General TBI info
Characteristics of a moderate TBI
What is
LoC > 30 mins and < 24 hours
Alteration of consciousness is > 24 hours
Post-traumatic amnesia lasts > 1 day and < 7 days
Glasgow coma scale (GCS) = 9-12
Neuroimaging is normal or abnormal
Same generalized response
What is:
II: Generalized response - total assist
The interventions clinicians should perform based on the Clinical Practice Guidelines for Improving Walking Function in Ambulatory Chronic CVA, iSCI, and TBI
What is:
Walking training at moderate to high aerobic intensities
Walking training with virtual reality
Characteristics of a Severe TBI
What is:
LoC > 24 hours
Alteration of consciousness is > 24 hours
Post-traumatic amnesia lasts > 7 days
Glasgow coma scale (GCS) = 3-8
Neuroimaging is normal or abnormal
Improved attention and use of memory aids
Able to self-monitor social appropriateness with SBA
A/O x 3
What is:
IX: Purposeful, appropriate - stand by assist on request
The principles of neuroplasticity
What is:
Use it or lose it
Use it and improve it
Specificity
Repetition matters
Intensity matters
Time matters
Salience matters
Age matters
Transference
Interference
Precautions for a craniotomy
What is:
Head of bed >/= 30°
If craniectomy, MUST wear helmet at ALL times when out of bed
Avoid being over with head in dependent position
May have lifting (no > 10 lbs) and exercise (no vigorous exercise), until cleared by MD
Avoid activities that increase ICP (sneezing, blowing nose or valsalva)
MinA for new learning and safety in routine tasks
Superficial awareness of deficits, overestimates abilities, unable to recognize inappropriate social behavior
A/O x 2 (person, place)
What is VII:Automatic, appropriate - min assist
Interventions for Rancho levels I-III
What is:
P-AAROM and low load prolonged stretch
Proper position for respiratory/integumentary function
Sensory stimulation
Upright tolerance with supporting standing/sitting
WC recommendations
Deficits related to temporal injury
What is hemiparesis, visual field deficits, memory deficits, speech and language deficits, seizures
Response with simple commands and structure for previously learned tasks
A/O x 0
What is:
V: Confused, inappropriate non-agitated - max assist
Interventions for Rancho levels IV-VI
What is:
Mat and walking activities in a structure, non-restrained environment
ADLs and purposeful activities
Cognitive-behavioral strategies ( provide consistency, calm behavior, flexibility, ensure safety)
When you should be monitoring ICP pressure
- Glasgow coma scale 3-8
- UL or BL motor posturing
- Abnormal CT
- > 40 yo
- SBP > 90 mmHg
Poor tolerance for stress
MinA to supervision for insight, judgement, and problem-solving
Awareness of deficit, depression, irritable
A/O x 3
What is:
VIII:Purposeful, appropriate - stand by assist
Interventions for Rancho levels VII- X
What is:
pt/client participation in goal determination
Techniques to gain motor control
Advanced ADLs
Community training/reintegration