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General TBI info
Rancho Los Amigos
Interventions
100

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

100

Same generalized response

What is:

II: Generalized response - total assist

100

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

200

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

200

  1. Improved attention and use of memory aids

  2. Able to self-monitor social appropriateness with SBA

  3. A/O x 3

What is:

IX: Purposeful, appropriate - stand by assist on request 

200

The principles of neuroplasticity

What is: 

  1. Use it or lose it 

  2. Use it and improve it 

  3. Specificity 

  4. Repetition matters 

  5. Intensity matters 

  6. Time matters 

  7. Salience matters 

  8. Age matters

  9. Transference 

  10. Interference

300

Precautions for a craniotomy

What is: 

  • Head of bed >/= 30Ā°

  • 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)

300

  1. MinA for new learning and safety in routine tasks

  2. Superficial awareness of deficits, overestimates abilities, unable to recognize inappropriate social behavior

  3. A/O x 2 (person, place)

What is VII:Automatic, appropriate - min assist

300

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

400

Deficits related to temporal injury

What is hemiparesis, visual field deficits, memory deficits, speech and language deficits, seizures

400

  1. Response with simple commands and structure for previously learned tasks

  2. A/O x 0

What is:

V: Confused, inappropriate non-agitated - max assist

400

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) 

500

When you should be monitoring ICP pressure 

- Glasgow coma scale 3-8

- UL or BL motor posturing

- Abnormal CT

- > 40 yo

- SBP > 90 mmHg

500

  1. Poor tolerance for stress

  2. MinA to supervision for insight, judgement, and problem-solving

  3. Awareness of deficit, depression, irritable

  4. A/O x 3

What is: 

VIII:Purposeful, appropriate - stand by assist 

500

Interventions for Rancho levels VII- X

What is:

  • pt/client participation in goal determination

  • Techniques to gain motor control

  • Advanced ADLs

  • Community training/reintegration