TBI, SCI, and Stroke Flashcards
Rancho Los Amigos Scale of Cognitive Functioning
Level I—
No response: is completely unresponsive to any stimuli presented
Rancho Los Amigos Scale of Cognitive Functioning
Levels VIII–X:
Purposeful and appropriate: is alert and oriented and able to recall
and integrate past and recent events. Each level (VIII, IX, and X) represents a
decreasing need for assistance with routine daily living skills
Rancho Los Amigos Scale of Cognitive Functioning
Level VII—
Automatic/appropriate: behaves appropriately and is oriented to place and
routine but frequently displays shallow recall
Rancho Los Amigos Scale of Cognitive Functioning
Level VI—
Confused, appropriate: exhibits goal-directed behavior but is dependent on
external input for direction
Rancho Los Amigos Scale of Cognitive Functioning
Level V—
Confused, inappropriate nonagitated: appears alert with fairly consistent
reactions, although increased complexity of commands causes more random responses
Rancho Los Amigos Scale of Cognitive Functioning
Level IV—
Confused/agitated: has heightened state of activity with severely decreased
ability to process information
Rancho Los Amigos Scale of Cognitive Functioning
Level III—
Localized response: reacts specifically to stimuli, though inconsistently
Rancho Los Amigos Scale of Cognitive Functioning
Level II—
Generalized response: exhibits inconsistent and nonpurposeful reactions to
stimuli
Complete lesions result in the absence of ______ and _______ function below the level of the injury.
motor
sensory
Incomplete lesions may involve a number of neurological segments, and sensorimotor function may be \_\_\_\_\_\_\_ or completely intact
partially
Initial stages of SCI are called spinal shock and may last between 24 hours and 6 weeks.
Spinal shock can result in the absence of _______ below the level of injury. If the injury
results in paralysis and reflex activity ceases, _________ can result.
reflexes
spasticity
Functional ability in spinal cord injury
C1-C4
i. Medical management: ________ assistance required; complete assistance for personal and domestic care
ii. Movement: limited _____ and neck movement; tetraplegia
iii. Nervous system: sympathetic nervous system compromised; possible ________
dysreflexia; no ______ or bladder control
iv. Mobility: ______ wheelchair with sip and puff possible
i. Medical management: respiratory assistance required; complete assistance for
personal and domestic care
ii. Movement: limited head and neck movement; tetraplegia
iii. Nervous system: sympathetic nervous system compromised; possible autonomic
dysreflexia; no bowel or bladder control
iv. Mobility: power wheelchair with sip and puff possible
Functional ability in spinal cord injury
S1–S5
i. Medical management: independent in _______ care; partial assistance for heavy-duty domestic care
ii. Movement: normal upper-extremity ROM and ________; some loss of function in
____ and legs
iii. Nervous system: little ______ or bladder control
iv. Mobility: __________ transfers; likely able to walk with assistance or aids,
though slowly and with difficulty; may drive with hand controls and load
wheelchair into car independently
i. Medical management: independent in personal care; partial assistance for heavyduty domestic care
ii. Movement: normal upper-extremity ROM and strength; some loss of function in
hips and legs
iii. Nervous system: little bowel or bladder control
iv. Mobility: independent transfers; likely able to walk with assistance or aids,
though slowly and with difficulty; may drive with hand controls and load
wheelchair into car independently
Functional ability in spinal cord injury
L1–L5
i. Medical management: ______ respiratory system; independent in _______ care; partial assistance for heavy-duty domestic care
ii. Movement: normal upper-extremity ROM and strength; partial paralysis in ____ and legs
iii. Nervous system: little _______ or bladder control
iv. Mobility: _________ transfers; may use _______ wheelchair or may walk with
braces; may drive with hand controls
i. Medical management: normal respiratory system; independent in personal care;
partial assistance for heavy-duty domestic care
ii. Movement: normal upper-extremity ROM and strength; partial paralysis in hips
and legs
iii. Nervous system: little bowel or bladder control
iv. Mobility: independent transfers; may use manual wheelchair or may walk with
braces; may drive with hand controls
Functional ability in spinal cord injury
T6–T12
i. Medical management: ________ capacity and endurance may be compromised;
independent in _______ care; partial assistance for heavy-duty domestic care
ii. Movement: normal upper-extremity ROM and ______
iii. Nervous system: little ______ or bladder control
iv. Mobility: ___________ transfers; may use ______ wheelchair or may stand in
standing frame or walk with braces; may drive with hand controls
i. Medical management: respiration capacity and endurance may be compromised;
independent in personal care; partial assistance for heavy-duty domestic care
