Traumatic Brain Injury

Question 1

Glascow Coma Scale

Answer 1

Objective measure of consciousness

1. eye opening (spontaneous to none)
2. best motor response (commands to none)
3. verbal response (oriented, innapprop, none)

Score < 8 indicates severe brain injury

Question 2

Ranchos Los Amigos Scale - I

Answer 2

No Response

Completely Unresponsive to stimuli

Question 3

Ranchos Los Amigos Scale - II

Answer 3

Generalized Response

Reacts inconsistently and non-specifically to stimuli

Question 4

Ranchos Los Amigos Scale - III

Answer 4

Localized Response

Reacts inconsistently, but specifically to stimuli

Question 5

Ranchos Los Amigos Scale - IV

Answer 5

Confused & Agitated

Heightened state of activity. Behavior is bizarre and nonpurposeful relative to immediate environment. Recall and attention span are poor

Question 6

Ranchos Los Amigos Scale - V

Answer 6

Confused & Innapropriate

Able to respond to simple commands but not able to do complex tasks. Memory is impaired, verbalization is inappropriate

Question 7

Ranchos Los Amigos Scale - VI

Answer 7

Confused & Appropriate

Patient is dependent upon external input but can perfrom consistently. Memory improved

Question 8

Ranchos Los Amigos Scale - VII

Answer 8

Automatic & Appropriate

Performs automatically and appropriately in structured environments. Judgement remains impaired

*Involve patient in decision making process and monitor for safety.

Question 9

Ranchos Los Amigos Scale - VIII

Answer 9

Purposeful & Appropriate

Patient acts appropriately though not perfectly. May have some problems in stressful or unusual circumstances.

Question 10

Ranchos Levels I-III Management

Answer 10

• maintain ROM, prevent contracture, skin breakdown, and respiratory status
• provide sensory stimulation for arrousal
• promote early return of FMS: upright posture, and alignment

Question 11

Ranchos Levels IV-VI: Mid level Recovery Management

Answer 11

• provide structure, limit overstimulation, daily schedules, memory logs, relaxation techniques
• provide consistency, behavior modification techniques, clear feedback, written contracts
• task specific training, limit activities to familiar
• control rate of instruction, emphasize safety, whole to part breakdown

Question 12

Ranchos Levels VII-VIII High Level Management

Answer 12

• allow for increasing independence, wean from structure (closed to open environment)
• involve patient in decision making
• assist with reintegration - behavioral, cognitive, emotional
• prepare for community re-entry
• promote independent with ADLs
• improve postural control/stability
• increase CV endurance