TBI Interventions
Neurorehabilitation, remediation, and compensation are appropriate intervention strategies for what level of TBI?
Intermediate- higher level TBI
Jenny is seeing her first patient Brandon for OT treatment. She walks in and says “Good Morning” and Brandon turns to look at her but gives no response. Jenny wanted Brandon to good morning when people walked in the room so she continued to say good morning until eventually, he said it back. What level is Brandon at?
Level 3
Iris suffered a brain injury after she was ejected from a vehicle. Iris experienced a loss of consciousness, amnesia, and a skull fracture. The physician explained that the damage to her brain was ultimately caused by external mechanical forces. What type of brain injury did she suffer?
Traumatic Brain Injury (TBI)
Neurorehabilitation is evidence-based and specifically supported by which theory?
Neuroplasticity
Your longtime client experienced a left CVA at the age of 72. What are the likely causes of the stroke?
Occlusion or disruption of the cerebral blood flow causing diminished perfusion of brain tissue.
You are an OT working with your client who suffered from a TBI after a MVA. After weeks of attempting to assist your client in regaining previous skills, you identify that it is no longer possible and that you need to switch the intervention approach. What is the most appropriate intervention approach for this client?
Compensation
Carla is working with her client James on ADL’s. Carla wants James to remember how to wash hands after toileting. James is having difficulty on the sequence of washing hands and when Carla tries to give verbal cues, he throws a bottle of soap at her. What level is James at?
Level 4
Ms. Smith suffered a brain injury after she hit her head during a recent fall. The doctors identified that this injury was due to the brain colliding with the skull, bouncing back and forth. What type of brain injury did she suffer?
Focal brain injury
What is post-traumatic amnesia and what is it an important predictor of?
It is the length of time from initial injury to recovery of ongoing memory of daily events. It’s an important predictor of functional outcomes
After sustaining a stroke, your client has been experiencing involuntary muscle contractions. What sensorimotor symptom is this?
Clonus
You are working with a patient that is a Rancho level 2. Other than increasing the level of response and awareness to self, what other intervention strategies should you utilize?
Proper positioning, ROM, and family education
Tyler is a client who has been in therapy for a few weeks. He is finally able to greet his therapist every time they walk in the room. whenever he does simple task, he tends to lose focus and blurts out vulgar statements once he gets frustrated. What level is Tyler at?
Level 5
Brain tumors, infections, and encephalopathy are causes of what type of brain injury?
Carl is a Rancho Level 1 and is in a complete state of coma. What is a coma?
Absence of awareness of self/environment despite maximal stimuli
Your client, James, was recently admitted to the hospital due to a stroke. James began experiencing “stuttering” of his symptoms. What type of stroke is James specifically having?
Embolic
Sally has a low level TBI and inconsistently responds when an alcohol swab is placed under her nose. What is the best next intervention strategy that her OTR should utilize?
Ask her family to provide her favorite scent (e.g., perfume) to use as a stimuli
OTR Leslie has finally observed goal directed behavior from her client Vanessa. She is able to consistently follow commands and is becoming aware of her situation that led her to receive treatment. Leslie still is unable to get Vanessa to learn new activities however she’s competent in old task. What level is Vanessa at?
Level 6
Charlie fell and hit the back of his head. Following an MRI it was determined that he also had endured injury to the frontal lobe. This injury is indicative of what kind of focal brain injury?
Contrecoup
When doing a chart review, you notice the medical records note a glasgow coma scale score of 3. What is the glasgow coma scale used for?
Used for initial and subsequent assessment of brain injury including severity and prediction of outcomes
An OTR is working on dental hygiene with her patient that had a stroke. The patient initially puts toothpaste on his toothbrush, but instead of putting it in his mouth, he puts it back on the counter. What side was his CVA likely on?
Right CVA
You are working to address neuromuscular impairments for a high level TBI client. Name at least 1 strategy and the main intervention goal.
Facilitate control of muscle groups, encourage symmetrical trunk control, facilitate bilateral integration, and bilateral WB. The main goal is to develop volitional control
Gerald is seeing his client Calvin for treatment. While Gerald observes for safety, Calvin has shown ability to groom himself and complete toileting skills without any help. During treatment, Calvin mentioned he was ready to go home and get back to work. While Calvin is getting better, Gerald knows he is not ready to go home. What level is Gerald at.
Level 7
A client endured a subdural hematoma and seems to have no changes in mental status during the initial 48 hours following injury. What is important about the onset and progress of an SDH?
SDH occurs at a slower rate than EDH. Altered physical and mental status can present weeks after injury
You are attempting to increase arousal in your client by swabbing his gums and tongue with lemonade. Which TBI level does he likely have?
Low-level TBI (Levels 1-3)
Prior to his stroke, Paul was independent in all transfers. However, during his evaluation, he was scared to stand up from his bed even with assistance from his OT. What type of stroke did he likely have?
Left CVA