Trauma Induced Ch 31 Flashcards

1
Q

Post-Trauma Occupational Therapy Interventions

A

Preparatory methods
Purposeful activity/ Occupation-based intervention
Education

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2
Q

Caregiver grieving —> caregiver education —> multidisciplinary teamwork —> Therapeutic relationships

A

Post-traumatic scope of care

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3
Q

Care is focused on survival and basic medical
recovery

Child is often sedated

Child’s crucial occupations are rest and sleep

A

ICU

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4
Q

OT goals of ICU

A

Contracture prevention
➢ Ulcer prevention
➢ Pain management
➢ Safety
➢ Introduce family to condition

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5
Q

OT interventions of ICU

A

➢ Stretching
➢ Soft tissue mobilization
➢ Splinting
➢ Bed positioning

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6
Q

Increased medical stability.

Increased interaction with environment.

Intervention strives to promote homeostasis and
prevent secondary injury.

Pain management—does pain interfere with
functional progress?

May be the longest phase of inpatient care.

A

Acute care setting

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7
Q

OT goals of Acute Care

A

Resume available
motor functions
➢ Build tolerance to
activity
➢ Actively engage child
➢ Build rapport
➢ Provide in-depth
education on condition

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8
Q

OT interventions of Acute Care

A

➢ Bedside sitting
➢ Transfers
➢ Preferred activities

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9
Q

Medical stability is established.

Therapy can be provided in a structured, twice
daily sessions of all needed disciplines.

Focus is to facilitate independence.

Prepare for transition to home.

Generally the most “intense” phase of care for
the child and family.

Multidisciplinary teamwork is crucial for a
successful discharge.

A

Inpatient rehab

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10
Q

OT goals of inpatient rehab

A

➢ Adequate preparation
for transition home
➢ Increase
independence in self-
care skills
➢ Facilitate continued
progress toward prior
level of functioning
➢ Communicate with
other disciplines

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11
Q

OT intervention of inpatient rehab

A

➢ Begin balance
between restorative
and adaptive
approaches

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12
Q

Care becomes the primary responsibility of the
family for the first time.

This is often when reality sinks in and families
begin a stage of acute grief.

Progress toward independence pivots on family
priorities and values.

A

Outpatient Rehabilitation and Community Reintegration

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13
Q

OT goals for Outpatient Rehabilitation and Community Reintegration

A

➢ Identify family priorities
and values
➢ Clearly identify
differences between
current and premorbid
status
➢ Identification of
appropriate community
resources

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14
Q

OT intervention for Outpatient Rehabilitation and Community Reintegration

A

➢ Client-centered
interview
➢ Self-management
strategies to empower
the family and child

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15
Q

Incidence of pediatric spinal cord injury

A

➢ 1.99 times per 100,000 children
➢ Approximately 0.002%
➢ ~1455 new injuries per year
➢ < 4% of all spinal cord injuries

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16
Q

Gender discrepancy of pediatric SCI

A

➢ Boys are twice as likely to experience SCI than girls.

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17
Q

Traumatic causes of pediatric SCI

A

➢ Motor vehicle accident
(primary)
➢ Violence
➢ Falls
➢ Sports injury

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18
Q

Medical causes of pediatric SCI

A

➢ Spinal tumor
➢ Spinal procedure
➢ Disease process

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19
Q

Pediatric SCI

A

Can be at any spinal
level.

Young children are
more likely to have an
upper cervical injury
more than other age
groups.

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20
Q

Pediatric SCI—Therapeutic Overview

A

Major impairments are in motor function.

Motor return will not occur for complete injuries
but is possible for incomplete.

Main focus of therapy is to regain independence
in self-care skills and functional mobility.

It is essential to instruct care and injury
prevention for nonfunctional limbs in order to
maintain overall heath.

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21
Q

Preparatory methods for SCI in ICU

A

• Bed positioning
• ROM
• Pain management via collaboration

22
Q

Purposeful activities for SCI in the ICU

A

Communication via adapted call lights

23
Q

Education in SCI in the ICU

A

Introductory info

Pressure area prevention

Autonomic dysreflexia

24
Q

Preparatory methods for SCI in acute care

A

• ROM
• Splinting
• Tone management via collaboration
• Orthostatic hypotension management

25
Q

Purposeful activities of SCI in acute care

A

• Neuromuscular re-education
• Supported sensorimotor activities
• Use of equipment to promote function

26
Q

Education for SCI in acute care

A

• In-depth education on SCI
• Model empowerment of the child to direct own care

27
Q

Preparatory methods for SCI in inpatient rehab

A

• Pain management
• ROM
• Tone/Spasticity
management
• Positioning
schedules
• Pressure relief
schedules
• Tenodesis grasp
promotion

