TBI Misc.

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  1. What is the worst case scenario after acute care?
    • long term care
    • -progression of intervention and goals
    • -instructions for restorative aide
    • -instructions for caregiver training
  2. What is the best case scenario after acute care?
    • in-patient rehab
    • -generally at least level 3-4 w/ realitvely quick recovery
  3. Motor issues addressed in in-pt rehab:
    • same motor theories apply
    • lack of movement-facilitation theories
    • has movement motor learning
    • sustained abnormal tone will cause muscle length issues and capsular mobility deficits
    • correct muscle length/capsular deficits as they progress
  4. How can we correct muscle length/capsular deficits as they progress?
    through orthopedic techniques such as splinting, casting, joint mob, modalities, soft tissue mob, and ADL prescription/adaptation
  5. Heterotrophic ossification
    formation of bone in soft tissue and peri-articular areas
  6. When is heterotrophic ossification common?
    in severe brain injury w/ prolonged coma and limb spasticity
  7. What are the early clinical signs of heterotrophic ossification?
    warmth, swelling, significant decrease in ROM, pain
  8. Which joints are affected by heterotrophic ossification (in order of frequency)?
    • shoulder
    • elbow
    • hip
    • knee
  9. Medical management of heterotrophic ossification:
    • radiation
    • forceful joint manipulation under anesthesia
    • medication
  10. Rehab treatment of heterotrophic ossification:
    • splints
    • ROM
    • positioning
    • --avoid extremes of pain
  11. What is an intrathecal baclofen pump system?
    muscle relaxant
  12. How does intrathecal baclofen pump system work?
    • blocks the release of excitatory neurotransmitter in spinal cord
    • restores balance of excitatory and inhibitory input to reduce muscle hyperactivity, allowing normal motor movement
  13. What are the ways to give baclofen?
    oral or intrathecally
  14. Is oral or intrathecal baclofen better?
    • intrathecal
    • oral causes side effects that may limit usefulness b/c only small portion goes to spinal fluid
  15. Amnesia(s) is/are damage to:
    the medial temporal lobes and the hippocampus
  16. Retrograde Amnesia:
    loss of the ability to recall events that occurred immediately, previous to the head injury
  17. Anterograde Amnesia:
    new events in the immediate memory can't be transferred into long-term memory; therefore, inability to form new memory
  18. What is the last function to return after trauma?
    anterograde amnesia
  19. Is Post-Traumatic Amnesia (PTA) retrograde or anterograde?
    either, mixed and transient
  20. Post-Traumatic Amnesia (PTA) is the inability to:
    lay down continuous day-to-day memory (every day is a new day)
  21. Duration of Post-Traumatic Amnesia is indicator of:
    cognitive and functional deficits
  22. 80% of patients with post-traumatic amnesia lasting less than 2 weeks had _____ recovery.
  23. Measuring Severity of TBI using Post-Traumatic Amnesia length:
    Very Severe=
    • Mild = less than 24 hrs
    • Moderate = 1-7 days
    • Severe = 1-4 weeks
    • Very Severe = over 4 weeks
  24. Ongoing consequences of TBI
    residual physical impairments (contracture management, skin integrity, etc)

    chronic medical problems (seizures, respiratory problems, pain management)

    post concussion syndrome (headaches, fatigue, dizziness, irritability; cognitive difficulties [attention, memory, judgment])
  25. Personality and Behavioral consequences of TBI
    • limited coping skills
    • reduced insight
    • loss of mental flexibility
    • impaired perception of social relationships
    • unrealistic expectations
    • out of sync w/ the situation and others
    • loss of social competence
    • GCS <8 association
    • frustration, anger, apathy, anxiety, depression, impulsivity, disinhibition, difficulty w/ self modulation, dual diagnosis, early onset Alzheimer's
  26. Lifestyle consequences of TBI
    • limited social contact 1 year post
    • social life mainly includes family
    • socially isolated
    • difficulty making new friends
    • dissatisfied with social interactions
    • loss of independence
    • caregiver stress
    • unemployment and financial hardship
    • lack of transportation
    • lack of leisure and recreation opportunities
    • difficulty w/ interpersonal relationship
    • loss of roles
  27. Intervention for psychological and behavioral consequences
    Metacognitive Approach
  28. Metacognitive approach:
    • Cognitive Behavior Therapy
    • Approaches designed to improve social competence
    • -self awareness
    • -self motivation
    • -strategy training (problem solving, identifying alternatives)
    • -role play
    • -rehearsal
    • -reinforcement
  29. Community Re-entry and Supportive Living
    • Facilities that provide resources, support, and advocacy to assist members in achieving their goals for community living
    • -skills for renewing and developing relationships
    • -occupational activities
    • -volunteer opportunities

    • To empower people to enhance:
    • -self-esteem
    • -self-determination
    • -personal growth
    • -independence
    • -community involvement
  30. Barriers to independence:
    • economic changes
    • housing changes
    • most live w/ family and are dependent
    • limited services and access to service designed for people w/ TBI
    • resources and social supports
  31. Disability Rating Scale: average score for SEVERE brain injury =
  32. Disability Rating Scale: average score for MODERATE brain injury =
  33. Disability Rating Scale: MILD disability
  34. Using the DRS, what does MILD disability imply?
    67% employed/school
  35. Disability Rating Scale: MODERATE disability
  36. Using DRS, what does MODERATE disability imply?
    39% employed/school
  37. Disability Rating Scale: SEVERE disability
  38. Using DRS, what does SEVERE disability imply?
    11% rate of employment/school
  39. Rehab predictors:
    • ability to live independently
    • appropriate leisure/social outcomes
    • vocation?
Card Set
TBI Misc.
review of random TBI lecture material
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