • Increase safety & independence w/ mobility & ADL’s
  • Improve postural control, balance, & gait
  • Improve strength & endurance
  • Patient & family education (considering cognitive & behavior concerns)
94
Q

Is formalized testing possible when a patient is at level V or VI?

95
Q

How should formalized testing be administered when a patient is at level V or VI?

A
  • May need to complete in several short sessions
  • Keep distractions concise
  • Determine focal injury deficits
96
Q

Is new learning possible in level V or VI?

A

No they are still confused

97
Q

T/F: Patients have poor safety awareness in levels V & VI

A

True- still needs supervision

98
Q

T/F: A patient in LOCF V or VI does not have memory deficits

99
Q

T/F: Frequent re-orientation to situation, place, date, & time is needed for patients in LOCF V or VI

100
Q

What type of environment should treatment of patients in Levels V/VI occur in?

A
  • Meaningful environment
  • Reduce distractions
101
Q

How should treatment sessions for patients in Level V/VI be implemented and what tasks should be selected?

A
  • Start with short PT sessions or incorporate breaks
  • Limit task complexity
  • Provide structure & routine
  • Saliency
102
Q

Name some intervention examples that can be used for patient in Level V/VI?

A
  • Ball toss while maintaining standing balance
  • Kicking a ball/basketball/lacrosse
  • STS transfer training while reaching for various colored targets
  • Navigate to/from therapy gym back to room
  • Stair training
  • Slowly begin to increase the cognitive load (sequencing, command following, visual scanning, social interaction w/ staff)
103
Q

What communication strategies should be implemented when working with patients in levels V/VI?

A
  • Repeat info as needed
  • Use a memory planner
  • Avoid asking too many questions
  • Explain what is going on
  • Allow time for processing & response
104
Q

What is Moss Attention Rating Scale used for and at what level is it valid?

A
  • Observational tool which evaluates attention after TBI
  • Valid LOCF IV or higher
105
Q

What does Orientation Log measure?

A

Orientation to time, place & circumstance

106
Q

What does Galveston Orientation & Amnesia Test measure?

A

PTA through orientation questions

107
Q

What outcome measure are appropriate for examining balance in patients in V/VI?

A
  • Berg Balance Scale
  • Community Balance & Mobility scale (typically later stage)
  • High Level Mobility Assessment Tool (typically later stage)
108
Q

What outcome measures can examine attention & cognition in patient in V/VI?

A
  • Moss attention rating scale
  • Orientation log
  • Galveston Orientation & Amnesia Test
109
Q

At what LOCF is a patient out of PTA?

110
Q

Describe Level VII: Automatic- Appropriate

A
  • Patient is now oriented in environment
  • Follows daily schedule & routine in a robot like way
  • Unable to recall all the details of daily events
  • New learning possible with extra time
  • Ongoing safety concerns & Impaired judgement
111
Q

Describe Level VIII: Purposeful - Appropriate

A
  • Able to recall & integrate past & recent events
  • Aware of & responsive to the environment
  • Independent in the home
  • Developing community reentry skills
  • Shows carryover with new skills & no supervision required once skill is learned
  • May continue to demonstrate decreased abilities as compared to premorbid status
  • Vocational/drivers training may be appropriate
112
Q

At what level can new learning occur?

113
Q

Patients in Levels VII & VIII are more oriented (no PTA) what is the difference between the two?

A
  • VII: robot like, impaired judgement
  • VIII: Responsive to environment, does not require supervision once activities learned, struggles with new situation
114
Q

T/F: During examination of patients in Levels VII & VIII you can identify more focal injuries and typically examine gait & balance in greater depth than previous levels

115
Q

What are rehab goals centered around for patient in Levels VII & VIII?

A
  • Helping the patient function w/ less structure
  • Improving independent problem solving & decision making
  • Increasing safety awareness & insight (Often anosognosia)
  • Decreasing assistance & supervision
  • Integrating cognitive, emotional & social skills needed to function in the community
116
Q

What is anosognosia?

A

Lack of insight

117
Q

What do cognitive rehab programs aim to do?

A
  • Promote community reintegration
  • Return to work/school
  • Address behavioral, psychosocial & cognitive impairments after TBI
118
Q

What are some cognitive intervention strategies for patients in levels VII & VIII?

A
  • High level balance & walking skills
  • Dual task
  • Provide opportunities for problem solving
  • Enhancing social skills
119
Q

What type of practice and feedback would be appropriate for patient in LOCF IV- VI?

A
  • Distributed
  • Extrinsic
120
Q

What types of practice and feedback may be considered for a patient in LOCF VII-VIII?

A
  • Massed practice
  • Self-generalization feedback
  • Video self- monitoring feedback
121
Q

What are some ways you can develop awareness patients in Levels VII & VIII?

A
  • Actively involve patient
  • Allow patient to make mistakes in safe environment
  • Ask patient to predict future performance
  • Ask patient for self-assessment after task completion
  • Provide cueing & assistance in systematic manner to allow patient to perform as much of problem solving as possible
122
Q

What are some signs of fatigue in patients?

