TBI Assessment and Management Overview

TBI Assessment

• Assess for generalized signs of increased intracranial pressure.
• Evaluate level of consciousness and cognitive function using the GCS.
• Examine cognitive function (LOCF) by assessing learning, attention, memory, and complex information processing.

TBI Assessment (Behavioral Changes)

• Observe for inappropriate physical, verbal, or sexual behaviors.
• Evaluate judgment.
• Assess irritability and low frustration tolerance.
• Examine aggression.
• Identify impulsivity and safety issues.
• Note depressed mood and anxiety.

TBI Assessment (Cranial Nerve and Motor Function)

• Evaluate cranial nerve function.
• Assess motor function, including the presence of paresis, hypertonia, and hyperreflexia.
• Examine apraxia.
• Check balance deficits.
• Assess ataxia and coordination (cerebellar damage is common).
• Evaluate functional mobility skills (FMS).
• Determine the level of general deconditioning.

TBI Management (Overall Objective)

• The overall objective is to maximize functional recovery and support patients with residual disabilities.

TBI Management (Acute Phase)

• Prioritize life preservation.
• Ensure a functioning respiratory system.
• Maintain good circulation (monitor BP and ICP).
• Prevent secondary brain damage (including pharmacological intervention and hypothermia).
• Prevent potential complications (pressure sores, contractures, DVT, respiratory problems, postural hypotension).

TBI Management (Chronic Phase)

• The PT program is structured around the cognitive level.
• Prevent secondary complications at Rancho Los Amigos I-III levels (no response to inconsistent response).
• Maintain range of motion (ROM) and prevent contractures using passive movement, positioning, splinting, and serial casting
• Maintain skin integrity by frequently changing patient positions.
• Maintain respiratory status, avoiding complications through postural drainage, percussion, vibration, and suctioning to maintain a clear airway.
• Maintain upright positions for improved body alignment.

TBI Management (Rancho Los Amigos I-III)

• Goal: Enhance the interaction of the patient with their environment. Use sensory stimulation (stimulate all sensory modalities for arousal). -Auditory: use speech and intermittent radio/TV.
  • Visual: use people and pictures to stimulate all visual fields.
  • Olfactory: use favorite smells.
  • Gustatory: cautiously use flavored cotton swabs to lips and gums, avoiding aspiration.
  • Tactile: use different textures.
  • Vestibular stimulus: implement head movements (angular or rotational).

TBI Management (Sensory Stimulation)

• Administer sensory stimulation in short, orderly periods.
• Assess response after each stimulus.
• Evaluate latency and consistency of response.
• Monitor response intensity.
• Observe for changes in vital signs due to potential autonomic nervous system impairment.

TBI Management (Rancho Los Amigos IV-VI)

• Encourage patient mobility by getting them out of bed.
• Focus acute phase exercises on ROM, transfers, and mat exercises (rolling, lying, to sitting to standing).
• Consider gait training or wheelchair training.
• Increase endurance.
• Address specific problems
• Provide daily structure & consistency.
• Avoid overstimulation.
• Employ memory logs and relaxation techniques.
• Provide short instructions and clear feedback.
• Offer task-specific training focusing on routine, liked tasks broken down into components.
• Provide external cues (verbal or physical).
• Control instruction pace.
• Regularly re-orient patient to time, place, name, and task.

TBI Management (Rancho Los Amigos VII-VIII)

• Patient is in control and typically discharged at this stage.
• Residual memory and judgment impairment is still possible.
• Develop specific programs for continuing needs and residual problems.
• Transition back into the real world with consistent feedback.
• Implement activities of daily living (ADL) training in a practical environment.
• Encourage active lifestyle with realistic fitness routines.
• Improve posture, balance, and symmetry.
• Monitor for potential robot syndrome (robot-like movement, excessive eating, and sedentary behaviors).

This quiz covers the assessment techniques and management strategies for Traumatic Brain Injury (TBI). It includes evaluations of consciousness, cognitive functions, behavioral changes, cranial nerve, and motor functions. Perfect for healthcare professionals seeking to enhance their knowledge on TBI protocols.