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87 Cards in this Set

  • Front
  • Back
Name Level I of Rancho Los Amigos Levels of Cognitive Function.
No Response.
What would your interventions be for Level I?
Vitals, PROM, tone, skin integrity, positioning, sensitivity stimulation, Patient/nurse/family education, spasticity prevention
Name Level II of Rancho Los Amigos Levels of Cognitive Function.
General Response
What would your interventions be for Level II?
Same as Level I intervention
Name Level III of Rancho Los Amigos Levels of Cognitive Function.
Localized Response
What would your interventions be for Level III?
Same as Level I intervention, add early transitions to sitting
Name Level IV of Rancho Los Amigos Levels of Cognitive Function.
Confused and Agitated
What would your interventions be for Level IV?
Decreased confusion, Increase endurance, give patient control is ok for safety, patient education for safety, provide lots of choices, positive reinforcement, NO NEW SKILLS LEARNED, eliminate external disturbances, model calm behavior, offer options.
Name Level V of Rancho Los Amigos Levels of Cognitive Function.
Confused and Inapporpriate
What would your interventions be for Level V?
Compensatory treatments, task specific interventions, posture, functional mobility, safety, motor learning/planning, use of most affected UE
Name Level VI of Rancho Los Amigos Levels of Cognitive Function.
Confused and Appropriate
What are some interventions you would use for Level VI?
Same as Level V
Name Level VII of Rancho Los Amigos Levels of Cognitive Function.
Autonomic Appropriate
What are some interventions you would use for Level VII?
Ween to external environment, return to work/school, judgement, problem solving, ADL's, independence and group work, behavior issues, self-awareness, cognition, family/patient ed on compensation, exercise, aerobic
Name Level VIII of Rancho Los Amigos Levels of Cognitive Function.
Purposeful Appropriate
What are some interventions you would use for Level VIII?
Same as Level VII
What three activities does the Glasgow Coma Scale measure?
1. Eye Opening
2. Best Motor response
3. Verbal Response
How does a TBI compare to a stroke?
1. TBI is due to a trauma, and stroke involves blood vessels.
2. Impairments as a result may be the same
3. Behavior/Cognition are much more affected with a TBI
What are three examples of a local injury to the brain? give an example of a local injury
1. Clot
2. Contusion
3. Laceration
i.e. Local injury would be hit on the head with a hammer
What is a polar injury?
Head on collision in a MVA or whiplash
What is a diffuse axonal injury?
Scattered shearing of subcortical axons, ripped up.
What are 5 mechanisms of a TBI?
1. Hematoma
2. Gunshot
3. Aneurysm due to a weak vessel in the brain that hemorrhages
4. Diffuse Axonal injury (DAI)
5. Coup-contrecoup (whiplash)
Describe a mild TBI
aka Concussion
-Brief loss of consciousness--Loss of memory immediately before and after the injury
-Alteration in mental state at the time of the accident
-Focal neurological deficits
What is Post-concussion syndrome?
Long-term effects of mild TBI, cognitive and personality changes. Long lasting effects could mimic a brain injury.
What is a "Period of Vulnerability?"
High demand of glucose in the brain, low blood flow. Another concussion at this time could cause irrepairable damage or death.
What are some secondary injuries that could occur due to a primary TBI? (6)
Hypoxix-Ischemic injury
Arterial hypoxemia
Increased ICP
Neurochemical changes
What is a Hypoxic-Ischemic Injury?
No blood flow to the brain that is secondary to shifting of the brain structures
What is Arterial Hypoxemia?
Obstruction of airways, myocardial infarct; arterial hypotension.
Where can secondary hematomas occur?
Epidural, Subdural and intracerebral. Causes reduced blood flow to the brain.
What is normal ICP?
4-15 mmHg
If someone has abnormal ICP what precautions should be taken?
What are neurochemical changes secondary to TBI?
Auto-destructive cellular phenomena w/ DAI
What are some diagnostic procedures that can be done for a TBI?
