TBI pt2

sequelae of TBI

leads to tremendous activity limitations, participation restrictions, and diminished quality of life

neurom, cog, neurobehavior

impairment types included in sequelae of TBI

paresis, abnorm tone, motor func, postural control

4 neurom impairments of TBI

arousal lvl, attention, concentration, memory, learning, *executive funcs*

6 cog impairments of TBI

veg state

lvl of consciousness: disassociation btwn wakefulness and awareness

veg state

lvl of consciousness: higher cortical regions not integrated w/ BS so can manage all vital funcs

veg state

lvl of consciousness: demonstrate reflexive type responses (ex: open eyes but considered reflexive in nature)

persistent veg state

no meaningful motor/cog func and complete loss of awareness of self/env for >1 yr (>3 months after if anoxic brain injury)

minimally conscious state

lvl of consciousness: pt exhibits minimal evidence of themselves or env

minimally conscious state

lvl of consciousness: pt exhibit localization to stim and may inconsistently reach for objects (exs: localize to tactile stim if touch pt; localize to auditory stim if talk when enter room)

neurobehavioral impairments

agitate/aggression, disinhibition, apathy, emotional liability, mental inflexibility, impulsive, irritable, com, swallowing

CRS-R, LOCF

outcome measures to examine arousal/attention/cog

arousal/attention/cog; skin integrity, sensory/motor func, RoM, reflex integrity, ventilation/gas exchange

7 key areas to examine during acute stage

1 no response

LOCF: pt has no observable behavior change when presented w/ visual, auditory, tactile, proprioceptive, or painful stim

2 generalized response

LOCF: generalized reflex response to painful stim; respond to repeated auditory stim w/ increased or decreased activity; respond to external stim w/ physiological changes; generalized gross body movement

2 generalized response

LOCF: non purposeful vocalization; delayed responses

2 generalized response

LOCF: responses not specific to stim

3 localized response

LOCF: w/drawal or vocal to painful stim; turn away from auditory stim; blink when light cross visual field; follow moving objects passed w/in visual field; respond to noxious/discomfort (pull on tubes/restraints)

3 localized response

LOCF: inconsistent response to simple commands; may respond only to friend/fam

3 localized response

LOCF: responses are directly related to stim

4 confused-agitated

LOCF: very alert and in heightened state of activity

4 confused-agitated

LOCF: purposeful attempts to remove restraint/tubes; try to get out of bed; lash out/cry out; flight risk if ambulatory; not cooperative in PT

4 confused-agitated

LOCF: perform motor activities (sit at edge of bed, perform ADLs, walk) but w/o purpose; brief/usually non-purposeful movements; absent short term memory

5 confused-inappropriate

LOCF: not agitated (can be in response to external stim); alert (not oriented x3)

5 confused-inappropriate

LOCF: wander randomly; vague intentions on what's going on in rehab; start to participate in PT but need frequent breaks; memory severely impaired

5 confused-inappropriate

LOCF: not good at directing goals/self-monitoring behaviors; can’t learn new info

6 confused-appropriate

LOCF: consistently oriented to person/place/time

6 confused-appropriate

LOCF: able to, in a non-distracting env, maintain concentration up to 30 mins w/ little redirection

6 confused-appropriate

LOCF: remote memory has more depth/detail than recent memory; require max assist for new learning; not a lot of carryover

6 confused-appropriate

LOCF: more consistently follow directions but still considered a safety risk; generally unaware of impairments

7 automatic-appropriate

LOCF: consistently oriented to person/place (very familiar w/ env); little assist for orientation

7 automatic-appropriate

LOCF: able to attend to activities for 30 min w/ little redirection; supervision needed for new learning

7 automatic-appropriate

LOCF: able to carry out treat plans; able to start helping w/ initiating household/personal tasks on a routine basis; not aware of deficits; don't understand consequences for their actions

8 purposeful-appropriate

LOCF: consistently oriented to person/place/time

8 purposeful-appropriate

LOCF: can indeply complete tasks for up to an hr in distracting envs

8 purposeful-appropriate

LOCF: can recall past/recent info; doesn’t need assistance once activity learned

8 purposeful-appropriate

LOCF: not a lot of insight into deficits; overestimate abilities; depress/frustrate easy; more self-centered behaviors