Intervention TBI vision
0.0(0)
Studied by 5 people
Call Kai
Learn
Practice Test
Spaced Repetition
Match
Flashcards
Knowt PlayCard Sorting
1/115
Earn XP
Description and Tags
Last updated 10:40 PM on 12/13/22
Name | Mastery | Learn | Test | Matching | Spaced | Call with Kai |
|---|
No analytics yet
Send a link to your students to track their progress
116 Terms
1
New cards
What are the TBI precautions?
\-Check ICP (Intracranial Pressure) monitor in session if available
\-Note changes in pupils
\-Note decreased neurological responses
\-Note abnormal reflexes
\-Note flaccidity
\-Note behavioral changes
\-Note vomiting
\-Note change in BP
\-Note change in pulse
\-Note change in respiratory rate
\-Seizures are common
\-Do not lay patients in prone, sidely is best
\-Wear helment if craniotomy is performed
\-Note changes in pupils
\-Note decreased neurological responses
\-Note abnormal reflexes
\-Note flaccidity
\-Note behavioral changes
\-Note vomiting
\-Note change in BP
\-Note change in pulse
\-Note change in respiratory rate
\-Seizures are common
\-Do not lay patients in prone, sidely is best
\-Wear helment if craniotomy is performed
2
New cards
What are the early treatment goals for TBI patients?
increase patient level of response and awareness of self and the environment
3
New cards
What are the general treatment priorities in the early stage for TBI patients?
\-sensory stimulation
\-wheelchair positioning
\-bed positioning
\-casting or splinting
\-dysphagia management
\-behavioral and emotional management
\-family and caregiver education
\-wheelchair positioning
\-bed positioning
\-casting or splinting
\-dysphagia management
\-behavioral and emotional management
\-family and caregiver education
4
New cards
During the early stage of treatment for TBI patients, what are the actions of the OT?
\-structure stimulation
\-break down simple steps and commands
\-allow time for responses
\-break down simple steps and commands
\-allow time for responses
5
New cards
During the intermediate stage of treatment for TBI patients, what are the actions of the OT?
\-simple 2 to 3 step verbal directions
\-keep distractions to a minimum
\-allow for breaks in treatment session
\-keep distractions to a minimum
\-allow for breaks in treatment session
6
New cards
What are the intermediate-advanced treatment goals for TBI patients?
to improve patients' function in ADLs, cognitive skills via compensatory and remediative (due to neuroplasticity) treatment strategies
7
New cards
In what levels of the Ranchos Los Amigos Scale do begin implementing intermediate to advanced level goals/treatment intervention?
levels 4-8
8
New cards
What are the general treatment priorities in the intermediate to advanced stages?
ADL and Home Management TrainingNeuromuscular Impairments and Ataxia interventions
\-NDT, PNF, etc
\-Ataxia (use weights on extremities to deal with tremors
\- place in correct position
\-Cognition, Vision, Perception Training
\-Behavioral Management
\-Dysphagia and Self-feeding Training
\-Functional Mobility and Transfers Training
\-Community Reintegration
\-Psychosocial Skills
\-NDT, PNF, etc
\-Ataxia (use weights on extremities to deal with tremors
\- place in correct position
\-Cognition, Vision, Perception Training
\-Behavioral Management
\-Dysphagia and Self-feeding Training
\-Functional Mobility and Transfers Training
\-Community Reintegration
\-Psychosocial Skills
9
New cards
How do you address limitations in joint motion for those with TBIs?
\-Determine what cause of limitation is
\-If due to tone, splinting may be appropriate
\-Serial casting can assist with ROM
\-PROM and SROM training
\-Stretching and other techniques if orthopedic problems
\-Some neuromuscular techniques can help with tone management to increase ROM
\-If due to tone, splinting may be appropriate
\-Serial casting can assist with ROM
\-PROM and SROM training
\-Stretching and other techniques if orthopedic problems
\-Some neuromuscular techniques can help with tone management to increase ROM
10
New cards
How do you address muscle weakness for those with TBIs?
