Term
| What is the #1 killer of children and young Adults |
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Definition
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Term
| What are deficits seen with TBI |
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Definition
-Cognitive
-Neuromuscular
-Visual
-Perceptual
-Behavioral |
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Term
| What are the most enduring and socially disabling impairments with TBI |
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Definition
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Term
| What are some cognitive deficits associated with TBI |
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Definition
-altered level of consciousness
-decreased memory
-altered orientation
-decreased attention span
-decreased problem solving/reasoning
-impaired safety awareness
-impaired insight
-impaired executive functioning |
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Term
| what are some neuromuscular deficits with TBI |
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Definition
-abnormal tone
-sensory deficits
-motor control deficits
-impaired balance/ataxia/nystagmus
-paresis/paralysis |
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Term
| What are some beavioral deficits with TBI |
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Definition
-disinhibition: emotional, sexual
-apathy
-aggression
-low tolerance for frustration
-depression |
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Term
| what are some factors that influence the outcome of a TBI |
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Definition
-premorbid status
-duration of coma and post traumatic amnesia
-primary injury
-secondary injury |
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Term
| What is the primary injury |
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Definition
| amount of immediate damage from the impact of the brain injury |
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Term
| what is the secondary injury |
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Definition
| damage from systemic and intracranial mechanisms that occur after the initial injury |
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Term
| what are treatment stategies based on with TBI |
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Definition
-levels of cognition
-Rancho Los Amigos scale of cognitive function |
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Term
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Definition
No Response
-no response to any stimulation |
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Term
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Definition
Generalized Response
-non-purposeful and inconsistent response to any stimulus
-responses the same regardless of type or location of stimulation
-reflexive in nature to pain stimulus |
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Term
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Definition
-response directly related to type of stimulus but inconsistent
-ex: blinks when strong light crosses visual field, pulls at tubes & restraints that are uncomfortable |
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Term
| Interventions for levels I - III should focus on |
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Definition
-maintaining functional ROM - includes manageing tone
-positioning to prevent indirect impairments
-facilitating any kind of active movement & response (sensory stim): movement may not be purposeful at this point
-family education: teach to assist with ROM, positioning, and sensory stimulation
-upright positioning: sitting, tilt table |
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Term
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Definition
-neutral position
-roll placed behind neck to support head and neck curvature
-roll parallel to head to prevent lateral flexion and rotation |
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Term
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Definition
-gentle ROM when ICP and cerebral perfusion stable
-hands at base of skull or on sides of head |
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Term
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Definition
-rolls behind shoulders
-roll behind hip if rotation is occurring
-normal alignment needs to be maintained |
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Term
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Definition
-hand on scapula, arm supported, rhythmical protraction/retraction, elevation/depression
-hand on posterior pelvis, leg supported rhythmical elevation and depression
-when patient stable: rolling segmentally |
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Term
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Definition
-roll behind shoulder
-cone in hand if fingers in flexion
-wedges between fingers if adducted
-when stable: turn onto side for weightbearing into arm |
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Term
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Definition
-relaxation of scapula
-hand placed in patient's hand from ulnar side to help decrease flexor tone of elbow, wrist and hand
-ROM of 5th finger or thumb to help break up flexor tone
-hand placed over biceps when increased extensor tone and over the triceps when increased flexor tone |
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Term
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Definition
-hips and knees supported in a slightly flexed position
-no pressure on ball of foot medially
-roll between legs if strong adduction or internal rotation |
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Term
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Definition
-hand on lateral side sole of foot for range of motion of foot, knee, and hip
-hands placed above and below knee, medially for external rotation, hip and knee flexion
-hand behind knee for flexion and external rotation of hip, flexion of knee |
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Term
| Why do you keep hand on scapula, arm supported, rhythmical protraction/retraction, elevation/depression |
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Definition
| -to maintain the mobility of the scapula, and to also help decrease tone |
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Term
| why do you not put pressure on the ball of the foot medially |
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Definition
| -to prevent the positive support refex |
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Term
| what does therapeutic guiding help with |
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Definition
guide the patient through a function motion to help the brain remember what it needs to do
-what muscles it needs to use
-what the action is |
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Term
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Definition
Confused-Agitated
-increased level of activity
-non-purposeful behaviors
-inappropriate or incoherent speaking
-cries out or screams out of proportion to a stimulus
-may be aggressive or exhibit flight behavior
-no short term or long term memory
-may display disinhibition behavior |
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Term
| Intervention for level IV should focus on |
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Definition
-maintaining any functional abilities: usually more automatic, previously acquired abilities
-may try to add functional tasks depending on physical abilty of the patient
-may still attend to maintaining range and positioning if patient needs attention
-dont expect new learning or much carryover
-need highly structured, closed environment:build in succes
-family education |
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Term
| what should family education focus on during level IV rancho |
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Definition
-reassure the family that the patient is not intentionally trying to hurt others but patient cannot control the behaviors
-teach behavior management strategies |
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Term
| how could you handle a restless patient in bed |
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Definition
| -use firm packs to position and provide sensory input helps the patient stay calm |
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Term
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Definition
Confused-Inappropriate
-gross attention to environment but easily distracted without a structured environment
-responds to simple commands and performs previously learned tasks with external cues and a structured environment
-difficuly with complex tasks; responses nonpurposeful and random; may inappropriately use objects with external direction
-may confabulate
