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Year 2: Neuromuscular > Test 3: Moderate TBI > Flashcards

Test 3: Moderate TBI Flashcards

1
Q

what is a moderate TBI

A

middle GCS
moderate to high medical needs
some LOC
PTA at least 1 day and less than 7
marked confusion- Rancho level indicates

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2
Q

what is a mild TBI

A

concussion

no LOC

<1 day PTA

no injury on image

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3
Q

GCS for moderate TBI

A

9-12

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4
Q

PTA for moderate TBI and score on O-log

A

1-7 days PTA

O-log score <25/30 for at least 1 day but less than 7

or

GOAT score of <75 for 1-7 days

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5
Q

LOC for those with moderate TBI

A

30 min to 24 hours

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6
Q

rancho levels IV-VI and meaning

A

IV = confused/agitated

V = confused/inappropriate

VI = confused/appropriate

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7
Q

describe characteristics of pts with Rancho level IV (confused/agitated)

A

heightened activity

bizarre behavior

unable to cooperate directly with treatment

incoherent/inappropriate verbalization

lack of short and long term recall

may confabulate- create story that makes sense for them; not intentionally lying

limited ability to learn

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8
Q

describe characteristics of pts with rancho level V (confused/inappropriate)

A

can consistently respond to commands

random response to complex commands

has attention to environment but lacks focused attention to task

confabulatory/inappropriate verbalization

impaired memory

inappropriate use of objects

can perform old tasks but trouble with performing new ones

**Like IV but without violence; more confusion and “why” than hostility

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9
Q

describe characteristics of pts with rancho level VI (confused/appropriate)

A

can demonstrate goal behavior but need external input or direction

shows carry over for learned task

follow simple directions consistently

past memories are showing up more in depth than recent memories

may have wrong answer to questions, but is appropriate in answer

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10
Q

things to consider when taking history/doing pt interview with moderate TBI pt

A

Behavior, arousal, consciousness limit

pts not good historians - often confused and confabulate

medical status not as dynamic as severe TBU but still consult RN

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11
Q

cognitive screens/scales used for cognition with moderate TBI (if appropriate to test)

A

coma recovery scale (CRS)

moss attention rating scale (MARS)

rancho levels of consciousness scale

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12
Q

describe MARS

A

measurs attention related behaviors after TBI

22 items

5 point rating scale

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13
Q

selective vs divided attention

A

selective = requires pt to attend to a singular particular task (i.e. digit span task)

divided attention = examined by requiring pt to attend to 2 tasks simultaneously

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14
Q

basic cognitive functions vs advanced

A

basic = attention, memory, and language

advanced = abstract thinking, problem solving, judgement, and reasoning

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15
Q

how does attention require cognitive demand

A

difficulty paying attention = increases cognitive demand

leads to cognitive fatigue

fatigue leads to agitation and irritability

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16
Q

how does executive function allow us to behave appropriately and pragmatically

A

poor judgement = poor choices

decreased filter for what is appropriate = say inappropriate things

presents as misbehavior

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17
Q

recommended measure for looking at affect/behavior changes in moderate TBI pts

A

agitated behavior scale

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18
Q

describe the agitated behavior scale

A

measures behavior aspects of agitation during acute phase from TBI

measures aggression, disinhibition, and lability

can also be used with dementia

14 items scored 1-4 (1 is not present behavior, 4 is extremely present)

min score = 14, max = 56

lower scores better

19
Q

scoring scale for agitated behavior scale

A

</= 21 - WNL

22-28 = mild agitation

29-35 = moderate agitation

36 or over = severe agitation

20
Q

outcome measures used for general neurological injury

A

6 MWT

10 MWT

Berg Balance Scale

Functional Gait Assessment

Activities Specific Balance Confidence Scale

5 time STS

21
Q

outcome measures recommended for inpatient rehab TBI pts

A

FAM+FIM

Barthel index

Disability rating scale

22
Q

outcome measures recommended for outpatient rehab TBI pts

A

high level mobility assessment

community balance and mobility scale

quality of life after brain injury

23
Q

interpretation of berg balance scale

A

45-56 = independent

<45 = fall risk (for stroke and older adults)

ceiling effect possible

24
Q

describe the berg balance scale

A

14 item

geriatric adult or neuro pt to assess fall risk

15-20 min to administer

0-4 pt scoring; 0 is lowest, 4 is highest level of function

25
Q

describe the Functional Assessment Measure (FAM + FIM)

