Section 9.6

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Section 9.6
2011-03-11 16:41:35
Rehabilitation treatment CHI TBI Pt

Section 9.6
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  1. Acute care
    • Focus is on medical management and preventing further problems.
    • Most likely, pt is unconscious
  2. Positioning is used to:
    • Prevent contractures
    • Prevent pressure areas
    • NOrmalize tone
    • Positioning may be complicated by fractures, various tubes and wires.
    • *Best positioning is sidelying because hypertonia is easier to control and the goal is to place the body in reflex inhibiting patterns
  3. Reflex Inhibitive Patterns
    Midline w/o rotation or lateral flexioin
  4. Reflex Inhibitive Patterns
    • Scapula (protracted, upwardly rotated)
    • Humerus (abd slightly, ER, flexed)
    • Forearm (slight elbow flexion, supination)
    • Wrist (slight exension)
    • Fingers (thumb abd, fingers abd and almost extended)
  5. Reflex Inhibitive Patterns
    • Hip (ER, slight abd)
    • Knee (slight flexion)
    • Ankle/Foot (dorsiflexion, pronation)
  6. Reflex Inhibitive Patterns
    • In neutral rotation and pelvis in slight anterior tilt w/ positioning-use pillows, towel rolls, foam whatever is available
    • Try to sue as little as possible to position the pt. Make sure you teach other team members the techniques
  7. Purose of ROM:
    • Prevent contratures
    • Facilitate motor function
    • Remember movements should be donw slowly and involve all joints (to prevent stimulation of stretch reflex)
    • Cardinal planes are okay but PNF patterns are better. Verbal cuing even to a comatose pt. may be beneficial.
  8. ROM should begin...
    proximally, w/ rotation, to decrease tone; once movement is achieved, move distally
  9. Begin w/ joint haveing...
    • the least amount of tone
    • care should be taken in handling the limb to avoid increasing tone e.g./ palm of hand, or plantar surface of foot
  10. Inpatient Rehabilitation
    • Tx depends on a good eval!
    • Pts. behavior and motor control will vary day to day; therefore, Tx will be different
  11. Motor Learning Principles
    • Structured env.
    • Demonstration
    • Manual Guidance
    • Avoid fatigue
    • Provide reinforcement and feedback
    • practice, practice, practice
  12. Motor Control Strategies
    • Function-is tone functional or not
    • Ideal to how tasks were performed prior to injury
    • Avoid compensatory movements unless absolutely necessary
    • Use over learned automatic tasks early on
    • Follow a development approach to progress the pt. mobility, stability, controlled mobility, skilled
    • End on a positive note
  13. Recovery from TBI may continue over a long period of time. The most significant recovery occurs
    w/i the first 6 months after trauma for 9% of th epts w/ a TBI
  14. Recover is dependent on a variety of factors. These include:
    • Age
    • Extent of lesion
    • Local or diffuse injury
    • Premorbid skills
    • Intelligence and behaviors
    • Genetic inheritance
    • Neuroplasticity
    • Nutriotion and Environment
  15. dept and duration of a coma can be affected by
    the level of family interacion and adjustment
  16. client who is sitll in vegetative state, six months post injury, is labeled
    in the severe disability category
  17. Cognitive dysfuction can significantly interfere w/ recovery since
    impaired function cannot occur when a pt is cognitively impaired
  18. Rehab procedures/TBI
    • Prevent loss of ROM
    • Reinforce cognitive rehab during TX; utilization of memor log if appropriate
    • Maximize use of all extremities
    • Facilitate highest level of independence possible
    • Continue education efforts to pt. and family
    • Assist w/ discharge planning
    • Obtain appropriate equipent as needed
    • Arrange for follow-up care, if appropriate
  19. Treatment
    • Ongoin from acute phase
    • Transfers-progress to supine to sit, sit to stand, w/c to bed, floor to mat and floor to stand, in and out of car
    • W/C mobility
    • ROM
    • strengthening/endurance activities-bike, restorator, UBE, aambualtion may be appropriat efor the pt unable to follow simple directives
    • Balance-sittin and standing, static and dynamic. Use of jump rope, mini-trampoline, rocker boards, treadmill and Nordic Track for the igher livel pt.
    • Gait
    • Cognition
  20. FIM Levels of Function
    • 7-Complete Independence (timely, safely) NO helper
    • 6-Modified Independence (device) NO helper
    • 5-Supervision (cuing, setup, coaxing) HELPER
    • 4-Minimal assist (Subject=75%+) HELPER
    • 3-Moderate Assist (Subject=50%-74%) HELPER
    • 2-Max assst (Subject = 25%-49%) HELPER
    • 1-Total Assist (Subject <25%) HELPER
  21. Adaptive Equipment
    • Braces
    • Ambulation Devices
    • Splints
    • OT adaptive devices (for bathroom, bedroom, etc.)
    • Wheelchair selection