\-Must have normal tone
\-Refer to previous information regarding Progressive Resistive Exercise, Regressive Resistive Exercises, and the various types of exercises programs that were discussed with SCI
\-Also functional activities to promote UE strengthening
\-Refer to previous information regarding Progressive Resistive Exercise, Regressive Resistive Exercises, and the various types of exercises programs that were discussed with SCI
\-Also functional activities to promote UE strengthening
11
New cards
How do you address discharge planning for those with TBIs?
\-Home safety
\-Equipment Evaluation and Ordering
\-Family and Caregiver Education
\-Recommendations for Driver's Training
\-Recommendations for Vocational Training and Work Skills
\-Equipment Evaluation and Ordering
\-Family and Caregiver Education
\-Recommendations for Driver's Training
\-Recommendations for Vocational Training and Work Skills
12
New cards
T/F: Vision does not involve identification of objects
TRUE (this would be perception)
13
New cards
ability to accurately see stimuli from the external environment
Vision
14
New cards
What are the common visual problems due to TBI?
\-Lateral or medial strabismus(AKA esotropia or exotropia)
\-Accommodative dysfunction
\-Convergence insufficiency
\-Nystagmus
\-Hemianopsia
\-Impaired scanning or pursuits
\-Impaired saccades
\-Reduced blink rate
\-Ptosis of eyelid (drooping)
\-Lagophthalmos
\-Accommodative dysfunction
\-Convergence insufficiency
\-Nystagmus
\-Hemianopsia
\-Impaired scanning or pursuits
\-Impaired saccades
\-Reduced blink rate
\-Ptosis of eyelid (drooping)
\-Lagophthalmos
15
New cards
Accomodative dysfunction causes what?
blurred vision
16
New cards
inability to maintain a single vision while fixating on an object
Convergence insufficiency
17
New cards
Involuntary rapid eye movements
Nystagmus
18
New cards
absence of vision in half of the visual field
Hemianopsia
19
New cards
incomplete eyelid closure
Lagophthalmos
20
New cards
How does a patient present with deficits in visual acuity?
unable to see clearly, usually squints
21
New cards
What remediative treatment can be done to improve visual acuity?
surgery (nothing else)
22
New cards
What adaptive treatment can be done to improve visual acuity?
-Lenses-Enlarged print-Increase contrast of items-Increase light, minimize glare-Use solid colors for sheets, rugs, etc.
23
New cards
How does a patient present with deficits in visual fields?
they tend to:-bump into objects on 1 side-c/o "blind spot"-head turn to direction opposite of field loss
24
New cards
What remediative treatment can be done to improve visual fields?
stimulate visual receptors by:
\-placing Rx and ADL items on side of cut, forcing pt. to look to that side
\-provide verbal, auditory, etc. stimulation forcing pt. to look to the side of the deficit
\-practice visual scanning and unilateral neglect worksheets-fresnel prisms
\-placing Rx and ADL items on side of cut, forcing pt. to look to that side
\-provide verbal, auditory, etc. stimulation forcing pt. to look to the side of the deficit
\-practice visual scanning and unilateral neglect worksheets-fresnel prisms
25
New cards
What adaptive treatment can be done to improve visual fields?
\-place all ADL items in field of vision
\-educate pt. and family regarding field cut
\-some remediative strategies can become compensatory if you see no gains made with remediation
\-educate pt. and family regarding field cut
\-some remediative strategies can become compensatory if you see no gains made with remediation
26
New cards
How does a patient present with deficits in visual alignment?
double vision
27
New cards
What adaptive treatment can be done to improve visual alignment?
Fresnel Prisms
28
New cards
What remediative treatment can be done to improve visual alignment?
\-eye AROM exercises in direction of paresis
\-alternate eye patching (occlusion)
\-provide target at distance where patient can get fusion of object, then gradually increase distance
\-alternate eye patching (occlusion)
\-provide target at distance where patient can get fusion of object, then gradually increase distance
29
New cards
How does a patient present with deficits in eye ROM?
\-double vision during eye movement
\-unable to follow target
\-unable to follow target
30
New cards
What remediative treatment can be done to improve eye ROM?
eye AROM exercises in circular, "H", and diagonal patterns
31
New cards
What adaptive treatment can be done to improve eye ROM?
