Rancho Los Amigos Scale-Revised
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Questions and Answers

Qual es le percento de recupero motor que generalmente occurre durante le prime 6 menses post-trauma?

  • 85% (correct)
  • 50%
  • 15%
  • 100%

    • Qual condition non es associate con un recupero positive post-trauma cranioencephalico?

  • Lesione unilateral
  • Coma pro < 2 hebdomadas
  • Scossa cerebrale recente
  • Lesione in le bulbo cerebrale (correct)

    • Qual es le scopo de le programma de rehabilitazione post-trauma?

  • Facilitar le cooperativa del patient
  • Promover le autoabus
  • Restaurar le function motor (correct)
  • Reducer le agitation

    • Qual de iste comportamentos es indicative de agitation sever?

    <p>Anger explosivo</p> Signup and view all the answers

    Qual es un indicatore de prognosis pessimistic post-trauma cranioencephalico?

    <p>Coma pro &gt; 2 hebdomadas</p> Signup and view all the answers

    Como se describe un patient que non collabora in le care?

    <p>Resistente</p> Signup and view all the answers

    Qual es un symptom de agitation moderat?

    <p>Rapiditate de parlar</p> Signup and view all the answers

    Qual factor de risco es associate con un recupero minus bon?

    <p>Age &gt; 65 annos</p> Signup and view all the answers

    Qual de iste comportamentos es un signum de autostimulo?

    <p>Pacing</p> Signup and view all the answers

    Qual es le nivel de assistentia necesse pro un patient in le nivello VI del Scala Rancho Los Amigos?

    <p>Moderate Assist</p> Signup and view all the answers

    Qual es le differente inter le nivellos VIII e IX del Scala Rancho Los Amigos?

    <p>Le nivello VIII es considerato automatic, le IX es activamente apropriato</p> Signup and view all the answers

    Qual es le figura de assistentia pro un patient in le nivello IV del Scala Rancho Los Amigos?

    <p>Maximal Assist</p> Signup and view all the answers

    Qual es un aspecto decisiv in le reabilitation de un patient con disorders de conscientia?

    <p>Supporto emotional e stimulation</p> Signup and view all the answers

    In le nivello III del Scala Rancho Los Amigos, qual es le response del patient?

    <p>Localized Response</p> Signup and view all the answers

    Qual tipo de assistentia es requirit pro un patient que es considerate in le nivello VII del Scala Rancho Los Amigos?

    <p>Minimal Assist</p> Signup and view all the answers

    Qual es le prognose pro un patient cu un disorder de conscientia in le nivello II?

    <p>Le patient responde generalmente a stimulos</p> Signup and view all the answers

    Le quales de le sequente factores es le minus importante in le processu de reabilitation?

    <p>Le nivello de assistentia academic</p> Signup and view all the answers

    Qual es le correcta descrition pro le nivello V del Scala Rancho Los Amigos?

    <p>Confuso e inappropriate, non agitate.</p> Signup and view all the answers

    In le reabilitation, quales approachs es preferite pro mejorar le conscio?

    <p>Activitates physique e cognitives in combination</p> Signup and view all the answers

    Qual es le assistentia necessitate in le nivello VIII del Scala Rancho Los Amigos?

    <p>Stand-by assist</p> Signup and view all the answers

    Qual est le porcentage de success in reabilitation pro pacientes in le nivello I?

    <p>Le minus probable</p> Signup and view all the answers

    Qual es le focus principal in management pro un patient in le nivello IX?

    <p>Promover le activitate cognitive</p> Signup and view all the answers

    Qual é le niveau appropriato de assistentia pro un paciente in un estado de responsiveness generalizate?

    <p>Total</p> Signup and view all the answers

    Qual categorisation de response indica un paciente con un nivel de consciousness confundite e agitate?

    <p>Level IV</p> Signup and view all the answers

    Quo es le definition de agitation post-traumatica?

    <p>Behaviour excessive in un state alterate de consciousness</p> Signup and view all the answers

    Quo indica un patient in le nivel VIII de Carlos Rancho?

    <p>Purposeful and appropriate</p> Signup and view all the answers

    Quo es le grau de assistentia necessitate pro un patient in le niveau VI?

    <p>Moderate Assist</p> Signup and view all the answers

    Quantos comportamentos es observate in le Agitated Behavioral Scale?

