Mgmt for Rancho lvls V-X

what rancho lvl has very poor memory→ no new learning or carryover

Highly distractible

Follows simple, one-step commands

Often does best in comforting, familiar environments and with familiar people

Rancho Level V: Confused, Inappropriate

what Rancho lvl where pt has attention to highly familiar tasks in non-distracting environments?

New learning is possible with MAX repetition and assistance

Poor self-awareness/insight

Requires LOTS of structure

Rancho Level VI: Confused, Appropriate

Intervention environment design for mid Level TBI

closed

Intervention Practice Type and Schedule design for mid Level TBI

Blocked practice (lots of reps!)

Distributed practice (lots of rest!)

Intervention feedback design for mid Level TBI

Motivational feedback is important

KR

Key Considerations for Intervention design for mid Level TBI

Combine cognitive & physical activities→ document impact of one on the other

Family involvement

Key considerations for goal setting for a mid level TBI pt

Focus on function w/in current cognitive limitations

Consider opening environment as appropriate

Potential emphases of tx for goal setting a mid level TBI pt

Complete activity w/ less cues/distractions

Improve carryover

Improve ability to follow verbal & written instruction

Improve attention

what rancho lvl does pt have poor insight, judgement, problem solving?

New learning requires supervision & increased time

Appropriate in structured settings

Rancho Level VII: Automatic, Appropriate

What Rancho lvl does pt demonstrates carryover?

Can attend for up to 1 hr

Generally appropriate but demos poor frustration tolerance

Rancho Level VIII: Purposeful, Appropriate

Intervention environment design for high level TBI pt

Move towards open environment

Intervention Practice Type & Schedule design for high level TBI pt

Progress to random & variable practice

Intervention Feedback design for high level TBI pt

Increase use of self-developed (intrinsic) feedback, ability to set & monitor success of activity

Key considerations for intervention design for high level TBI pt

Continue to combo cognitive & physical activities

More complex tasks are possible

Key considerations for goal setting for a high level tbi pt

May require ↑ time for processing

May demo ↓ fnx in new or stressful situations→ will need A

May report new complaints as awareness improves→ dizziness, neck pain, HA

Potential Emphases of Tx towards Goal setting for a high level tbi pt

Independent set up & completion of tasks, including daily routine

Improve attention in distracting environments & w/ dual-tasks

Appropriate interactions in groups to prepare for community

Mobility goals w/ emphasis on community & vocational needs

what Rancho lvl does pt have selective attention up to 2 hrs?

Recognizes need for assistance

Rancho Level IX: Purposeful, Appropriate, Standby Assistance on Request

what Rancho lvl is pt functional w/ compensatory strategies & increased time?

May demo low frustration tolerance w/ fatigue

Can multi-task, but requires breaks

Rancho Level X: Purposeful, Appropriate, Mod I

what is the goal for Rancho level IX-X?

Community re-entry

what are some indications for community re-entry?

Ability to participate 3x/week, 4-5 hrs/day

Potential to resume prior life roles & responsibilities: goals to achieve

motivated, insurance coverage