NONE
32
New cards
How does a patient present with deficits in pursuits/scanning?
\-letters jumping all over the page
\-unable to stay on 1 line when reading
\-unable to stay on 1 line when reading
33
New cards
What remediative treatment can be done to improve pursuits/scanning?
\-H-letter cancellation activities
\-paper mazes, puzzles
\-scavenger hunts-have pt. locate items in store, cabinets, newspapers, telephone books
\-paper mazes, puzzles
\-scavenger hunts-have pt. locate items in store, cabinets, newspapers, telephone books
34
New cards
What adaptive treatment can be done to improve pursuits/scanning?
\-use techniques such as anchoring with tape on page
\-teach pacing
\-read each word slowly
\-use rulers, fingers, etc. to identify each line/word as it is read
\-teach pacing
\-read each word slowly
\-use rulers, fingers, etc. to identify each line/word as it is read
35
New cards
How does a patient present with deficits in saccades?
\-letters jumping all over the page
\-unable to stay on 1 line when reading
\-unable to stay on 1 line when reading
36
New cards
What remediative treatment can be done to improve saccades?
\-call out or point to letters on 2 sides of a page, etc.
\-provide vestibular based movement while using saccades (i.e. turn 1/4 way to left to find object)
\-computer retraining software
\-provide vestibular based movement while using saccades (i.e. turn 1/4 way to left to find object)
\-computer retraining software
37
New cards
What adaptive treatment can be done to improve saccades?
\-use anchoring during reading tasks
\-control the density of the material being presented
\-use larger fonts
\-control the density of the material being presented
\-use larger fonts
38
New cards
How does a patient present with deficits in visual-spatial attention?
unable to maintain focus on an object
39
New cards
What remediative treatment can be done to improve visual-spatial attention?
\-Fresnel Prisms
\-monocular patching
\-dynamic stimuli
\-provide stimulation to force patient to look at unattended spaces forced use causes improvements
\-computer retraining software
\-monocular patching
\-dynamic stimuli
\-provide stimulation to force patient to look at unattended spaces forced use causes improvements
\-computer retraining software
40
New cards
What adaptive treatment can be done to improve visual-spatial attention?
\-patient/family education regarding safety concerns
\-use of compensatory strategies
\- head turn, etc.
\-place all items in field of vision
\-have patient look at items in environment and do eye movements, then without head movements
\-use of compensatory strategies
\- head turn, etc.
\-place all items in field of vision
\-have patient look at items in environment and do eye movements, then without head movements
41
New cards
How does a patient present with deficits in visual convergence?
unable to read due to double vision, but OK with far vision
42
New cards
What adaptive treatment can be done to improve visual convergence?
None (but some eyeglasses may help)
43
New cards
What remediative treatment can be done to improve visual convergence?
follow target at different distances until fusion is attained
44
New cards
ability to interpret stimuli from the external environment
perception
45
New cards
What part of the brain performs the function of perception?
secondary cortical areas of right hemisphere
1\. secondary visual areas
2\. secondary somatosensory area
3\. secondary auditory area
4\. multi-modal parietal-occipital-temporal area
1\. secondary visual areas
2\. secondary somatosensory area
3\. secondary auditory area
4\. multi-modal parietal-occipital-temporal area
46
New cards
What are the perception categories?
\-visual perception
\-body schema perception
\-motor perception
\-speech and language perception
\-body schema perception
\-motor perception
\-speech and language perception
47
New cards
Perceptual deficits are typically due to damage in which hemisphere of the brain?
more often due to right; but some can occur in left
48
New cards
What are the different visual perception skills?
\-right-left discrimination
\-figure-ground discrimination
\-form constancy/discrimination
\-position in space/spatial relations
\-topographical orientation
\-depth perception (stereopsis)
\-figure-ground discrimination
\-form constancy/discrimination
\-position in space/spatial relations
\-topographical orientation
\-depth perception (stereopsis)
49
New cards
How does a patient present with deficits in right-left discrimination?