A

12 items added to FIM; enhances utility for brain injury population

rated on same 7 pt scale as FIM

increased time to administer

26
Q

what are the 12 items added to FIM to create FIM+FAM

A

swallowing
car transfer
community access
readign
writing
speech intelligibility
emotional status
adjustable to limitations
employability
orientation
attention
safety judgement

27
Q

describe the barthel index

A

assesses ability of individual with neuromuscular or musculoskeletal disorder to care for him/her self

inpatient rehab

activity domain - caring for yourself

not specific to TBI/stroke

evaluation of independence; measures changes in disability over time

score measures functional independence; higher score = better function

28
Q

describe the disability rating scale

A

tracks recovery of individual from coma to community

measures general functional changes ove rcourse of recovery for mod-severe TBI

30 pt scale

observer rated

evaluates 8 areas of functioning and 4 categories
-consciousness
-cognitive ability
-dependence on others
-employability

high score = higher level of disability (29 highest, 0 min)

29
Q

outcome measures for gait

A

setting doesnt matter; outcome measures for gait are same no matter the setting

diagnosis does not matter

TUG
6MWT
10 MWT
Dynamic gait index

30
Q

gait outcome measure for TBI pt

A

high level mobility assessment (HiMAT)

community balance and mobility scales

31
Q

describe the HiMAT outcome measure

A

assesses high level performance in TBI

may use orthoses

must be able to ambulate 20 m independently w/o AD

used in outpatient

activity ICF domain

13 items performed at max speed (running, skipping, hopping, etc)

total scores from 0-54 (each item 0-4)

higher scores = better performance

32
Q

normative values for HiMAT 18-25 years old

A

males: 50-54

females: 44-54

33
Q

describe the community balance and mobility scale

A

detects high level balance and mobility deficits based on tasks that are commonly encountered in community environments

similar to HiMAT but not specific to TBI

allowed to wear orthotic

cant use ambulation aids

13 challenging tasks with 6 tasks performed on both sides

34
Q

scoring for community balance and mobility scale

A

items scored from 0-5 and reflect progressing difficulty

0 = complete inability to perform

5 = most successful completion of item possible

max score of 96

high score = high function

35
Q

intervention considerations for PTs with moderate TBI pt

A

distribute practice with frequent rest (mental fatigue leads to irritability, lowered attention, etc)

self efficacy and executive function

dual task performance for community reintegration

aerobic conditioning (helps with deconditioning associated with prolonged stay in ICU/acute care)

36
Q

where to start with return to mobility for moderate TBI pts

A

upright interventions

good for BP management, WBing, strength, building against gravity, prevention of contractures, and progression toward function

for more alert pts: standing frame, BW support, or sabina lift

37
Q

examples of task oriented training

A

crossing street
doing laundry
folding towels
cooking a meal
taking the bus
playing the guitar

38
Q

when is behavior management most often used

A

rancho IV TBU

cant participate in new learning and pt is easily agitated

reorientation is primary focus

39
Q

ways to manage behavior in pts

A

work on familiar activities (no new learning; dont overstimulate)

coregulation of ANS (use your ANS to regulate theirs; open posture, calm voice, low stimulation)

do no escalate with them

consistent time/schedule; team effort

nonviolent crisis intervention training

40
Q

what is a behavior modification plan

A

uses behavioral modification techniques such as positive reinforcement with an accompanied point or reward system

developed with pt based on percieved goals for behavioral modificaiton

must have capacity to learn (Rancho V and VI)

41
Q

describe management of cognitive/executive function as an intervention

A

focus of SLP and OT

PT needs to reinforce

use outcome measures (MMSE, MOCA, SLUMS)

work on prioritization of tasks

reinforce appropriate vs inappropriate behavior

promote safety

start simple then ass complex as they emerge through rancho stages (usually applicable to rancho VI and beyond)

for PT, incorporate cognitive thought into mobility exercises (i.e. self reflection or mental walkthroughs)

42
Q

neuroprotective benefits of ecercises - pros

A

aerobic conditioning for cognitive benefit

43
Q

neuroprotective benefits of exercises - cons

A

TBI pts have decreased ability to perform aerobic exercise due to deconditioning due to prolonged ICU/acute care stays

44
Q
A

Year 2: Neuromuscular (20 decks)

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