-Evoked Potentials (EP) Mapping, MEP, SSEP
-Computed Tomography (CT) scan
-Cerebral Blood Flow Mapping
What is MEP?
Motor Evoked Potential. Stimulate brain and see what happens.
What is SSEP?
Somatosensory Evoked Potential. Touch the body and see what activity is going on in the brain.
What considerations should be taken into account with an MRI?
It's expensive, but much more sensitive. Have to be able to be very still and it takes time.
What is a MRA?
Contrast is injected into the vessels of brain and indicated bleeding
How does Cerebral Blood Flow Mapping work?
Same as MRA, Positive emission tomography and single photon emission ocmpute tomography. Radioactive substance is injected into the brain and blood circulation is tracked.
What other simplier, less expensive diagnostic procedures can be done?
Urine analysis, blood test, cholesterol and lipid test, blood sugar, chest xray, ECG, echocardiogram, doppler ultrasound (arterial blood flow)
What types of acute medical management would be done if someone came in w/ a TBI?
-Peripheral Circulation
-Cerebral Circulation
-Arterial Blood Pressure
-Intracranial Pressure
-Cerebral Perfusion Pressure
What is the normal range for Mean Arterial Pressure? (MAP)
70-100 mmHG
What is the normal range for ICP?
What happens if ICP gets above 20mmHg?
Limits blood perfusion ot brain and interventions must be done to reduce it
How is Cerebral Perfusion Pressure determined? What is it a measure of?
Cerebral Circulation
What is the normal range for Cerebral Perfusion?
Range 60-90mmHg, >70mmHg
What are three signs of increased ICP?
1. Slowing of pulse
2. Decreased consciousness
3. Cheyne-Stokes breathing
What is Cheyne-Stokes breathing?
Respiration that waxes and wanes cyclically. Periods of deep breathing alternating with periods of apnea.
What types of medications should be used with a TBI?
Drugs that poorly penetrate the brain (hydrophilic) should be used instead of drugs that readily cross the blood-brain barrier.
What are the Glasgow levels of Eye Opening?
T-To speach
T-To pain
N-No response
What are the Glasgow levels of Verbal Response?
C-Confused Conversation
I-Inappropriate words
I-Incomprehensible Sounds
N-No Response
What are the Glasgow levels of Best Motor Response?
F-follows command
A-abnormal flexion
E-extensor response
What is the critical score for Glasgow Coma Scale? and Why?
8 is critical score. Anything less means the person is in a coma. 9 or more means they are not in a coma.
What are the ranges of scores for Glasgow coma?
3-8 severe
9-12 moderate
13-15 mild
How does Glasgow Coma scale describe good recovery?
Being able to participate in normal social life and can return to work.
How does Glasgow Coma scale describe moderate disability?
Being independent, but with a disability
How does Glasgow Coma describe severe disability?
Being conscious but dependent
What are four signs of sympathetic arousal?
1. Increased HR
2. Increased BP
3. Dialated Pupils
4. Sweating
What are three factors that influence TBI outcomes?
1. Premorbid status
2. Primary injury
3. Secondary injury
What are four factors affecting the extent of damage?
1. Location of lesion
2. Size of lesion
3. Blood flow to area
4. Structures involved
What are four primary functions that that cerebral cortex is responsible for?
1. Planning for the future
2. Problem solving
3. Learning from experience
4. Anticipating, reward and punishment
What are some frontal lobe impairments?
-Expression of language (broca's)
-Planning of complex mvmts. Have necessary actions, just can't plan mvmt
-Problem solving, reasoning
-Focusing on a task
-Emotion control, moods
-Loss of flexibility in thinking, mental rigidity
-Loss of spontaneity
-Persistance of single thought
-Changes in personality and social behavior
What are some parietal lobe impairments?
-Sensory and sensory integration
-Inability to focus visual attention
-Inability to attend to more than one object at a time
-Poor hand-eye coordination
-Confusing R/L orientation
-Lack of awareness of certain body parts/space
-Anomia, agraphia, alexia, dyscalculia
What are some temporal lobe impairements?