\-unable to denote right-left
\-unable to follow right-left directionals
\-unable to follow right-left directionals
50
New cards
What adaptive treatment can be done to improve right-left discrimination?
\-adapt environment and activities (i.e. have pt. wear watch on one wrist consistently mark clothing with R/L
\-use environmental cues vs. R/L cues (i.e. "your comb is next to...)
\-use environmental cues vs. R/L cues (i.e. "your comb is next to...)
51
New cards
What remediative treatment can be done to improve right-left discrimination?
provide tactile and proprioception input during activities (i.e. weighted cuff on wrists)
52
New cards
How does a patient present with deficits in figure-ground discrimination?
\-difficulty finding things in a cluttered drawer
\-unable to find sleeves of a white shirt
\-unable to find sleeves of a white shirt
53
New cards
What remediative treatment can be done to improve figure-ground discrimination?
\-scatter items in front of patient (name object and have patient point to it)
\-utilize worksheets, computer programs, etc.
\-utilize worksheets, computer programs, etc.
54
New cards
What adaptive treatment can be done to improve figure-ground discrimination?
\-decrease clutter
\-organize drawers and separate articles
\-mark items with tape to distinguish them
\-teach patient to be systematic: organized scanning of countertops, etc.
\-educate patient/family regarding functional/safety implications
\-organize drawers and separate articles
\-mark items with tape to distinguish them
\-teach patient to be systematic: organized scanning of countertops, etc.
\-educate patient/family regarding functional/safety implications
55
New cards
How does a patient present with deficits in form constancy/discrimination?
unable to distinguish subtle variations in form
\-patient may mistake water pitcher for urinal, etc.
\-patient may mistake water pitcher for urinal, etc.
56
New cards
What adaptive treatment can be done to improve form constancy/discrimination?
\-place items that are used in upright positions (i.e. toothbrush in holder)
\-organize items so the patient can distinguish items by location
\-organize items so the patient can distinguish items by location
57
New cards
What remediative treatment can be done to improve form constancy/discrimination?
-patient match of parquetry forms-sort objects (i.e. kitchen utensils, cards, coins)
58
New cards
How does a patient present with deficits in position in space/spatial relations?
unable to distinguish up/down/next to/above/below/etc.
59
New cards
What remediative treatment can be done to improve position in space/spatial relations?
\-retrieve items on request (i.e. "get the shirt next to the cap")
\-have patient verbally state where requested items are in relation to himself-computer retraining software
\-have patient verbally state where requested items are in relation to himself-computer retraining software
60
New cards
What adaptive treatment can be done to improve position in space/spatial relations?
\-organize environment so items are consistently in same place
\-mark areas in drawers, cabinets, etc.
\-mark areas in drawers, cabinets, etc.
61
New cards
How does a patient present with deficits in topographical orientation?
pt. unable to find his way around
62
New cards
What adaptive treatment can be done to improve topographical orientation?
\-provide signs
\-provide landmarks
\-provide landmarks
63
New cards
What remediative treatment can be done to improve topographical orientation?
\-scavenger hunts
\-map reading activities
\-map reading activities
64
New cards
How does a patient present with deficits in depth perception (stereopsis)?
\-patient will reach too far for objects
\-patient will fall down curbs
\-patient will knock items over
\-patient will fall down curbs
\-patient will knock items over
65
New cards
What remediative treatment can be done to improve depth perception (stereopsis)?
\-utilize computer retraining
\-provide tactile kinesthetic guiding during activities
\-provide tactile kinesthetic guiding during activities
66
New cards
What adaptive treatment can be done to improve depth perception (stereopsis)?
\-alter environment (i.e. place bright colored tape at edge of each step)
\-use other senses to compensate (i.e. tactile, verbal cues)
\-educate patient/family regarding functional/safety implications
\-use other senses to compensate (i.e. tactile, verbal cues)
\-educate patient/family regarding functional/safety implications
67
New cards
What are the four different body schema perception skills?
\-body part identification (asomatosognosia)
\-finger agnosia
\-anosognosia
\-unilateral neglect
\-finger agnosia
\-anosognosia
\-unilateral neglect
68
New cards
What is another term for "body part identification"?
asomatosognosia
69
New cards
How does a patient present with deficits in body part identification?
unable to identify parts of one's own or other's body
70
New cards
What adaptive treatment can be done to improve body part identification?