    <p>14</p> Signup and view all the answers

    Qual es le principale differentia inter un stato vegetativo e un stato minimo consciente?

    <p>Le patientes in un stato minimo consciente pote responder ad stimulos.</p> Signup and view all the answers

    In le context de management medical, quo es un potentielle consideration pro un patient con agitation post-traumatica?

    <p>Interventiones psychologic</p> Signup and view all the answers

    Quo deve considerarse in le prognosis de un patient in un stato de confusion appropriata?

    <p>Possibilitate de recuperation</p> Signup and view all the answers

    Qual es un signale de un estado agitato in un patient?

    <p>Repulsione a stimulos</p> Signup and view all the answers

    Qual es le response necessitate pro un patient in un stato de response localized?

    <p>Moderate Assist</p> Signup and view all the answers

    Quo es le beneficio de usar le Coma Recovery Scale-Revised (CRS-R)?

    <p>Facilitar le determination de le niveau de consciousness</p> Signup and view all the answers

    Qual es le assistentia necessitate pro le niveau X in le Rancho Los Amigos Scale?

    <p>Modified independence</p> Signup and view all the answers

    What level of assist is required for a patient at Rancho Level VI?

    <p>Moderate Assist</p> Signup and view all the answers

    At which Rancho Level is a patient confused and agitated, requiring maximal assist?

    <p>Level IV</p> Signup and view all the answers

    Which observation indicates a patient is at Rancho Level VIII?

    <p>Purposeful, appropriate responses</p> Signup and view all the answers

    In post-traumatic agitation, which behavior is considered excessive?

    <p>Excessive motor activity</p> Signup and view all the answers

    Which level requires total assist due to no response from the patient?

    <p>Level I</p> Signup and view all the answers

    What is the appropriate assistance level for patients at Rancho Level IX?

    <p>Stand-by Assist</p> Signup and view all the answers

    What is the maximum score on the Agitated Behavioral Scale?

    <p>14</p> Signup and view all the answers

    Which level describes a patient who is confused and inappropriate but non-agitated?

    <p>Level V</p> Signup and view all the answers

    What characteristic defines Rancho Level VII?

    <p>Automatic and appropriate response</p> Signup and view all the answers

    Which of the following describes a patient at Rancho Level II?

    <p>Generalized response</p> Signup and view all the answers

    What is a common misconception about the Coma Recovery Scale-Revised (CRS-R)?

    <p>It can differentiate between all levels of consciousness accurately.</p> Signup and view all the answers

    What level of consciousness is characterized by a lack of response to stimuli?

    <p>Vegetative state</p> Signup and view all the answers

    In terms of rehabilitation, what does the term 'maximum assist' signify?

    <p>Patient requires full support for all activities</p> Signup and view all the answers

    What is the assist level for a patient at Level II of the Rancho Los Amigos Scale?

    <p>Total</p> Signup and view all the answers

    During rehabilitation, what is the primary focus for patients at Level IV of the Rancho Los Amigos Scale?

    <p>Ensure safety and orientation</p> Signup and view all the answers

    What is the anticipated prognosis for a patient exhibiting appropriate responses at Level VI of the Rancho Los Amigos Scale?

    <p>Variable, depending on individual factors</p> Signup and view all the answers

    What type of assistance is required for a patient at Level IX of the Rancho Los Amigos Scale?

    <p>Stand-by assist</p> Signup and view all the answers

    In the context of rehabilitation, which of the following is critical for managing patients at Level VII of the Rancho Los Amigos Scale?

    <p>Promoting consistent behaviors in familiar environments</p> Signup and view all the answers

    What is the key characteristic of responses observed in patients at Level V of the Rancho Los Amigos Scale?

    <p>Agitated and inappropriate actions</p> Signup and view all the answers

    For a patient at Level X of the Rancho Los Amigos Scale, what is the expected level of assistance required?

    <p>Modified independence</p> Signup and view all the answers

    Which level of the Rancho Los Amigos Scale is associated with the need for maximal assist due to confusion and agitation?

    <p>Level IV</p> Signup and view all the answers

    What is the primary intervention focus during rehabilitation for patients at Level III of the Rancho Los Amigos Scale?

    <p>Stimulating localized responses to commands</p> Signup and view all the answers

    Which aspect is least likely to be a primary concern in managing patients at Level VIII of the Rancho Los Amigos Scale?