ii. Movement: normal upper-extremity ROM and strength
iii. Nervous system: little bowel or bladder control
iv. Mobility: independent transfers; may use manual wheelchair or may stand in
standing frame or walk with braces; may drive with hand controls
Functional ability in spinal cord injury
T1-T5
i. Medical management: _________ capacity and endurance may be compromised;
________ in personal care; partial assistance for heavy-duty domestic care
ii. Movement: normal upper-extremity ROM and strength
iii. Nervous system: little bowel or bladder control
iv. Mobility: ________ transfers; _______ wheelchair; may drive with hand controls
T1-T5
i. Medical management: respiration capacity and endurance may be compromised;
independent in personal care; partial assistance for heavy-duty domestic care
ii. Movement: normal upper-extremity ROM and strength
iii. Nervous system: little bowel or bladder control
iv. Mobility: independent transfers; manual wheelchair; may drive with hand
controls
Functional ability in spinal cord injury
C8
Medical management: ____ stamina, but breathing with diaphragm; primarily
___________ in personal care; partial assistance for heavy-duty domestic care
ii. Movement: full head and neck; ability to raise _____ and flex and extend elbows;
wrist flexion and extension; ______ finger movement
iii. Nervous system: little bowel or bladder control
iv. Mobility: ________ transfers; _______ wheelchair with hand controls; ______
wheelchair for short distances; may drive with hand controls
C8
Medical management: low stamina, but breathing with diaphragm; primarily
independent in personal care; partial assistance for heavy-duty domestic care
ii. Movement: full head and neck; ability to raise arms and flex and extend elbows;
wrist flexion and extension; partial finger movement
iii. Nervous system: little bowel or bladder control
iv. Mobility: independent transfers; electric wheelchair with hand controls; manual
wheelchair for short distances; may drive with hand controls
Functional ability in spinal cord injury
C7
i. Medical management: low stamina, but breathing with diaphragm; limited
assistance for personal care; partial assistance for heavy-duty domestic care
ii. Movement: ____ head and neck; ability to raise arms and flex and extend elbows;
wrist flexion and extension; ______ finger movement
iii. Nervous system: little ______ or bladder control
iv. Mobility: _________ transfers; _____ wheelchair with hand controls; ______
wheelchair for short distances; may drive with hand controls
C7
i. Medical management: low stamina, but breathing with diaphragm; limited
assistance for personal care; partial assistance for heavy-duty domestic care
ii. Movement: full head and neck; ability to raise arms and flex and extend elbows;
wrist flexion and extension; partial finger movement
iii. Nervous system: little bowel or bladder control
iv. Mobility: independent transfers; power wheelchair with hand controls; manual
wheelchair for short distances; may drive with hand controls
Functional ability in spinal cord injury
C6
i. Medical management: low stamina, but breathing with diaphragm; _________
assistance for personal care; complete assistance for domestic care
ii. Movement: full head and neck; ability to raise arms and flex elbows (__
extension); some wrist extension
iii. Nervous system: little bowel or bladder control
iv. Mobility: ______ wheelchair with hand controls; _______ wheelchair for short
distances; may drive a vehicle with hand controls
C6
i. Medical management: low stamina, but breathing with diaphragm; moderate
assistance for personal care; complete assistance for domestic care
ii. Movement: full head and neck; ability to raise arms and flex elbows (no
extension); some wrist extension
iii. Nervous system: little bowel or bladder control
iv. Mobility: power wheelchair with hand controls; manual wheelchair for short
distances; may drive a vehicle with hand controls
Functional ability in spinal cord injury
C5
i. Medical management: low stamina, but breathing with diaphragm; _______
assistance for personal and domestic care
ii. Movement: full head and neck; ability to raise arms and flex elbows (no
extension)
iii. Nervous system: sympathetic nervous system compromised; possible _______
dysreflexia; ___ bowel or bladder control
iv. Mobility: _______ wheelchair with hand controls
C5
i. Medical management: low stamina, but breathing with diaphragm; complete
assistance for personal and domestic care
ii. Movement: full head and neck; ability to raise arms and flex elbows (no
extension)
iii. Nervous system: sympathetic nervous system compromised; possible autonomic
dysreflexia; no bowel or bladder control
iv. Mobility: power wheelchair with hand controls
Orthostatic hypotension can be addressed by positioning the client in ______ and
elevating the feet above the heart (Adler, 2013, p. 960). Therapists should use caution
when transferring a client from supine to sitting to avoid a rapid drop in blood pressure.
