Symptoms/Deficits
To help with skin breakdown, which can occur with the loss of controlled body movement, postural deficits, and decreased joint Rom/sensations, what is the name of the adaptive device that the patient can sit on to evenly disperse seated pressure?
ROHO Cushion
During Rancho Levels I and II, name at least three treatments that would be appropriate.
BONUS: When looking at the Ranchos Los Amigos Scale, what form of treatment is the most important during levels I, II, and III?
Sensory stimulation (document ANY response)- EX. Auditory: Bell ringing; Command Responsiveness; Visual: flashlight; Olfactory: ammonia capsule; Tactile: shoulder taps/nasal swipe; Pain: firm pinch, pressure, ear pinch/pull, trapezius pinch; Vocalization: spontaneous, moans/groans, none
Environmental Management- Ex. Bed and wheelchair positioning
Prevention of complications: PROM/Stretching/Joint mobilization, splinting/casting evaluation, tone management, and orient to surroundings
Family training
BONUS: Family education/education of caregivers on what to expect during upcoming agitated states
What is the difference between ABI and TBI?
BONUS: Name an example of an ABI and then name an example of a TBI.
ABI is an injury to the brain that is not hereditary, congenital, or induced by trauma. *INTERNAL PROBLEM
TBI is an injury that is induced by trauma or a brain pathology caused by an *EXTERNAL FORCE
BONUS:
ABI Ex.: stroke, nera drowning, aneurysm, tumor, infection disease that affects brain, lack of oxygen to the brain
TBI Ex.-falls, assaults, motor vehicle accidents, sports injuries
What is the most common cause of a TBI?
Motor Vehicle Accidents
What are the levels that would represent the "calm before the storm"?
BONUS 1: What levels represent the 3 levels of confusion?
The levels that represent the calm before the storm are: I, II, III
I: No response
II: Generalized response
III: Localized response
BONUS: Think: the 3 levels of confusion is the "storm", so it is IV, V, VI
IV: confused-agitated
V: Confused inappropriate
VI: Confused-appropriate
Regarding perceptual deficits, individuals with TBI can often have anosognosia, what does this mean?
BONUS: Also regarding perceptual deficits, individuals will have neglect, what test measure can be used to identify if a client has unilateral visual neglect?
Ataxia is the lack of coordinated movement/control of movement
Anosognosia is the lack of awareness of condition
BONUS: The BIT (Behavioral Inattention Test)
To treat rigidity in clients that have had a TBI, what type of cast and splint can you use?
BONUS: To treat spasticity in clients that have had a TBI, what type of splints could you use?
A bivalve cast and a static progressive splint
BONUS: Antispasticity hand-based splint or a cone forearm based splint.
During a whiplash injury, what kind of damage is caused to the brain stem that can lead to decreased arousal and attention, as well as slowed processing of information? (this is because the nucleus/locus coeruleus is affected)
Axonal shearing
From the following causes of TBI, name the population that is the most associated with each:
Falls, assaults, motor vehicle accidents, sports injuries
BONUS: Is there a difference in gender regarding the prevalence of TBIs?
Falls: old and young age
Assaults: middle age
Motor vehicle accidents: middle age (everyone)
BONUS: YES, men are more likely to have a TBI than women because of risk-taking behaviors.
Describe the assist levels for the following Ranchos Los Amigos levels: VII, VIII, IV, X.
BONUS: Name the assist levels for level I, II, III (hint: they're all the same assist level) and then for IV, and V (hint: same assist level).
BONUS PT. 2 (this one is tricky!): The assist level for VI is what?
VII: Mod-assist
VIII: Min Assist- SBA
IV: SBA
X: Modified Ind-Ind.
BONUS: I, II, III are all total assit & IV and V are max assist
BONUS PT. 2: Mod assist- Max assist
1. The client understands emotional tone, but does not understand the context of what you are saying.
2. The client can not comprehend written words.
3. The client can not comprehend emotional tone, but does understand the context of what you are saying.
1. Weirnicke's aphasia
2. Alexia/dyslexia
3. Aprosodia
NAME THE RANCHO LEVEL WHERE THIS TX IS APPROPRIATE
1. You would treat the client by doing basic ADLs (simple automatic ADLs), address perceptual issues, simple gross motor, and address dressing apraxia, dynamic balance/reach.
2. You would do IADL training, tone management, address cognition and perception, as well as ROM/Jt. mobilization and mobility.
3. You would do ADL training that focuses on problems or advanced areas of the ADL, address executive functioning, focus on independent living, and increase patient participation in planning/making choices. This could also be through community reintegration and outdoor home tasks.
4. This level was added because it is used to address the barriers to gaining independence from a cognitive, emotional, and behavioral standpoint. In this level, the client may need to take periodic breaks, but is able to adjust to tasks and perform tasks as needed WITHOUT CUEING provided for performance advice or problem identification.
5. You would want to work on increasing speed and intensity of the task demands. Also, multiple tasks could be practiced at this time. Working on increasing activity tolerance. Also, organization of daily schedule and tasks is appropriate during this level, budgenting, computerized banking, use of public transportation, vocational reintegration, and job site analysis.
1. Rancho Level IV
2. Rancho Level VI
3. Rancho Level VII
4. Rancho Level X
5. Rancho Level VIII
What do you see in a minimally responsive state?
