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Neurologic conditions > Traumatic Brain Injury❗️❗️❗️ > Flashcards

Traumatic Brain Injury❗️❗️❗️ Flashcards

1
Q

Information to be collected during Ax

A
  1. occupational profile
  2. level of consciousness & MMSE
  3. Muscle tone, ROM
  4. Sensation
  5. Hand function and Eye hand coordination
  6. Cognitive abilities
  7. Psychological issue
  8. Functional performance
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2
Q

What and How to assess occupational profile?

A

premorbid information, medical hx…
*gathered from family members, depending on the client’s level of consciousness

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3
Q

What and How to assess level of consciousness & MMSE?

A

MMSE:
- Motor
- Appearance
- Speech
- Affect
- Thought process, content
- Intelligence, insight
- Perception

Level of consciousness
- Glasgow coma scale (Eye opening –> Verbal response –> Motor response)
- The Rancho Los Amigos Scale

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4
Q

What and How to assess muscle tone and ROM?

A

Muscle tone:
- Modified Ashworth Scale

ROM: Goninometer

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5
Q

What and How to assess sensation?

A
  • potential for safety awareness & spontaneous use of extremity
  1. Temperature discrimination
  2. Tactile (2-point, monofilament)
  3. Proprioception
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6
Q

What and How to assess Cognitive abilities?

A
  • Attention, memory, EF, perception

MoCA
NCSE (neuro-behavioral cognitive status exam)
Digit span / Trail making test
EMQ (Everyday Memory Questionnaire)
RBMT (Rivermead behavioral memory test)
CAMPROMT (Cambridge Prospective Memory)
MVPT (Motor free visual perception test)
Stroop test

Intelligence
WAIS (Wechsler Adult Intelligence scale)
TONI (Test of non-verbal intelligence)

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7
Q

What and How to assess psychological issue?

A
  • depression (BDI (Beck Depression Inventory))
  • agitation (observation, Agitated Behavior Scale (ABS))
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8
Q

What and How to assess Functional performance?

A

Berg Balance Scale 
- 14-item
- sit to stand, standing unsupported, transfer etc

MBI (Modified Barthel Index)
- focus on level of assistance
- >85 = d/c

FIM (Functional Independence Measure)
- physical, psychological and social function
- focus on level of independence

HK Lawton IADL Scale

CIQ (Community Integration Questionnaire)
- home integration, social integration, productive activities

DRS (Disability Rating Scale)
- arousability + cog ability for self care + dependence on others + psychosocial adaptability (employment)

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9
Q

Occupational performance issues?

A
  1. immobilization –> pressure sore, limited ROM
  2. ambulation –> wheelchair
  3. spasticity
  4. agitation
  5. Motor dysfunction (E.g. ataxia, Ideomotor apraxia, Ideational apraxia)
  6. Visuo-perception (neglect)
  7. Cognitive impairment
  8. Speech and language
  9. impaired alertness and mental fatigue
  10. ADL IADL performance
  11. Community participation, Occupation
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10
Q

Tx goal and Tx plan (immobilization –> pressure sore, limited ROM)

A

Tx goal:
1. Prevent pressure sore
Proper bed positioning –> Pillows, foam wedges, and splinting –> facilitate normal positions and prevent abnormal postures

  1. limited ROM
    Passive ROM
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11
Q

Tx goal and Tx plan (ambulation –> wheelchair)

A
  • Prevents skin breakdown and joint and muscle deformity, inhibits primitive reflexes
  • Increases sitting tolerance, improves respiration and swallowing ability, and provides opportunities to interact with the environment.
  • Includes a stable base of support at the pelvis, maintenance at the trunk and midline, and facilitation of the head in the upright midline position
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12
Q

Tx goal and Tx plan (spasticity)

A

Tx goal: decrease spasticity
- Antispasticity splints position the hand and wrist in functional positions and abduct the fingers

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13
Q

Tx goal and Tx plan (agitation)

A
  • Behavior management strategies are useful to avoid reinforcing inappropriate behavior
  • Tracking arousal and alertness is important to establish a method of communication.
  • A yes–no system + using eye blinks, head nods, or discernible motor movements (e.g., thumbs up).
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14
Q