Having the client move slowly to allow time for the blood pressure to adjust minimizes
the risk of orthostatic hypotension (Atkins, 2014, p. 1175).
supine
Autonomic dysreflexia may be addressed by _______ the client up, ________ restrictive clothing or devices, and checking the _______ for obstruction
standing
loosening
catheter
Heterotopic ossification may be controlled through proper positioning in bed and the
wheelchair and maintenance of the client’s joint ____. Monitoring ____ regularly is
important to identify heterotopic ossification
ROM
Deep vein thrombosis is the formation of a blood clot, most often in the ______ extremity, abdominal area, or pelvic area. ______ skin inspection for asymmetry of lower-extremity color, size, or temperature is essential
lower
Visual
Bowel and bladder function is affected for all injuries at and above the __–__ level.
Establishing new ______ and habits for bowel and bladder elimination is essential to minimize risk of infection and decrease the occurrence of autonomic dysreflexia.
Nursing typically establishes the bowel and bladder routine with guidance from the physician.
Occupational therapy is essential to support new skill and habit acquisition for transfers, clothing management, safety with task performance, and bowel elimination and catheter care.
S2-S5
routines
Fatigue is affected by multiple factors, including physiological, psychological, and environmental. Fatigue can affect functional outcomes; addressing ______ disturbances, medication side effects, and optimal awake hours for therapy can be useful
sleep
Clients with C__ tetraplegia may benefit from mobile arm support to assist in supporting the weight of the arm during activities. Grasping and holding objects require wrist stabilization and use
of an assistive device such as a ________ cuff or C-clamp.
C5
universal
Clients with C_ and C_ tetraplegia have more fully innervated shoulder girdles,
allowing greater force for rolling in bed and crossing the midline with the arms.
Grasping of objects is facilitated by innervation of the radial wrist extensors, which
allows for tenodesis. The wrist-drive wrist–hand orthosis (or ________ splint) is
useful in maximizing pinch strength
C6 and C7
tenodesis
C_ tetraplegia interventions should focus on grasping objects with
metacarpophalangeal joint extension and proximal and distal interphalangeal joint
flexion.
C8
Psychosocial adaptation begins immediately and is most prominent during the
acute rehabilitation phase. Positive coping skills
development for clients with SCI should be emphasized throughout
interventions. Clients should be encouraged to solve their own problems, be
involved in making decisions about their ____, and be engaged in meaningful
activities. ______ learning is particularly beneficial for
people with SCI to allow them to learn from their peers
care
Group
_______: neurological language disorder
Aphasia
__________: articulation disorder resulting from paralysis of the organs of speech
Dysarthria
_______ aphasia: difficulty finding words
Anomic
________ aphasia or receptive aphasia: impaired auditory reception; speech
may be fluent but is often meaningless or nonsensical
Wernicke’s
______ aphasia: broken speech; slow, labored speech with frequent
mispronunciations
Broca’s
_______ aphasia: loss of all language ability
Global
Spatial relations and positioning impairment: difficulty _________ distance and object placement
perceiving
______ agnosia: difficulty recognizing objects
Visual
Figure–ground impairment: difficulty differentiating an ________ from its natural ___________
object
background
Ideational apraxia: difficulty conceptualizing _______, multistep movements
planned
Motor apraxia: difficulty ________ planned movements
completing
Stroke interventions
a. The treatment environment should mimic reality as much as possible (including
challenges).
b. Activity simulation should be as realistic as possible.
c. Opportunities should be available for client engagement and practice outside of
therapy sessions.
d. Ineffective or inefficient movements should be limited.
q
Stroke interventions
Specific methods to address performance skills and client factors include postural
adaptation, use of the upper extremity, and inclusion of motor learning ability factors
a. Postural adaptation: Intervention strategies to facilitate postural stability while
seated
i. Establish a neutral and active sitting alignment.
Both feet flat on floor
Equal weight on pelvis
Neutral or slight anterior pelvic tilt
Erect spinal posture
Head over shoulders, shoulders over hips
ii. Perform reaching activities while maintaining neutral sitting alignment.
