TBI interventions and D/C planning

What is the focus of intervention in low level (I-III) patients?

focus on prevention of secondary complications

Who is the center of the team?

patient and family

What should you obtain information on from the family members?

patient's prior lifestyle, favorite activities, family dynamics

what is the goal of caregiver training in low level patients?

goal is to reduce caregiver burden

What should we educate caregivers on?

diagnosis, positioning, ROM program

What are examples of sensory stimulation?

visual, auditory, olfactory, gustatory, tactile, kinesthetic

visual sensory stimulation

light of flashlight, bright colored objects, pictures, familiar faces, mirrors

auditory sensory stimulation

talking, ring bells, familiar voice, music

olfactory sensory stimulation

scented sticks, spirits, swab

gustatory sensory stimulation

sugar or salt solution, mint mouthwash, orange juice

tactile sensory stimulation

touch, massage, textures, joint approximation

why is sensory stimulation used in low level (I-III) patients?

to increase level of arousal and elicit movement in individuals with low levels of arousal

what are examples of generalized responses?

agitation, calming, flinching, eye opening or blinking, nasal flaring, munching or suckling, change in facial expression, change in vital signs

what are examples of localized responses?

turning head or eyes away or toward stimuli, visual fixation and tracking, withdrawl of extremity from stimulus, initiatio of simple command following

T/f: visual stimulation is the only modality that can work alone

false: auditory

what are medical managements to help with spasticity if conservative PT techniques do not work alone?

oral medications, injections (botulinum toxin A, phenol), intrathecal baclofen (ITB) pump

what is the purpose of a multi-podus boot?

prevents foot drop and skin breakdown for patient positioning

what is the goal for serial casting?

maintain or improve ROM (usually ankle or elbow)

what are the goals for positioning low level (I-III) patients?

1. provide normal sensory experiences to facilitate normal movement

2. provide support for proper body alignment

3. precent skin deformities and breakdown

4. allow mobility

5. improve cosmesis

Why are proper pelvic positioning and head positioning key elements in wheelchair positioning of low level patients?

promote good posture in a wheelchair, prevent secondary contractures, and optimize sensory stimulation

t/f: you should keep a craniectomy patient off the side with the crani

true!

When should you don a helmet for a craniectomy patient?

prior to transfer when OOB

what are benefits of early mobilization

shorter LOS, improved outcomes, likelihood of home d/c

what are contraindications for early mobilization in low level pts?

unstable spine, increased ICP

what are precuations for early mobilization in low level pts?

weightbearing restrictions, skin and joint integrity, autonomic instability, cardiovascular status

what must you do during early mobilization?

MUST monitor cardiovascular status and arousal level

Can you provide PT during a sympathetic storming episode?

YES

What interventions are you choosing for level IV patients

emphsis on functional activities patient is familiar with and behavior management

what interventions are you choosing for level V-VI patients?

address participation, activity, and impairment level issues (gait training, PNF, balance exercises, electrical stimulation, VR, therex, manual techniques, strength training, cycling)

utilize weight bearing positions

build interventions into daily schedule

what interventions are you choosing for level VII-VIII patients?

similar to V and VI, emphasis on physical tasks needed to return to work

what interventions are you choosing for level IX-X patients?

behavioral management, vocational rehab, RTW/S

What are the biggest limitations after a brain injury?

cognitive and behavioral limitations (only 1/3 go back to work and 1/2 go back to PLOF)

What type of feedback should be used?

extrinsic feedback focused on knowledge of results in faded, delayed manner

compensatory approach

seeks to improve functional skills by compensating for the lost ability

restorative approach

seeks to restore the normal use of the affected extremity

higher level patients demonstrate independence basic mobility in a closed environment, what deficits impact community mobility?

residual motor and persistent cognitive deficits

Why do behaioral issues occur in TBI patients?

occur due to PTA, impaired communication, method to control environment, and/or damage to specific brain regions

what are the behavioral management models?

1. antecedent management

2. errorless learning

3. behavioral momentum

4. Contingency Management

5. Crisis Management

antecedent

trigger (cues or stimuli) that occur before a behaior and increase propbability of a given response

consequence

event or behavior that immediately follows

solution in antecedent management

identify environmental or social triggers (antecedent) and control environment to avoid these triggers

Errorless Learning

provider gives 100% cues so patient completes task without any errors

wean cues overtime with continued success rate

What is the goal of bejavioral momentum?

to experiece success in a less challenging activity so they are more likely to keep going and trying more challenging activities

What behavior management model should you sandwich difficult tasks?

behavioral momentum

What is contingency management procedures?

positive reinforcement, negative reinforcement, differential reinforcement, punishment