    <p>Managing confusion and agitation</p> Signup and view all the answers

    What is the primary characteristic of patients at Level I of the Rancho Los Amigos Scale?

    <p>No response to stimuli</p> Signup and view all the answers

    Which level of the Rancho Los Amigos Scale shows a shift from generalized to localized responses?

    <p>Level III</p> Signup and view all the answers

    In rehabilitation, what is the focus for managing a patient at Level VI of the Rancho Los Amigos Scale?

    <p>Providing cues and support to enhance awareness</p> Signup and view all the answers

    What is the primary reason most motor recovery occurs within the first six months after a traumatic brain injury?

    <p>Neuroplasticity is maximized during the initial recovery.</p> Signup and view all the answers

    Which of the following factors is NOT associated with a poor prognosis after traumatic brain injury?

    <p>High levels of initial agitation</p> Signup and view all the answers

    Which behavior is typically considered a sign of severe agitation in patients?

    <p>Pacing and excessive movement</p> Signup and view all the answers

    What aspect is crucial in the management of a patient with traumatic brain injury who exhibits self-abusiveness?

    <p>Maintaining a structured environment</p> Signup and view all the answers

    Which of the following is a common presentation that indicates a patient might be moderately agitated?

    <p>Sudden mood changes</p> Signup and view all the answers

    What is indicated when neuroimaging reveals a bilateral brainstem lesion?

    <p>Unlikely association with positive recovery</p> Signup and view all the answers

    In which Rancho Los Amigos scale level is a patient likely to exhibit behaviors like rocking, rubbing, or moaning?

    <p>Level III</p> Signup and view all the answers

    What behavior might a patient exhibit when they are under care and demonstrate a low tolerance for frustration?

    <p>Impulsivity and irritability</p> Signup and view all the answers

    Which prognosis is associated with patients who experience coma for less than two weeks?

    <p>Rarely associated with severe disability</p> Signup and view all the answers

    What is a major consideration for rehabilitation of older patients post-traumatic brain injury?

    <p>Older age is associated with poorer prognosis</p> Signup and view all the answers

    Study Notes

    Rancho Los Amigos Scale-Revised

    • The scale assesses the level of assistance required for patients
    • Levels range from no response (total assistance) to modified independence (level X).

    Clinical Examination Levels

    • Level I: No Response: Patient shows no response to any form of external stimulus.
    • Level II: Generalized Response: Response to external stimuli is inconsistent and not purposeful; responses may be the same regardless of the stimulus.
    • Level III: Localized Response: Response to external stimuli is inconsistent but specific to the stimulus.
    • Level IV: Confused and Agitated: Hyperactive behavior with bizarre and inappropriate actions; behavior stems more from internal confusion than external stimuli.
    • Level V: Confused, Inappropriate, Non-Agitated: Patient may follow simple commands but verbalization and behavior are often inappropriate and confused.
    • Level VI: Confused, Appropriate: Patient can follow simple commands consistently. They retain familiarity tasks but struggle with new learning.
    • Level VII: Automatic and Appropriate: Patient is oriented in familiar settings and performs daily tasks automatically.
    • Level VIII: Purposeful and Appropriate: Patient is independently oriented to person, place, and time, and performs familiar tasks in a distracting environment; needs assistance with complex tasks.
    • Level IX: Purposeful, Appropriate: (Stand-by Assistance on Request): Patient independently shifts tasks, recognizes impairments, and uses compensatory strategies.
    • Level X: Purposeful, Appropriate (Modified Independence): Patient can independently complete multitasking in different environments using extra time or assistive devices.

    Rancho Los Amigos Level-Revised Review

    • Level I (No Response): Total Assistance: No response to external stimuli.
    • Level II (Generalized Response): Total Assistance: Inconsistent, non-purposeful responses to external stimuli.
    • Level III (Localized Response): Total Assistance: Inconsistent but specific responses to external stimuli, often related to the stimulus.

    Disorders of Consciousness Rancho I-III

    • Coma: No response, absent motor function, reflexes, and postural responses.
    • Vegetative State: Present sleep-wake cycling, postural responses to noxious stimuli, and possible startle response.
    • Minimally Conscious State: Occasional, inconsistent but intelligible verbalization or gestures.

    Importance of determining level of consciousness

    • Ensure precise distinctions between vegetative and minimally conscious states.