Reaching straight ahead
Reaching to an object on the floor (near feet)
Reaching on the left or right side
Reaching above the head to retrieve an object
iii. Perform activity to maintain trunk in midline.
Use of verbal cues (e.g., “sit up straight”) and visual cues (e.g., mirror) to address
alignment
Wheelchair adjustment to promote trunk alignment
Weight shifting activity to promote weight bearing in pelvis
Trunk strengthening against gravity
Compensation and environmental adaptation to reduce risk for injury
q
Stroke interventions
g. Transition to the community involves thorough discharge planning throughout the
rehabilitation process. Family and caregiver education should address adaptations
to the home environment, strategies for delivering home programs, and fall
prevention. When possible, the occupational therapist should facilitate the client’s
resumption of valued roles and areas of occupational performance, including work,
leisure and recreation, sexual activity, and driving
q
Stroke interventions
f. Psychosocial adjustment involves both the client and the family. Clients should be
encouraged to use positive coping strategies, including seeking social support
systems, positive reframing, and acceptance of current abilities. Participation in
activities may improve a client’s sense of self-efficacy (Gillen, 2013, p. 876; Wolf &
Nilsen, 2015; Woodson, 2014, p. 1025).
q
Stroke interventions
d. Motor learning ability: Intervention tasks to address cognitive and visual–perceptual impairment
i. Interventions should focus on the client’s participation in the task rather than on
remediation of specific cognitive deficits such as attention and memory. Transfer of learning should also be considered when addressing
cognitive deficits to determine whether the skills learned will transfer from one
task to another and from one environment to another. Interventions that provide compensatory approaches for
perceptual deficits, such as visual field scanning, are shown to improve client
performance
ii. Spatial relations and positioning: brushing teeth, including positioning the
toothbrush for toothpaste application and on teeth
iii. Spatial neglect: searching for needed utensils in a silverware caddy
iv. Body neglect: brushing the neglected side of the mouth
v. Motor apraxia: opening kitchen supplies or preparing a small meal
vi. Ideational apraxia: grooming with a washcloth, soap, hairbrush, and so forth
vii. Organization and sequencing: dressing, including sequencing of task (e.g.,
putting on socks, putting on shoes, tying shoes)
viii. Attention: providing a distraction during an activity (e.g., turning on the faucet)
and helping the client refocus after the distraction
ix. Figure–ground: distinguishing the toothbrush from the sink
x. Initiation: prompting the client with a command and monitoring for task
completion
xi. Visual agnosia: promoting the use of touch to identify objects
xii. Problem solving: finding alternatives—for example, if milk is not available for a
cooking activity
q
Stroke interventions
c. Motor learning ability: Interventions to address communication difficulties (Gillen,
2013, pp. 864–865; Woodson, 2014, p. 1024)
i. Although speech therapists are generally responsible for treatment of
communication disorders, occupational therapists can be active in facilitating
communication for occupational performance in the following ways:
Encourage gestures and visual cues, such as having the client communicate through
demonstration.
Communicate in a quiet, calm area.
Allow increased time for client response.
Frame questions to allow yes-or-no responses.
Be concise.
Do not be forceful.
Encourage speech through routine or familiar ADL performance.
q
Stroke interventions
b. Postural adaptation: Intervention strategies to facilitate postural stability while
standing. Kitchen activities (e.g., washing dishes at the sink) are particularly useful because they allow for sturdy
support with use of countertop if postural correction is needed.
i. Maintain center of mass over base of support with activity.
Feet kept shoulder width apart
Equal weight bearing across left and right legs
Neutral pelvis
Slight knee flexion
Trunk aligned and symmetrical
ii. Maintain or restore equilibrium.
Beam walking on surfaces smaller than feet to promote equilibrium
iii. Use stepping strategies to widen base of support.
Simulation of riding on a bus while seated and stopping to practice widening the
base of support
q
Stroke Intervention should focus on improving __________ in occupations through early ADL
training using both compensatory and remedial approaches.
