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Acute care
- Focus is on medical management and preventing further problems.
- Most likely, pt is unconscious
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Positioning is used to:
- Prevent contractures
- Prevent pressure areas
- NOrmalize tone
- Positioning may be complicated by fractures, various tubes and wires.
- *Best positioning is sidelying because hypertonia is easier to control and the goal is to place the body in reflex inhibiting patterns
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Reflex Inhibitive Patterns
Head/Neck
Midline w/o rotation or lateral flexioin
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Reflex Inhibitive Patterns
UE's
- Scapula (protracted, upwardly rotated)
- Humerus (abd slightly, ER, flexed)
- Forearm (slight elbow flexion, supination)
- Wrist (slight exension)
- Fingers (thumb abd, fingers abd and almost extended)
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Reflex Inhibitive Patterns
LE's
- Hip (ER, slight abd)
- Knee (slight flexion)
- Ankle/Foot (dorsiflexion, pronation)
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Reflex Inhibitive Patterns
Trunk
- In neutral rotation and pelvis in slight anterior tilt w/ positioning-use pillows, towel rolls, foam whatever is available
- Try to sue as little as possible to position the pt. Make sure you teach other team members the techniques
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Purose of ROM:
- Prevent contratures
- Facilitate motor function
- Remember movements should be donw slowly and involve all joints (to prevent stimulation of stretch reflex)
- Cardinal planes are okay but PNF patterns are better. Verbal cuing even to a comatose pt. may be beneficial.
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ROM should begin...
proximally, w/ rotation, to decrease tone; once movement is achieved, move distally
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Begin w/ joint haveing...
- the least amount of tone
- care should be taken in handling the limb to avoid increasing tone e.g./ palm of hand, or plantar surface of foot
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Inpatient Rehabilitation
- Tx depends on a good eval!
- Pts. behavior and motor control will vary day to day; therefore, Tx will be different
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Motor Learning Principles
- Structured env.
- Demonstration
- Manual Guidance
- Avoid fatigue
- Provide reinforcement and feedback
- practice, practice, practice
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Motor Control Strategies
- Function-is tone functional or not
- Ideal to how tasks were performed prior to injury
- Avoid compensatory movements unless absolutely necessary
- Use over learned automatic tasks early on
- Follow a development approach to progress the pt. mobility, stability, controlled mobility, skilled
- End on a positive note
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Recovery from TBI may continue over a long period of time. The most significant recovery occurs
w/i the first 6 months after trauma for 9% of th epts w/ a TBI
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Recover is dependent on a variety of factors. These include:
- Age
- Extent of lesion
- Local or diffuse injury
- Premorbid skills
- Intelligence and behaviors
- Genetic inheritance
- Neuroplasticity
- Nutriotion and Environment
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dept and duration of a coma can be affected by
the level of family interacion and adjustment
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client who is sitll in vegetative state, six months post injury, is labeled
in the severe disability category
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Cognitive dysfuction can significantly interfere w/ recovery since
impaired function cannot occur when a pt is cognitively impaired
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Rehab procedures/TBI
Goals
- Prevent loss of ROM
- Reinforce cognitive rehab during TX; utilization of memor log if appropriate
- Maximize use of all extremities
- Facilitate highest level of independence possible
- Continue education efforts to pt. and family
- Assist w/ discharge planning
- Obtain appropriate equipent as needed
- Arrange for follow-up care, if appropriate
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Treatment
- Ongoin from acute phase
- Transfers-progress to supine to sit, sit to stand, w/c to bed, floor to mat and floor to stand, in and out of car
- W/C mobility
- ROM
- strengthening/endurance activities-bike, restorator, UBE, aambualtion may be appropriat efor the pt unable to follow simple directives
- Balance-sittin and standing, static and dynamic. Use of jump rope, mini-trampoline, rocker boards, treadmill and Nordic Track for the igher livel pt.
- Gait
- Cognition
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FIM Levels of Function
- 7-Complete Independence (timely, safely) NO helper
- 6-Modified Independence (device) NO helper
- 5-Supervision (cuing, setup, coaxing) HELPER
- 4-Minimal assist (Subject=75%+) HELPER
- 3-Moderate Assist (Subject=50%-74%) HELPER
- 2-Max assst (Subject = 25%-49%) HELPER
- 1-Total Assist (Subject <25%) HELPER
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Adaptive Equipment
- Braces
- Ambulation Devices
- Splints
- OT adaptive devices (for bathroom, bedroom, etc.)
- Wheelchair selection
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