626-TBI Intro and Rancho Scale

The highest age risk for TBI is

≥ 75 years

Hospitalizations and death form TBI is greatest in those > _____ years

65

______ are the leading cause of TBIs

Falls

Describe the timeline of a TBI

1. external forces

2. primary injury

3. secondary injury

4. complications

What are the 4 mechanisms or injury for TBIs?

direct, penetrating, acceleration/deceleration, blast

The longer the cellular cascade of secondary injury lasts, the _____ the prognosis

worse

1 multiple choice option

True or False:

Secondary injury from TBI evolves into hypoxia, edema, and elevated ICP.

True

_____ injury is the result of brain tissue coming into contact with an internal or external object OR rapid acceleration/decelerations of the brain

primary

Which lobes of the brain are most commonly impacted in TBI?

Frontal and temporal

Coup-contrecoup injuries most commonly occur with-

whiplash

The ______ portion of the coup contrecoup injury occurs when the brain strikes the skull on the opposite side of impact.

contrecoup

The ____ portion of the coup contrecoup injury occurs when the brain strikes the skull on the side if impact

coup

Coup contrecoup injuries usually impact which 2 lobes?

frontal and occipital

______ injuries occur when transient shockwaves cause severe brain damage

blast

_________ sequelae are much more prevalent after TBI than neuromuscular ones

neurobehavioral

________ occurs due to contact injury of the head

hematoma

An ________ hematoma is profuse arterial bleeding that causes an immediate thunderclap headache

epidural

A _______ hematoma is slowly oozing venous blood that may have a delayed symptom onset

subdural

Which type of brain hemorrhage has the absolute worst outcomes due to blood mixing with CSF?

intraventricular

Which type of brain injury occurs when shearing leads to disruption and tearing of axons?

DAI

If a patient has TBI symptoms but a clean CT or MRI, what type of injury did they sustain?

DAI

The leading cause of DAI is

high speed MVA

In a Rancho level 1,

Patient appears to be in a deep sleep and is completely unresponsive to any stimuli

In a Rancho level _____, Patient reacts inconsistently and non-purposefully to stimuli in a nonspecific manner. Responses are limited and often the same regardless of the stimulus presented. Responses may be physiological changes, gross body movements, and/or vocalizations

2

A patient at a rancho level ____ has no eye movements or reflexes

1

A patient at a rancho level _____ may have changes in vital signs in response to any stimulus

2

Generalized responses describes which rancho level?

2

You are evaluating a patient who had a TBI 1 week ago. When you knock on the door, the patient's heart rate spikes and they go into a flexor synergy pattern. Which LOCF is this patient demonstrating?

2

In a Rancho level ____, Patient reacts specifically, but inconsistently to stimuli. Responses are directly related to the type of stimulus presented. May follow simple commands such as closing the eyes or squeezing the hand in an inconsistent, delayed manner

3

Localized response describes a Rancho level _____

3

A patient in which Rancho level would turn their head to a door opening or swat hands when being touched?

3

Most IPR facilities begin to accept TBI patients at which Rancho LOCF?

4-5

Rancho levels 1-3 are typically seen in which domain of care?

LTACH or acute care

Confused and agitated describes which Rancho level?

4

Name the Rancho level that would exhibit the following behavior:

nonexistent selective attention

4

In a rancho level _____, Patient is in a heightened state of activity. Behavior is bizarre and non-purposeful relative to the immediate environment. Does not discriminate among persons or objects; is unable to cooperate directly with treatment efforts, Verbalizations frequently are incoherent and/or inappropriate to the environment; confabulation MAY be present.

4

Name the Rancho level that would exhibit the following behavior:

severe disorientation with agitation and disinhibition

4

Name the Rancho level that would exhibit the following behavior:

elopement and severe perseveration

4

Motor function and gait tend to return at which Rancho level?

4

In a Rancho level ______, Patient is able to respond to simple commands fairly consistently. However, with increased complexity of commands or lack of any external structure, responses are nonpurposeful, random, or fragmented. With structure, may be able to converse on a social automatic level for short periods of time.”

5

Name the Rancho level that would exhibit the following behavior:

extreme confabulation

5

Name the Rancho level that would exhibit the following behavior:

severe agitation in response to external stimulation or lack of structure

5

Name the Rancho level that would exhibit the following behavior:

unable to learn new information but may perform previously learned tasks with structure

5

Name the Rancho level that would exhibit the following behavior:

wanders randomly with a vague intention of going home

5

Confused and inappropriate describes which Rancho level?

5

Name the Rancho level that would exhibit the following behavior:

may converse on a social automatic level for brief periods

5

True or False:

it is fine to treat Rancho levels 4 and 5 in a noisy gym

False

At a Rancho level ____, the patient shows GOAL DIRECTED behavior but is dependent on external input or direction. Follows simple directions consistently and shows carryover for RELEARNED tasks, such as self care. Responses may be incorrect due to memory problems, but they are appropriate to the situation. Past memories show more depth and detail than recent memory.

6

Confused Appropriate describes which rancho level?

6

Name the Rancho level that would exhibit the following behavior:

Maximum assistance for new learning with little or no carryover

6

Name the Rancho level that would exhibit the following behavior:

vague recognition of staff with and emerging awareness of some basic needs

6

Name the Rancho level that would exhibit the following behavior:

supervision required for old learning (self care)

6

Name the Rancho level that would exhibit the following behavior:

inconsistently but sometimes oriented to person, time, and place

6

At a Rancho level _____, Patient appears appropriate and oriented within the hospital and home setting. Goes through daily routine automatically, but frequently robot-like. Patient shows minimal to no confusion and has shallow recall of activities. With structure, is able to initiate social or recreational activities

7

Name the Rancho level that would exhibit the following behavior:

shows carryover for new learning but at a decreased rate

7

Name the Rancho level that would exhibit the following behavior:

severely impaired judgement, overestimate abilities, and unaware of feelings of others

7

Name the Rancho level that would exhibit the following behavior:

demonstrates carryover with new skills

7

Patients with TBI usually discharge from IPR at a Rancho level ____

7

Name the Rancho level that would exhibit the following behavior:

consistently oriented to person and place in familiar environments

7

Automatic appropriate describes which rancho level?

7

At a rancho level ____, Patient is able to recall and integrate past and recent events and is aware of and responsive to the environment. Shows carryover for new leaterm-63rning and needs no supervision once activities are learned May continue to show a decreased ability relative to premorbid abilities, abstract reasoning, tolerance for stress, and judgement in emergencies or unusual circumstances

8

Name the Rancho level that would exhibit the following behavior:

Can complete familiar AND new tasks with good carryover

8

Name the Rancho level that would exhibit the following behavior:

overestimates OR underestimates abilities

8

Purposeful appropriate describes which rancho level?

8

Name the Rancho level that would exhibit the following behavior:

acknowledges others needs and feelings and responds appropriately with minimal assistance

8

Name the Rancho level that would exhibit the following behavior:

doing great overall but has a severely low tolerance for stress or overstimulation

8

Purposeful appropriate with stand by assist on request describes which rancho level?

9

Name the Rancho level that would exhibit the following behavior:

acutely aware of deficits and asks for help with difficult tasks

9

At a Rancho level _____, the patient is back to baseline with a history of TBI

10