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brau2308
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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
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What is the best case scenario after acute care?
- in-patient rehab
- -generally at least level 3-4 w/ realitvely quick recovery
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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
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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
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Heterotrophic ossification
formation of bone in soft tissue and peri-articular areas
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When is heterotrophic ossification common?
in severe brain injury w/ prolonged coma and limb spasticity
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What are the early clinical signs of heterotrophic ossification?
warmth, swelling, significant decrease in ROM, pain
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Which joints are affected by heterotrophic ossification (in order of frequency)?
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Medical management of heterotrophic ossification:
- radiation
- forceful joint manipulation under anesthesia
- medication
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Rehab treatment of heterotrophic ossification:
- splints
- ROM
- positioning
- --avoid extremes of pain
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What is an intrathecal baclofen pump system?
muscle relaxant
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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
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What are the ways to give baclofen?
oral or intrathecally
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Is oral or intrathecal baclofen better?
- intrathecal
- oral causes side effects that may limit usefulness b/c only small portion goes to spinal fluid
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Amnesia(s) is/are damage to:
the medial temporal lobes and the hippocampus
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Retrograde Amnesia:
loss of the ability to recall events that occurred immediately, previous to the head injury
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Anterograde Amnesia:
new events in the immediate memory can't be transferred into long-term memory; therefore, inability to form new memory
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What is the last function to return after trauma?
anterograde amnesia
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Is Post-Traumatic Amnesia (PTA) retrograde or anterograde?
either, mixed and transient
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Post-Traumatic Amnesia (PTA) is the inability to:
lay down continuous day-to-day memory (every day is a new day)
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Duration of Post-Traumatic Amnesia is indicator of:
cognitive and functional deficits
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80% of patients with post-traumatic amnesia lasting less than 2 weeks had _____ recovery.
good
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Measuring Severity of TBI using Post-Traumatic Amnesia length:
Mild=
Moderate=
Severe=
Very Severe=
- Mild = less than 24 hrs
- Moderate = 1-7 days
- Severe = 1-4 weeks
- Very Severe = over 4 weeks
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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])
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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
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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
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Intervention for psychological and behavioral consequences
Metacognitive Approach
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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
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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
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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
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Disability Rating Scale: average score for SEVERE brain injury =
13.3
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Disability Rating Scale: average score for MODERATE brain injury =
5.7
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Disability Rating Scale: MILD disability
1-3
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Using the DRS, what does MILD disability imply?
67% employed/school
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Disability Rating Scale: MODERATE disability
3-6
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Using DRS, what does MODERATE disability imply?
39% employed/school
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Disability Rating Scale: SEVERE disability
7-20
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Using DRS, what does SEVERE disability imply?
11% rate of employment/school
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Rehab predictors:
- ability to live independently
- appropriate leisure/social outcomes
- vocation?
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