What o you see in a vegetative state?
What do you see in a coma state?
BONUS: Rate them on a scale of severity (from the most severe to the least severe)
Coma: Nothing
Vegetative state: Spontaneous (eye opening), but otherwise total lack of interaction
Minimally responsive: Reactions/meaningful responses are inconsistent. Long latency periods (period between stimulus and processing of stimulus)
Bonus: Coma, vegetative, minimally responsive
What is the region that becomes stretched during a concussion? Why is it bad that this is stretched? (think of what its job is) Do you know the percentage at which it is stretched?
The corpus callosum and it is important for enabling communication between the 2 hemispheres. So, when it is damaged, there is a disruption of communication between the right and left hemispheres. It can be stretched up to 50% its normal length.
What does the Ranchos Los Amigos scale test?
What does the Glascow Coma Scale test?
The Ranchos Los Amigos scale tests cognition.
The Glascow Coma Scale tests consciousness.
Based on these definitions, what is present? Hint: they are all EXPRESSIVE Aphasias
1. Poor sequencing of words (yoda)
2. Cannot transfer specific names of objects (Ex. "Is this a stapler?" "Yes." "Okay what is this called?" (stapler) "I don't know")
3. Inability to speak/transfer thoughts to words
1. Agrommation
2. Anomia
3. Broca's aphasia
What is one important reason to change the client's position when laying in bed?
BONUS: If the client is in a supine position with the head in a lateral position, then this reflex can become elicited. Name the reflex.
To avoid pressure ulcers/decubitus ulcers. These can occur because of poor circulation around bony prominences.
Bonus: Asymmetrical Tonic Neck Reflex
A secondary brain injury can cause hypoxia and anoxia. What do these two terms mean?
BONUS: What can hypoxia cause?
Hypoxia: little oxygen
Anoxia: no oxygen
BONUS: Hypoxia from a heart attack can cause diffuse injuries, or brain tissue death because of the lack of oxygen.
When looking at positive prognostic indicators...
1. If one is in a coma for less than ___ hours that is a good sign.
2. If one has posttraumatic amnesia for less than ____ hours that is a good sign.
3. If their Glascow Coma Scale is greater than ___, then that is a good sign.
1. 6
2. 24 NOTE: If someone has posttraumatic amnesia for weeks or longer, then they most likely have a major long term disability.
3. 8 NOTE: A Glascow Coma Scale score of an 8 or below indicates a bad prognosis because they score in the "severe" category of the Glascow Coma Scale.
Name the 5 stages of treatment protocols for TBI and MTBI (Hint: it is in the Defense and Veterans Brain Injury Center “Progressive Return to Activity” PDF)
1)Rest
2)Light Routine Activity
3)Light Occupation-oriented Activity
4)Moderate Activity
5)Intensive Activity
Dysphagia is what? What structure must be damaged for dysphagia to occur? Why is it important to address dysphagia?
BONUS: When referring to visual deficits, what is strabismus? Hemianopsia? Saccades?
Dysphagia is difficulty in swallowing and dysphagia is caused by damage to the cranial nerve. It is important to address dysphagia to prevent aspiration, which can be fatal. NOTE: Dysphagia can occur because of sequencing deficits (when to breathe vs. eat vs. chew)
BONUS: Strabismus- difficulty aligning eyes (cross eyed), Hemianopsia- only half of the visual field can be seen, and Saccades- fast, jerky eye movements.
Why would it be important for a client with a TBI to complete an online (clinical) driving assessment before taking the road test?
Because the client can use compensatory strategies to pass the online/clinical driving assessment, but fail the road test.
A concussion is a form of MTBI (mild traumatic brain injury). What is the condition that describes the long-term effects following a concussion?
BONUS: Can you list symptoms associated with the condition above?
BONUS (ANOTHER ONE?! WHAT!?): Repeated concussions can cause this type of severe brain condition. This condition is degenerative. Name this condition.
PCS: Post-concussion syndrome
BONUS 1: Cognition and personality changes, memory impairments (short and long term), and often depression follows
BONUS 2: Chronic Traumatic Encephalopathy
This type of accident is the #1 source of concussions. This stat is not applicable for older adults.
BONUS 1: What are helmets supposed to prevent/what do they not prevent?
BONUS 2: What occurs in a coup and contrecoup?
Biking accidents
BONUS 1: Helmets prevent skull fractures, they do not prevent concussions.
BONUS 2: In a coup, the brain makes an impact with the front of the skull because an outside source stops movement. In a contrecoup, or the secondary impact, the brain will hit the back of the skull as the head recoils from what it hit.
Name the 3 evaluation areas that are analyzed in the Glascow Coma Scale.
BONUS: Pick one area that is analyzed and go through the check, observe, stimulate, and rate process. For each, just pick one thing you could do to address the check, observe, stimulate, and rate portions of the scale. Ex, "*This evaluation area* could be impeded by____ (addressing 'check')", then "I can observe this evaluation area by doing____ (addressing 'observe')"
Eye opening, verbal response, and motor response.
BONUS: Ex. Eye opening- the client's eyes may be closed shut due to swelling, so I can not evaluate this factor (check), I would check for any spontaneous eye movement that occurs without an applied stimulus (observe), then I could shout or speak a request to see if that elicits a response (stimulate), finally, I would rate the response to the stimulus.