Tx goal and Tx plan (Motor dysfunction (E.g. ataxia, Ideomotor apraxia, Ideational apraxia))

A
  • focuses on motor learning, skill acquisition, and exercise
  • beginning with gross motor functions
  • incorporate into occupation-based activities

Ataxia
- motor without coordination
- focused on compensatory strategies for control
e.g. weighting of body parts or use of weighted utensils and cups

Apraxia
a person is unable to perform tasks or movements when asked

  • internal (verbalize + implement steps) + external strategy (compensatory aids)
  • sensory stimulation (light and deep pressure, sharp and soft touch)
  • proprioceptive stimulation (lean on and put weight)
  • cueing, verbal or physical prompts
    chaining

Ideomotor apraxia
- impaired ability to perform a skilled gesture with a limb upon verbal command and/or by imitation
- use general statement “Let’s get ready”
imitate: visualize task and sequences
try to kick off unconscious action

Ideational apraxia
- cannot perceive the purpose of a previously learned complex task
e.g. put their shoes on before their socks
- step-by-step command
- forward chaining
- vanishing cures

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15
Q

Tx goal and Tx plan (Visuo-perception (neglect))

A

compensatory and rehabilitative strategies:
- Neglect –> encouraging the client to use the neglected side during functional activities.
- Environmental adaptation may necessitate interaction with the neglected side, such as moving the television or meal tray
- compensate by placing all objects in the field of vision to maximize success

Unilateral neglect/ inattention
- recruitment approach (trunk rotation, eye patching, limb activation, CIMT)
- cueing approach (phasic alert望左望右, visual scanning)

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16
Q

Tx goal and Tx plan (Cognitive impairment)

A
  • emphasizes self-awareness of deficits, attention, memory, and executive function through participation in functional activities
  • Compensatory approaches to address memory impairment

Deficits in Sustained Attentional Capacities:
be sure that you have that person’s attention before giving them the instruction

Memory Deficits:
- Try to pair new learning with old, familiar concepts that the patient is able to recall.
- Teach the patient to WRITE DOWN EVERYTHING

Impaired Ability to Carry Out a Plan of Action or Sequential Thinking/Actions:
Break down all behavior into their logical and step-wises sequential behaviors

Treatment approach:
1. Remedial = help a person reacquire or improve lost skills

  1. Adaptive = improve the performance of functional tasks such as activities of daily living by teaching strategies
    e.g. external memory aids = electronic memories, memory notebook system and computers
    e.g. internal memory aids = enhancing organization of information to be recalled, rehearsing information to be remembered, or training specific mnemonic devices such as peg words or visual imagery
  • more stable and consistent environment
17
Q

Tx goal and Tx plan (Speech and language)

A
  • Expressive aphasia: with conversation exercises, with OT recognizing client errors and asking the client to verbalize the words the client meant to say.
  • Compensation through communication devices, pictures, or charts
18
Q

Tx goal and Tx plan (impaired alertness and mental fatigue)

A
  • given frequent rest periods
  • not to overstimulate the patient → reduce confusion
  • Reduce demands on the patient
  • learn the predictable periods of alertness in patients and schedule important activities during the peak periods of alertness

-Patients often respond to one sensory mode (vision, hearing, smell, touch, or taste) better than others. Find out which is most effective and use this to stimulate the patient.

19
Q

Tx goal and Tx plan (ADL IADL performance)

A

Dysphagia and feeding
- Feeding instruction may begin in an isolated and quiet area to prevent distraction and then be graded to include social situations.

  • Adaptive equipment may include a rocker knife, plate guard, and non spill mug
  • Impulsivity may be controlled by requiring the client to place the fork down after each bite to ensure that a full chew-and-swallow routine is completed

General training:
- repetitive practice through errorless learning, fading cues, and positive encouragement

20
Q

Tx goal and Tx plan (Community participation, Occupation)

A
  • Vocational rehab
  • social skill training …

Neurologic conditions (5 decks)

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