\-educate patient/family regarding the deficits and how they will relate to function
\-you may be able to describe the part without using the word (i.e. "move the part of the body that you use to hold things")
\-you may be able to describe the part without using the word (i.e. "move the part of the body that you use to hold things")
71
New cards
What remediative treatment can be done to improve body part identification?
\-provide tactile stimulation
\-quiz patients on body parts
\-practice putting together human puzzle
\-incorporate bilateral activities into treatment-mirror the therapist's movements
\-quiz patients on body parts
\-practice putting together human puzzle
\-incorporate bilateral activities into treatment-mirror the therapist's movements
72
New cards
How does a patient present with presence of finger agnosia?
unable to name/point to fingers
73
New cards
What remediative treatment can be done to improve finger agnosia?
\-repeated sensory input into affected digits
\-patient identification of digit being stimulated
\-ADL activity follows sensory input
\-patient identification of digit being stimulated
\-ADL activity follows sensory input
74
New cards
What adaptive treatment can be done to improve finger agnosia?
\-provide environmental adaptations as needed (i.e. Velcro on keys of keyboard, etc.)
\-educate patient/family regarding functional/safety implications
\-educate patient/family regarding functional/safety implications
75
New cards
How does a patient present with presence of anosognosia?
unawareness of hemiplegia, unawareness of disability
76
New cards
What adaptive treatment can be done to improve anosognosia?
if patient denies problem, it is difficult to get patient to buy into adaptation
77
New cards
What remediative treatment can be done to improve anosognosia?
follow remediation for awareness deficits in cognition
78
New cards
How does a patient present with presence of unilateral neglect?
patient ignores one half of his body
79
New cards
unilateral neglect can also be called what? (3 diff names)
\-hemi-inattention
\-unilateral spatial agnosia
\-hemi-spatial neglect
\-unilateral spatial agnosia
\-hemi-spatial neglect
80
New cards
What remediative treatment can be done to treat unilateral neglect?
\-rub patient's affected arm with varied stimuli while pt. watches
\-patient rubs on own arm
\-patient does SROM while watching-use bilateral tasks as in NDT
\-patient rubs on own arm
\-patient does SROM while watching-use bilateral tasks as in NDT
81
New cards
What adaptive treatment can be done to treat unilateral neglect?
\-educate patient/family regarding functional implications, etc.
\-provide visual cues to patient (i.e. signs as reminders to shave whole face, etc.)
\-provide verbal cues-train patient to self-monitor
\-provide visual cues to patient (i.e. signs as reminders to shave whole face, etc.)
\-provide verbal cues-train patient to self-monitor
82
New cards
this set of skills refers to impairments of motor planning or an apraxia
motor perception skills
83
New cards
What are the four different types of motor perception impairments?
\-ideomotor apraxia
\-ideational apraxia
\-constructional apraxia
\-dressing apraxia
\-ideational apraxia
\-constructional apraxia
\-dressing apraxia
84
New cards
what part of the brain is usually impaired with the presence of apraxias?
premotor cortex and primary motor area in frontal lobe
85
New cards
\-these areas store established motor patterns for specific activities
\-can access these areas to execute common movement patterns
\-can access these areas to execute common movement patterns
premotor cortex and primary motor area in frontal lobe
86
New cards
How does a patient present with presence of ideomotor apraxia?
\-patient is unable to imitate gestures or perform purposeful motor tasks on command even though patient fully understands the idea or concept of the task
\-patient may be able to perform task reflexively
\-patient may be able to perform task reflexively
87
New cards
What remediative treatment can be done to treat ideomotor apraxia?
\-provide proprioceptive, tactile, and kinesthetic input prior to and during a task
\-hand over hand task performance, then gradually reduce the amount of assist as patient performs tasks correctly
\-hand over hand task performance, then gradually reduce the amount of assist as patient performs tasks correctly
88
New cards
What adaptive treatment can be done to treat ideomotor apraxia?