A
  • Increased irritability
  • Decreased attention & concentration
  • Deterioration in performance of physical skill
  • Delayed initiation
123
Q

What are some strategies to maximize outcomes for all patients at all levels of cognitive functioning in all rehab settings?

A
  • Beware of overstimulating the patient
  • Gradually increase cognitive complexity when appropriate
  • Use a structured organizational system
124
Q

What are some outcome measures that can examine balance in patients in levels VII & VIII?

A
  • Community Balance & Mobility Scale
  • HiMAT
125
Q

What are some outcome measures that can examine gait in patients in levels VII & VIII?

A
  • 6MWT
  • 10 MWT
  • Functional gait assessment (FGA)
  • Rancho Los Amigos Observational Gait Analysis
126
Q

What outcome measures can examine QOL in patients in levels VII & VIII?

A
  • Quality of Life after Brain Injury
  • Community Integration Questionnaire
127
Q

What outcome measure can examine overall function in patients?

A

Functional Assessment Measure/ Quality Indicators - Inpt settings

128
Q

What is a compensatory based interventions?

A
  • Improve functional skills by compensating for lost ability
  • Brain activation in areas formerly not used for a given task
129
Q

What is a restorative (Recovery) Approach?

A
  • Restore normal use of the movement pattern
  • Reactivate areas of the brain, or penumbra, typically responsible for the task
130
Q

What are some examples of compensatory approaches?

A
  • Using an alternative motor pattern or strategy
  • Increased time
  • Increased cuing
  • Assistive Device
131
Q

What is the over arching goal of intervention strategies?

A

Intensive, challenging, meaningful & Task specific to promote motor cortex changes and functional recovery

132
Q

At what frequency should constraint induced movement therapy be performed?

A
  • 6hrs/day
  • 2-3x/week
  • Population may require more support & structure
133
Q

How should locomotor training with BWS be implemented?

A
  • Parameters not fully understood
  • Chronic patients with TBI
  • 45 min, 3x/wk, 18 sessions
134
Q

Why do patients have severe deconditioning following TBI?

A
  • Period of bed rest & immobility
  • More likely to develop a sedentary lifestyle
  • Decreased aerobic capacity
135
Q

T/F: TBI does not affect life expectancy

A

False- shorter life expectancy by 7 years
- 3x more likely to die of CV disease, CVA, & thromboembolic disease

136
Q

Patients after TBI have an increased risk of what?

A
  • Alzheimers, (early onset) Dementia
  • Parkinson Disease
  • Mental Health & emotional concerns
  • Fatigue
  • Sleep disturbances
137
Q

What are the benefits of aerobic conditioning?

A
  • Reduce long term CV risks
  • Improve aerobic capacity (VO2 max)
  • Improved sleep
  • Decrease fatigue
  • Decreased depression & anxiety
  • Improved cognitive function
138
Q

What should aerobic conditioning be dosed at?

A
  • 60-90% of age predicted max HR
  • RPE scale: Somewhat hard to vigorous (12-16)
  • 20 -40 min per session
  • 3-4 days/wk
139
Q

What is the dosage of resistance training?

A

2-3 days/wk, 3x8-12 reps (10 rep max)

140
Q

What are some interventions for balance?

A
  • Agility training
  • Challenging environmental conditions
  • Dual task
141
Q

Name some negative prognostic indicators

A
  • Low initial GCS score
  • No pupillary response
  • Age (<5 or older adult)
  • Low educational level
  • Hypoxia
  • Coma > 2wk
  • High ICP (>20mmHg)
  • Hyperthermia within 72 hrs of injury
  • Brain bleed
  • Obliteration of 3rd ventricle or basal cisterns
  • Midline shift (herniation)
142
Q

What are some positive prognostic indicators

A

Multidisciplinary intensive rehab has been shown to be effective in improving consciousness & body function

143
Q

If a patient is in PTA <48.5 days what is the typical outcome?

A

Higher FIM score at d/c from inpt rehab

144
Q

If a patient is in PTA <27 days what is the outcome?

A

More likely to be employed

145
Q

If a patient is in PTA <34days what is the outcome?

A

Good overall recovery

146
Q

If a patient is in PTA <53 days what is the outcome?

A

Live w/o assistance

147
Q

In terms of prognosis what is it an older adults?

A
  • Longer length of stay in rehab
  • a slower functional recovery
  • Greater cognitive impairment at discharge
  • 2x greater chance of nursing home placement
148
Q

Why are there poorer outcomes in older patients?

A
  • Brain has decreased capacity for repair as it ages
  • Increased frequency of systemic complications after injury
  • More often have preexisting conditions
149
Q

Young brains has time to heal, some cognitive deficits may not manifest until later. When and what are some deficits?

A
  • School aged
  • Attention
  • Increased processing time
150
Q

T/F: After TBI a majority of patients are employed at 5 years

A

False- 55% unemployed at 5 years

151
Q

T/F: Patients after TBI are at high risk of depression & Anxiety

152
Q

T/F: Patients after TBI are at higher risk of developing PD, Alzheimer’s, Dementia, CTE

153
Q

T/F: Seizure, accidental drug poisoning, infections & pneumonia are all examples of long term negative effects after TBI

NMR II (14 decks)

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