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What is the worst case scenario after acute care?
- long term care
- -progression of intervention and goals
- -instructions for restorative aide
- -instructions for caregiver training
What is the best case scenario after acute care?
- in-patient rehab
- -generally at least level 3-4 w/ realitvely quick recovery
Motor issues addressed in in-pt rehab:
- same motor theories apply
- lack of movement-facilitation theories
- has movement motor learning
- sustained abnormal tone will cause muscle length issues and capsular mobility deficits
- correct muscle length/capsular deficits as they progress
How can we correct muscle length/capsular deficits as they progress?
through orthopedic techniques such as splinting, casting, joint mob, modalities, soft tissue mob, and ADL prescription/adaptation
formation of bone in soft tissue and peri-articular areas
When is heterotrophic ossification common?
in severe brain injury w/ prolonged coma and limb spasticity
What are the early clinical signs of heterotrophic ossification?
warmth, swelling, significant decrease in ROM, pain
Which joints are affected by heterotrophic ossification (in order of frequency)?
Medical management of heterotrophic ossification:
- forceful joint manipulation under anesthesia
Rehab treatment of heterotrophic ossification:
- --avoid extremes of pain
What is an intrathecal baclofen pump system?
How does intrathecal baclofen pump system work?
- blocks the release of excitatory neurotransmitter in spinal cord
- restores balance of excitatory and inhibitory input to reduce muscle hyperactivity, allowing normal motor movement
What are the ways to give baclofen?
oral or intrathecally
Is oral or intrathecal baclofen better?
- oral causes side effects that may limit usefulness b/c only small portion goes to spinal fluid
Amnesia(s) is/are damage to:
the medial temporal lobes and the hippocampus
loss of the ability to recall events that occurred immediately, previous to the head injury
new events in the immediate memory can't be transferred into long-term memory; therefore, inability to form new memory
What is the last function to return after trauma?
Is Post-Traumatic Amnesia (PTA) retrograde or anterograde?
either, mixed and transient
Post-Traumatic Amnesia (PTA) is the inability to:
lay down continuous day-to-day memory (every day is a new day)
Duration of Post-Traumatic Amnesia is indicator of:
cognitive and functional deficits
80% of patients with post-traumatic amnesia lasting less than 2 weeks had _____ recovery.
Measuring Severity of TBI using Post-Traumatic Amnesia length:
- Mild = less than 24 hrs
- Moderate = 1-7 days
- Severe = 1-4 weeks
- Very Severe = over 4 weeks
Ongoing consequences of TBI
residual physical impairments (contracture management, skin integrity, etc)
chronic medical problems (seizures, respiratory problems, pain management)
post concussion syndrome (headaches, fatigue, dizziness, irritability; cognitive difficulties [attention, memory, judgment])
Personality and Behavioral consequences of TBI
- limited coping skills
- reduced insight
- loss of mental flexibility
- impaired perception of social relationships
- unrealistic expectations
- out of sync w/ the situation and others
- loss of social competence
- GCS <8 association
- frustration, anger, apathy, anxiety, depression, impulsivity, disinhibition, difficulty w/ self modulation, dual diagnosis, early onset Alzheimer's
Lifestyle consequences of TBI
- limited social contact 1 year post
- social life mainly includes family
- socially isolated
- difficulty making new friends
- dissatisfied with social interactions
- loss of independence
- caregiver stress
- unemployment and financial hardship
- lack of transportation
- lack of leisure and recreation opportunities
- difficulty w/ interpersonal relationship
- loss of roles
Intervention for psychological and behavioral consequences
- Cognitive Behavior Therapy
- Approaches designed to improve social competence
- -self awareness
- -self motivation
- -strategy training (problem solving, identifying alternatives)
- -role play
Community Re-entry and Supportive Living
- Facilities that provide resources, support, and advocacy to assist members in achieving their goals for community living
- -skills for renewing and developing relationships
- -occupational activities
- -volunteer opportunities
- To empower people to enhance:
- -personal growth
- -community involvement
Barriers to independence:
- economic changes
- housing changes
- most live w/ family and are dependent
- limited services and access to service designed for people w/ TBI
- resources and social supports
Disability Rating Scale: average score for SEVERE brain injury =
Disability Rating Scale: average score for MODERATE brain injury =
Disability Rating Scale: MILD disability
Using the DRS, what does MILD disability imply?
Disability Rating Scale: MODERATE disability
Using DRS, what does MODERATE disability imply?
Disability Rating Scale: SEVERE disability
Using DRS, what does SEVERE disability imply?
11% rate of employment/school
- ability to live independently
- appropriate leisure/social outcomes