28
Q

Purposeful activities for SCI in inpatient rehab

A

• Developmentally
appropriate play
• Task training
• NMES with
functional activity
• Movement
pattern training
• Bowel & bladder
regimen training
• Skin inspections

29
Q

Education for SCI in inpatient rehab

A

• In-depth, level-
specific
information
• Preliminary
prognosis
• Sexual function
• Safety

30
Q

Preparatory methods for SCI in outpatient

A

• Pain management
• Tone management
• Surgery to promote
function

31
Q

Purposeful activities for SCI in outpatient

A

• Neuromuscular re-
education
• Functional NMES
devices
• ADLs, iADLs
• Leisure and
exercise activities
• Collaboration with
school
• Client-centered
goal focus

32
Q

Education for SCI in outpatient

A

How to problem-
solve
environmental
barriers to
participation
• Referral
• Community
resources
• Social supports

33
Q

Cause for pediatric TBI

A

➢ Falls
➢ Motor vehicle accidents
➢ Sports-related injuries
➢ Non-accidental trauma
➢ Violence-related

34
Q

Cause for pediatric ABI

A

➢ Stroke
➢ Anoxia
➢ Arteriovenous
Malformation rupture
➢ Tumor resection
➢ Seizure activity
➢ Seizure foci resection
➢ Infection (meningitis
and encephalitis)
➢ Metabolic disorders

35
Q

Functional prognosis in ped TBI

A

➢ Severity of injury
➢ Location of injury
➢ Extent of injury—localized or diffuse
➢ Premorbid factors — Socioeconomic status & Behavior and academic performance
➢ Rancho level of cognitive functioning

36
Q

Therapeutic overview of ped TBI

A

Impairments can be motor, neurological, or
cognitive.

Return of function is much less predictable due
to neuroplasticity of the brain.

Therefore, rehab focus may be in one or many
functional areas.

37
Q

TBI in ICU

A

Preparatory methods — automatic storming management, low stimulation environment

Purposeful activities — sensory stim

Education — rancho levels

38
Q

TBI in acute care

A

Preparatory methods — ROM, splinting, tone, cognition, sensory, safety measures

Purposeful activities — environmental interaction, task grading, neuromuscular re-education

Education — TBI education, motor learning

39
Q

TBI in inpatient

A

Preparatory methods — arousal, pain, and tone management; ROM

Purposeful activities — neuromuscular reeducation, NME, cognition and behavior, assessment of visual-perceptual skills

Education — standardized assessment and preliminary prognosis

40
Q

TBI in outpatient

A

Preparatory methods — arousal, pain, tone management; ROM and splinting

Purposeful activities — neuromuscular redaction, constraint induced movement, cognitive and behavior training/management

Education — Neuroplasticity education, alt treatments, equipment, resources, community, social support

41
Q

Pediatric burn injury may require

A

Skin grafting — Generally performed when an otherwise healthy
(noninfected) wound would take longer than 3 weeks to heal on it’s own
Sheet grafting
Meshed grafting

42
Q

Develops any time the dermal layer of the skin that is damaged.

The collagen fibers in hypertrophic scarring are orientated in a “whorl-like” pattern, as compared to normal skin in which collagen aligns in a parallel pattern.

A

Scar

43
Q

Identified by changes in four characteristics of
the skin:
➢ Vascularity (increases; may be red, pink, purple)
➢ Height (increases; thick)
➢ Pliability (decreases; firm)
➢ Pigmentation (can either decrease or increase; may
be hypo or hyper)

A

Active hypetrophic scarring

44
Q

scars that grow
beyond the border of the initial
wound boundary.

It is a genetic condition with
generally poor outcomes and
minimal treatment options.

A

Keloid scarring

45
Q

Functional problems w/ scarring

A

Limit ROM when crossing a joint = functional deficits

46
Q

Therapeutic overview of pediatric burns

A

Major impairments are in soft tissues, which
result in primarily motor deficits.

Treatment focus is on maximizing skin integrity
and function, then resuming participation in
occupations.

It is essential to discuss and facilitate
acceptance of changes in the physical body.

47
Q

Burns in the ICU

A

Preparatory methods — anti deformity, protective splinting, PROM 1x daily

Purposeful activities — interests?

Education — intro info

48
Q

Burns in acute care

A

Preparatory methods — scar massage and PROM 2x/day 5-10 days post wound closer; splinting and pressure therapy

Purposeful activities — pain management, ROM w/ func activity

Education — scar management, scar progression photo

49
Q

Burns in inpatient

A

Preparatory methods — aggressive ROM 2x daily; splinting

Purposeful activities — ROM

Education — ROM HEP, HEP tolerance

50
Q

Burns in outpatient

A

Preparatory methods — ROM, scar massage, pressure therapy, splinting, progressive exercise

Purposeful activities — client-specific occupations

Education — school reentry, social supports, HEP