Tasks that emphasize performing an occupation allow the client to feel a sense of competence in engaging in tasks again. Performance skills can also be addressed through occupation-based tasks. Environmental and activity considerations are addressed using the task-oriented approach, which has shown significant effectiveness in stroke rehabilitation compared with traditional therapy approaches
participation
According to motor learning approach, _______ practice involves the performance of several motor tasks in random order to encourage the reformulation of the solution to the presented motor problem.
random
A person w/ right CVA will often demonstrate __________ behaviors that manifest poor judgment and disregard for _______.
impulsive
safety
A person w/ left CVA will often demonstrate slow _______, hesitancy, fearfulness, and ________ behavior
responses
cautious
A neurofunctional approach emphasizes ________ activity performance in the actual environment.
functional
Walking, wheelbarrow walking, walking like a crab, and walking like a bear are ________ bilateral activities.
reciprocal
Cutting, stringing beads, tracing stencils, and getting dressed are __________ bilateral activities.
asymmetrical
Popping beads, rolling clay or dough, clapping, and catching a beach ball are __________ bilateral activities.
symmetrical
An OTA works with an individual recovering from traumatic brain injury who demonstrates behaviors consistent with Level VII of the Rancho Level of Cognitive Functioning Scale. The client is a resident in a transitional living program. Which is the most important focus for the OTA to include in the client’s intervention plan?
The provision of a high degree of environmental structure to decrease confusion and ensure safety.
The development of strategies to accurately and safely complete IADL with minimal assistance.
The development of adaptive techniques to accurately and safely complete BADL with moderate assistance.
The provision of maximum assistance to accurately and safely complete IADL.
The development of strategies to accurately and safely complete IADL with minimal assistance.
Rancho levels 1-3 require ________ assistance.
total
Rancho levels 4 and 5 (confused, agitated) require ________ assistance.
maximum
Rancho level 6 requires ________ assistance.
moderate
Rancho level 7 requires ________ assistance.
New learning possible at this level.
minimal
Rancho level 8 requires _________ assistance.
Can attend to task for an hour even in distracting environment.
standby
ACL level _ has short attention span, produce automatic actions and requires total assistance.
1
ACL level _ has about 3min attention span and requires maximum assistance. Important to prevent pt from engaging in unsafe activity. Create a calm sensory rich environment.
2
ACL level _ has attention span for about 30min and requires moderate assistance. May perform activity w/ task fully set up (brushing teeth, polishing, folding laundry). Tactile is imprtant. Reoetive actions.
3
ACL level _ has attention span for about 30min and requires moderate assistance. May perform activity w/ task fully set up (brushing teeth, polishing, folding laundry). Tactile is important. Repetitive actions.
3
ACL level _ is capable of new learning and requires standby assistance. Trial and error. Learning is generalized. May be impulsive. Able to live alone.
5
ACL level _ can plan new activities and is independent. Anticipate potential mistakes. Reflect on decisions. Occasionally seeks guidance.
6
An adolescent incurred a spinal cord injury at the C5 level. During a family caregiver education session, the OTA instructs family members in the provision of passive range of motion (PROM) to the patient’s wrist and fingers. Which method of PROM should the OTA teach the family members to perform?
Extend the fingers with the wrist extended.
Flex the fingers with the wrist flexed.
Flex and extend the fingers with the wrist in a neutral position.
Flex the fingers with wrist extension and extend the fingers with wrist flexion.
Flex the fingers with wrist extension and extend the fingers with wrist flexion.
MACS for children w/ CP
Level I: Walks ________ restrictions; limitations in more advanced _____ motor skills.
Handles objects easily and successfully.
without
gross
Level V: Self-mobility is severely limited, even with the use of __________ technology.
Does not handle objects and has severely limited ability to perform even _______ actions.
assistive
simple
Level IV: Self-mobility with ________; children are transported or use _____ mobility outdoors and in the community.
Handles a _______ selection of easily managed objects in adapted situations.
limitations
power
limited
Level III: Walks with ________ devices; limitations walking ________ and in the community.
Handles objects with _________; needs help to prepare and/or modify activities.
assistive
outdoors
difficulty
Level II: Walks ________ assistive devices; limitations walking outdoors and in the community.
Handles most objects but with somewhat _______ quality and/or _______ of achievement.
without
reduced
speed
C1-C4 uses a _______ wheelchair controlled by head, ____, or breath.
power
chin
C5 uses a _____ wheelchair controlled by ___ drive control. May use ______ wheelchair in the home.
Driving may be possible with highly specialized modified van.
power
arm
manual
A client who has moderate cognitive decline will benefit from task __________ and environmental adaptations, such as placing frequently used ADL items at eye level.
simplification
Misinterpretation of abstract information, difficulties with spatial perception and emotional instability are typically related to a ____ CVA.
right
Impairments in temporal sequencing of morning self-care routine, receptive language, and motor planning are typically affected by a ____ CVA.
left