-Wernicke aphasia
-Difficulty identifying and talking about objects, categorizing and locating objects in the envirnoment
-Short-term memory loss
-Increased aggressive behavior
-Disturbance w/ selective attention
What are some occipital lobe impairements?
-Visual defects
-Difficulty identifying colors, recognizing words or drawn objects, recognizing the mvmt of an object and difficulty reading and writing
What are some cerebellum impairments?
-Difficulty walking, reaching
-Slurred speech
What are some Brain stem impairments?
-Decreased vital capacity
-Difficulty w/ organization/perception of the environment
-Sleeping difficulties
-Arousal, consciousness
-Vestibular Function
-CN functions
What are some hypothalamus impairments?
-Body function, temperature, hormones, metabolism
-Impaired integration of ANS activities
What are some Cognitive Deficits?
-Altered level of consciousness/alertness
-Post traumatic amnesia/memory deficits
-Altered orientation
-Problem-solving, reasoning deficits
-Impaired safety awareness, insight and executive functioning
What are the 3 subcategories of Level VIII?
Level VIII: Purposeful Appropriate.
a) Standby assist
b) Standby assist on request
c) Modified independence
What are some observations you would take note of with a patient in Level I, II or III of Ranchos Los Amigos?
Posture, eyes open/closed, tracking via auditory or visual, vocalization, active movements, response to tactile/painful stimulus, changes in vitals w/ stimulation.
If someone reacts inconsistently and non-purposeful to stimuli and response are the same regardless of the stimuli, what Ranchos Level are they at?
II. Generalized response
If someone reacts specifically but inconsistently to stimuli, and responses are related to stimuli presented, what Ranchos Level are they at?
III. Localized response
What are some PT Outcomes for Ranchos levels I-III?
-Improve arousal, physical function, secondary impairments, postural control, endurance
-Maintain joint integrity, mobility
-Family/patient education
-Care coordination
What are some PT Outcomes for Ranchos levels IV?
-Improving endurance
-Maintain joint integrity/mobility
-Prevent 2ndary impairments
-Family/Patient ed
What would a Level IV patient look like?
-Weird behavior
-Increased activity
-No object discrimination
-Problems recalling info
-Problems with attention
-No carry over
What are some PT Outcomes for Ranchos Level V and VI?
-Improving functional mobility, ADLS
-Improving gait, mobility, balance, motor control and postural control
-Increase strength and endurance
-Address safety concerns
What would a Level V patient look like?
-Respond to simple commands
-Has better attention, but sill distracted
-Need a structured environment
-Can't handle complex tasks
-Inappropriate use of speech and objects
What would a Level VI patient look like?
Goal directed behavior, may see some carry over for relearned tasks. Follows simple directions consistently. Recent memory problems, but ok with long term memory.
What are some PT Outcomes for Ranchos VII and VIII?
-Education of patient and family
-Improve safety
-Improving functional independence
-Facilitating self-management
-Decrease level of supervision and assistance
What would a Level VII patient look like?
-Robot like, automatic like
-Appropriate and oriented
-Minimal confusion
-Shallow recall of activities
-Carry over for new learned material, but at a decreased rate
-Judgement remains impaired
-W/structure, is able to initate social or recreational activities
What would a Ranchos Level VIII patient look like?
-Able to recall and integrate past and recent events.
-Aware and responsive to environment
-Can learn NEW things
-No supervision with learned activities
-Decreases ability in abstract reasoning, tolerance for stress and judgement in emergencies or unusual circumstances.
What types of things would a PT look at for a functional assessment?
-Bed mobility
What are two disability measures used for TBI?
-Disability Rating Scale (DRS)
-SF-36 health status measure
What does a score of 0 mean for the DRS?
0 = no disability
What score on the DRS means vegetative state?
What does a score of 30 indicate on the DRS?
What are three functional assessments that a PT could use with TBI's?
1. Barthel - stroke, acute hospitalized patients
2. Berg
3. FIM