    Post-traumatic Agitation

    • Defined by excessive behavior during altered consciousness and cognitive impairment.
    • Incidence post TBI is reported in range of 10-96%.
    • Symptoms include verbal abuse, impulsivity, rage, sudden mood swings, lack of cooperation, and distractibility.

    Additional Medical and Rehab Considerations

    • Sleep dysregulation is common.
    • Patients with brain injuries may have urinary dysfunction, CN injuries, and fatigue.

    Acute care/ICU management

    • Neurosurgery consultation is needed in case of intracranial damage.
    • Intracranial pressure monitoring is important to ensure appropriate management.

    Cerebral Perfusion Pressure [CPP]

    • CPP = Mean Arterial Pressure [MAP] - Intracranial Pressure [ICP]
    • The normal CPP target range is 60-70 mmHg.
    • The typical normal MAP range is 70-100 mmHg.

    Monitoring Intracranial Pressure [ICP]

    • ICP monitoring uses various techniques such as intraventricular or intraparenchymal catheters, or subdural catheters.

    Post-Traumatic Hydrocephalus

    • Incidence is higher in moderate or severe TBI. (70% develop ventriculomegaly which can be due to atrophy).
    • Three common symptoms are change in gait, change in cognition, and urinary incontinence.

    Post-Traumatic Seizures

    • Incidence varies based on injury type and timing of seizure.
    • Anti-seizure medications (ASMs) are recommended in the early stages (within the first 7 days post injury).

    Paroxysmal Sympathetic Hyperactivity [PSH]

    • PSH is predominantly in response to non-noxious stimuli, and may last from minutes to 2 hours.
    • PSH is usually seen in patients with a GCS<8.
    • PSH is predominantly seen in younger males.

    Heterotopic Ossification

    • Heterotopic ossification is the formation of bone in non-osseous tissues.

    Craniotomy/Craniectomies

    • Decompressive bone flap removal and placement after decompression is performed.
    • Surgical excision of the bone flap is performed until swelling is resolved; repositioning is called cranioplasty.

    Precautions

    • Patients with craniotomies/craniectomies may require custom helmets when out of bed.
    • The head of the bed should be elevated and patient's should consult with the team for possible activity restrictions.

    Further Facility Training

    • Crisis Prevention Training and De-escalation Training are crucial for facility staff.

    Multi-disciplinary Team

    • A multidisciplinary team approach is critical in patient care encompassing social workers, speech therapists, doctors, physical therapists, recreational therapists, caregivers, nurses, and other professionals as required.

    Prevention of TBI

    • Educate all regarding the risk factors and management of seizures
    • Take proper precautions, and Manage triggers.

    Imaging

    • CT scans are common in TBI assessment.
    • CT scans evaluate for intracranial pathology like depressed skull fractures, subdural hematoma, epidural hematoma, etc.

    Specialized Long-Term Care Facilities

    • Depending on the patient's individual medical needs, long-term care facilities may be needed.

    Glasgow Coma Scale (GCS)

    • GCS scores in the initial 24 hours correlated to outcomes.
    • Lower GCS scores are associated with poorer patient outcomes
    • Motor scores of the GCS are highly accurate in predicting patient outcomes.

    Other Factors Affecting Prognosis

    • Duration of coma
    • Age at injury

    Neuroimaging

    • Bilateral brainstem lesions on MRI are not associated with positive outcomes.
    • CT findings of epidural, subdural, or subarachnoid hemorrhage may correlate with poorer outcomes.

    Motor Recovery and TBI

    • Most motor recovery happens within the first 6 months of the injury.
    • A shorter duration of loss of consciousness and mild initial deficits associates with faster recovery.

    Prognosis in Disorders of Consciousness

    • Minimally Conscious State has more favorable prognosis than Vegetative state.

    Factors Affecting ADL Independence in Older Adults with TBI

    • Age is significantly correlated with worse outcomes.
    • Co-morbidities are associated with poor outcomes.
    • Medical complications (including those related to injury) can negatively impact outcomes, sometimes for 12 months or more.

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    Description

    Este quiz examina le escala Rancho Los Amigos, que evalua le nivelle de assistance requirite pro patientes. Discuteremos de le divers nivelles de responsa, desde le no responsa usque a le independence modificate. Est-il important pro professionales in le salute entender ille nivelles.

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