-may display disinhibition behavior
-memory impaired |
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Term
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Definition
| -replacing fact with fantasy |
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Term
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Definition
Confused-Appropriate
-past memory shows more depth and detail
-goal directed behavior but needs structure and direction
-consistently appropriate response to simple direction but may be incorrect due to memory problems
-shows carryover for relearned tasks |
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Term
| Interventions for level V-VI rancho |
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Definition
-can add more formal and specific treatment for motor deficits that interfere with mobility, but there will still be little new learning
-still important to maintain structure and decrease stress to increase level of performance
-may use a variety of techniques to help the patient remember events, people, and skills
-emphasize safety with patient and family because patient may be more mobile than before
-teach family to assist with functional mobility |
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Term
| developmental sequence postures |
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Definition
-prone-on-elbows
-quadruped
-bridging
-sitting
-kneeling and half kneeling
-modified plantigrade
-standing |
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Term
| what is modified plantigrade |
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Definition
| -standing leaning against wall, not at a vertical |
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Term
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Definition
Automatic-Appropriate
-appears appropriate and oriented in hospital and home situations
-can learn new tasks but learning is slow
-judgment impaired: overestimates abilities; unrealistic; does not recognize unsafe situations
-robot-like: can go through daily routine automatically as long as there are no changes
-egocentric
-oppositional |
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Term
| what is level VIII rancho |
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Definition
Purposeful-Appropriate
-may continue to show decrease abstract thinking but can learn new tasks
-decreased tolerance for stress and decreased judgement in unusual circumstances |
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Term
| interventions for levels VII-VIII should focus on |
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Definition
-focus in on maintaining performance level while decreasing structure
-increase strength and endurance to allow for community activities
-safety, ADL's, social skills and community/work reentry: judgment problem solving, and planning emphasized |
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Term
| Guidlines for interaction with TBI patients Level I and II |
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Definition
-talk to the patient in a normal conversational manner
-provide appropriate stimulation for the patient
-change the patients position frequently |
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Term
| guidelines for interaction with patient with TBI Level III |
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Definition
-use simple 1-part directions. allow delay for the patient to respond
-realize that level of awareness fluctuates and attention span is cery diminished
-do not expect patient to remember or recall recent events
-provide the patients with visual orientation cues (family pictures, calendar) |
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Term
| guidelines for interaction with patients with TBI level IV |
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Definition
-family members must realize that agitation is due to the patient's confusion, fear & disorientation not ager with family or staff
-use short simple commands and repeat them frequently. simplify and slow down your rate of speech |
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Term
| guidelines for interaction with patients with TBI level V |
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Definition
-dont expect the patient to have ability to learn new information
-provide orientation information without quizzing the patient
-provide ways to support memory and reinforce these methods
-uses 1-step commands with concrete simple vocabulary
-the patient will not recognize or understand subtle humor or voice inflection
-attention span for one task may only be about 2-3 minutes - be prepared with a variety of tasks
-agitated behavior is usually caused by demands or pressures that excedd the patients tolerance |
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Term
| guidelines for interaction with patients with TBI level VI |
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Definition
-you can reduce cueing to elicit information
-you can use more complex directions (2-step) and normal vocabulary
-the patient may need a great deal of emotional support
-expect performance of brief tasks without supervision (if patient is physically impaired, you may have to assist) |
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Term
| guidelines for interaction with patients with TBI level VII |
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Definition
-use normal converstion with the patient
-expect literal interpretation of what is said (no subtle humor; no recognition of underlying tone and gestures)
-patient may deny future implications of disabilities |
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Term
| It is important to realize that physical recovery and cognitive recovery do not occur at the same rate. A patient may be ambulatory and have minimal physical impairment but be at a Level IV, or the patient may have few cognitive/behavioral deficits but be severely physically impaired. |
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Definition
| It is important to realize that physical recovery and cognitive recovery do not occur at the same rate. A patient may be ambulatory and have minimal physical impairment but be at a Level IV, or the patient may have few cognitive/behavioral deficits but be severely physically impaired. |
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Term
| what are the treatment benefits of prone-on-elbows |
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Definition
-improve upper trunk, UE and neck/head control
-increase ROM at hip extensors
-improve shoulder stabilizers strength
-wide BOS, low COG |
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Term
| what are the treatment benefits of quadruped |
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Definition
-improve upper trunk, lower trunk, LE, UE and neck/head control
-weightbearing through hips
-increase hi stabilizer strength
-decrease extensor tone at knees by WB
-increase shoulder stabilizers strength
-WB through shoulders, elbows, and wrists
-increase extensor ROM at wrists and fingers
-wide BOS, low COG |
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Term
| what are the treatment benefits of bridging |
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Definition
-improve lower trunk and LE control
-increase hip stabilizers strength
-WB through feet and ankles
-lead up activity for bed mobility
-wide BOS, low COG |
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Term
| what are the treatment benefits of sitting |
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Definition
-improve upper trunk, lower trunk, LE and head/neck control
-WB through UE
-functional posture
-Improve balance reactions
-medium BOS, medium COG |
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Term
| what are the treatment benefits of kneeling and half-kneeling |
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Definition
-improve head/neck, upper trunk, lower trunk, and LE control
-WB through hips
-inhibit extensor tone at knees
-increase hip stabilizer strength
-improve balance reactions
-WB through ankle in half-kneeling
-narrow BOS, high COG(kneeling)
-wide BOS, high COG(half-kneeling) |
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Term
| what are the treatment benefits of modified plantigrade |
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Definition
-improve head/neck, upper trunk, lower trunk, UE, and LE control
-WB through UE and LE
-improve balance reactions
-functional posture
-increase extensor ROM at wrists and fingers
-wide BOS, high COG |
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Term
| what are the treatment benefits of Standing |
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Definition
-improve head/neck, upper trunk, lower trunk, and LE control
-WB thourgh LE
-improve balance reactions
-functional posture
-narrow BOS, high COG |
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