\-keep commands on a subcortical level
\-instead of "lock your brakes", say "there's something on your brakes"
\-use gross motor activities rather than breaking down activities into small parts
\-perform activities in a normal environment
\-patient closes and visualizes task before doing
\-educate patient/family regarding apraxia and its functional implications
\-instead of "lock your brakes", say "there's something on your brakes"
\-use gross motor activities rather than breaking down activities into small parts
\-perform activities in a normal environment
\-patient closes and visualizes task before doing
\-educate patient/family regarding apraxia and its functional implications
89
New cards
How does a patient present with presence of ideational apraxia?
do tasks in the wrong order, OR do tasks, but omit parts of the sequence (i.e. brush teeth without toothpaste)
\-overshooting (pt. takes off all clothes, not just coat)
\-cut meat, but only one slice-objects are used inappropriately (i.e. eat sugar from spoon rather than place in coffee)
\-may pull away when trying to put a plug in the socket
\-overshooting (pt. takes off all clothes, not just coat)
\-cut meat, but only one slice-objects are used inappropriately (i.e. eat sugar from spoon rather than place in coffee)
\-may pull away when trying to put a plug in the socket
90
New cards
What adaptive treatment can be done to treat ideational apraxia?
\-keep commands on a subcortical level (i.e. instead of "lock your breakes" say "there's something on your brakes")
\-use gross motor activities rather than breaking down activities into small parts
\-perform activities in a normal environment
\-patient closes eyes and visualizes tasks before doing them
\-educate patient/family regarding apraxia and its functional implications
\-use gross motor activities rather than breaking down activities into small parts
\-perform activities in a normal environment
\-patient closes eyes and visualizes tasks before doing them
\-educate patient/family regarding apraxia and its functional implications
91
New cards
What remediative treatment can be done to treat ideational apraxia?
\-provide proprioceptive, tactile, and kinesthetic input prior to and during a task
\-hand over hand task performance, then gradually reduce the amount of assist as patient performs tasks correctly
\-hand over hand task performance, then gradually reduce the amount of assist as patient performs tasks correctly
92
New cards
How does a patient present with presence of constructional apraxia?
unable to produce designs in 2 or 3 dimensions by copying, drawing, or constructing either by command or spontaneously
93
New cards
What remediative treatment can be done to treat constructional apraxia?
\-practice various 2 and 3-D activities
\-provide tactile and kinesthetic cues by exploring 3-D items with hands prior to construction of item
\-hand over hand assist and gradually reduce as necessary
\-provide tactile and kinesthetic cues by exploring 3-D items with hands prior to construction of item
\-hand over hand assist and gradually reduce as necessary
94
New cards
What adaptive treatment can be done to treat constructional apraxia?
\-use backward chaining-order tasks for patient (i.e. lay out clothes & food in order they will be used)
\-educate patient/family regarding functional implications
\-educate patient/family regarding functional implications
95
New cards
How does a patient present with presence of dressing apraxia?
\-unable to orient clothes to self
\-unable to identify front from back
\-unable to identify front from back
96
New cards
What adaptive treatment can be done to treat dressing apraxia?
\-use labels for front/back
\-color code garments for left/right, etc.
\-do buttons from bottom-up
\-educate patient/family regarding functional implications
\-color code garments for left/right, etc.
\-do buttons from bottom-up
\-educate patient/family regarding functional implications
97
New cards
What remediative treatment can be done to treat dressing apraxia?
\-provide tactile, kinesthetic input prior to dressing (i.e. weight bearing, rubbing, etc.)
\-hand over hand guidance-reduce as patient is able to perform better
\-hand over hand guidance-reduce as patient is able to perform better
98
New cards
Damage to what part(s) of the brain results in deficits in speech and language perception?
can result from both right and left occipital, parietal, and temporal lobe damage
99
New cards
What are the three types of EXPRESSIVE aphasia?
\-Broca's aphasia
\-Anomia
\-Agrommation
\-Anomia
\-Agrommation
100
New cards
This type of expressive aphasia is characterized by the inability to express and transfer thoughts to spoken words
Broca's aphasia
Note 
Flashcards (21)