TBI Midterm

Rancho Los Amigos Scale

Cognitive function levels: I No Response, II Generalized Response, III Localized Response, IV Confused-Agitated, V Confused-Inappropriate, VI Confused-Appropriate, VII Automatic-Appropriate, VIII Purposeful-Appropriate, IX Purposeful w/ SBA, X Purposeful Modified Independent.

Definition of TBI

Sudden trauma causes damage to the brain; effects vary by severity, type, location, and patient age.

Etiology of TBI

Closed head injuries (blunt trauma, no skull penetration), open head injuries (penetration into brain tissue), non-traumatic (tumors, anoxia, infection, substance abuse).

TBI Epidemiology

Males 2x more likely; most common in ages 15-29.

Medical Management - Emergency

Protect head/neck/back, airway management, monitor BP, GCS assessment, CT scan.

Medical Management - Acute Phase

ICU stabilization, monitor vitals/reflexes, minimize swelling, begin OT/PT.

Medical Management - Survival Phase

Rehabilitation focus: new goals, improve quality of life.

Severity of TBI

Mild GCS 13-15, Moderate 9-12, Severe 3-8 (loss of consciousness >6 hrs).

Medical Precautions in TBI

Prevent additional injuries, monitor vitals, seizure/fall prevention, nutrition, prevent skin breakdown, watch alertness/impulsivity/safety awareness.

Symptoms That Limit Performance

Physical, cognitive, visual, perceptual, psychosocial, behavioral, motor impairments (spasticity, rigidity, contractures).

Motor Symptoms in TBI

Spasticity (hypertonicity), decorticate rigidity (UE flexion/LE extension), decerebrate rigidity (UE & LE extension).

Factors Affecting Prognosis

Age, family/social support, medications, intensity of therapy, prior health status, initial GCS/Rancho level and recovery speed.

OT Evaluation for TBI

Assess arousal, response to stimuli, vision, sensation, ROM, tone, motor control, swallowing, emotional/behavioral factors.

OT Interventions - Low Level (Rancho I-III)

Sensory stimulation, positioning, splinting/casting, family education.

OT Interventions - Intermediate (Rancho IV-VIII)

ADL training, UE ROM/tone, ataxia management, safety/cognition, vision/perception, home management.

OT Interventions - High Level (Rancho VIII-X)

Community reintegration, driving/work retraining, advanced IADLs.

Common Complications Post-TBI

Seizures, contractures, swallowing disorders, cognitive/behavioral deficits, agitation, poor safety awareness.

OT Role in TBI Rehab

Individualized care, patient/family education, team communication, transition from ICU to community reintegration.