TBI - Ranchos VII - IX (higher level rehab) Flashcards
What is the characteristic name for a ranchos level VII?
Automatic - Appropriate
What are the characteristics to be placed in ranchos level VII?
- pt is oriented with the environment
- follows daily schedule and routine in a robot like way
- unable to recall all details of daily events
- new learning possible (with extra time)
- continued safety concerns
What is the characteristic name for a ranchos level VIII?
purposeful - appropriate
What are the characteristics to be placed in ranchos level VIII?
- able to recall and integrate past and recent events
- aware of and responsive to environment
- independent in the home
- developing community reentry skills
- shows carryover with new skills and no supervision required once skill is learned
What will a patient in a ranchos level VIII still demonstrate a decreased ability to complete?
- novel problem solving
- stress management
- speed of reactions/responses
- abstract reasoning
- maintaining social relationships
- judgement in emergencies or unusual situations
Where is the most common setting for a ranchos level VII or VIII exam to take?
Outpatient rehab
How is the orientation of a ranchos level VII patient described?
robot like, impaired judgement
How is the orientation of a ranchos level VIII patient described?
responsive to movement, does not required supervision once activities learned, struggles with new situation
What are the rehab goals for ranchos level VII and VIII?
- help patient function with less structure
- improving independent problem solving
- increasing safety awareness
- decreasing supervision
- integrating cognitive, emotional, and social skills needed to function in community
What are the goals of cognitive rehab programs?
- promote community reintegration
- return to work/school
- address behavioral, psychosocial, and cognitive impairments
List 4 cognitive intervention strategies for a ranchos level VII and VIII?
1) high level balance and walking skills
2) dual task
3) provide opportunities for problem solving
4) enhancing social skills
What type of practice is important for a patient in ranchos IV-VI?
- blocked
- distributed
What type of feedback is necessary for a patient in ranchos LOCF IV-VI?
extrinsic feedback
What type of practice is important for a patient in ranchos level VII-VIII?
- massed
What type of feedback is important for a ranchos level VII-VIII?
Intrinsic feedback
What should you look for to identify patient physical and mental fatigue?
- increased irritability
- decreased attention and concentration
- deterioration in performance of the physical skill
- delayed initiation
List the main strategies to maximize outcome in patients of all levels of cognitive functions
- beware of overstimulating the patient
- gradually increase cognitive complexity when appropriate
- use a structured organizational system that contains a daily journal, calendar, and frequent communication with family
What SOMS do you use to measure balance in ranchos level VII and VIII patients?
- community balance and mobility scale
- HiMAT
What SOMS do you use to measure gait in ranchos level VII and VIII patients?
- 6MWT
-10MWT - FGA
- rancho los amigos observational gait analysis
What SOMS do you use to measure QOL in ranchos level VII and VIII patients?
- quality of life after brain injury scale
- community integration questionnaire
What SOMS do you use to measure overall function in ranchos level VII and VIII patients?
Functional assessment measure/quality indicators
What is the community balance and mobility scale made to measure?
- high level balance skills (unilat stance, hop, look and carry, stairs, etc)
What is the HiMAT skill made to measure?
high level balance items (return to sport, physically demanding vocational role)
What is the community integration questionnaire made to measure?
readiness to return to work
What is the functional assessment measure made to measure?
focuses on community functioning and behavior (swallowing, car transfer, reading, writing, employability, etc)
What is the compensatory intervention approach?
- improve functional skills by compensating for the lost ability.
- use brain activation in areas formerly not used for a given task
what is the restorative (recovery) intervention approach?
restore the normal use of the movement pattern. reactivate areas of the brain, or penumbra, typically responsible for the task
What are the 5 considerations for the compensatory intervention approach?
1) safety
2) impairments
3) cognitive and behavioral barriers
4) financial resources
5) discharge destination
What two principles of neuroplasticity are most important in a restorative intervention approach?
- specificity
- intensity matters
