Traumatic Brain Injury - Lecture Notes PDF

PT 351 PT IN NEUROLOGY (1) Traumatic Brain Injury PART 3 Dr. Ali Bani Ahmed PT, DPT, CPT, CKTP, CES, CDNP, PhD  TBI assessment For generalized signs of increased intracranial pressure Level of consciousness and cognitive: – GCS – Cognitive funct...

PT 351 PT IN NEUROLOGY (1) Traumatic Brain Injury PART 3 Dr. Ali Bani Ahmed PT, DPT, CPT, CKTP, CES, CDNP, PhD  TBI assessment For generalized signs of increased intracranial pressure Level of consciousness and cognitive: – GCS – Cognitive function (LOCF) – Examine disorders of learning, attention, memory, and complex information processing  TBI assessment For changes in behavior examine: – Inappropriate physical, verbal or sexual behaviors – Poor judgment – Irritability and low frustration tolerance – Aggression – Impulsivity and safety issues – Depressed mood; anxiety  TBI assessment Cranial nerve function Motor function: – Paresis – Hypertonia and hyper reflexia – Apraxia – Balance deficits – Ataxia and coordination (cerebellar damage is common) Functional mobility skills (FMS) Level of general deconditioning  TBI- MANAGEMENT Overall objective is maximal functional recovery and assisting the patient with residual disability. - Make a problem and an asset lists - Set priorities, sequencing and team work -Treatment program must be individualized. Acute Phase: - Life preservation - Functioning respiratory system - Good circulation (check BP, ICP) - Prevent secondary brain damage (pharmacological intervention, hypothermia) - Prevent complications: - Pressure sores, contractures, DVT, respiratory problems, postural hypotension  TBI- MANAGEMENT Chronic Phase: Acquiring motor skills or relearning → PT program is built around the cognitive level 1. Rancho Los Amigos I-III (no response - inconsistent response) Goal: Prevent secondary complications A. Maintain ROM and prevent contracture development : Passive movement (full range all joints), Positioning, splinting, serial casting. B. Maintain skin integrity: frequent position changes C. Maintain respiratory status, prevent complications: postural drainage, percussion, vibration, suctioning to keep airway clear. D. Upright position for improved body alignment  TBI- MANAGEMENT 1. Rancho Los Amigos I-III Goal: Increase the interaction with environment. Sensory stimulation (Stimulate all sensory modalities for arousal)  Auditory: talk to the patient, intermittent use of radio or T.V.  Visual: people, pictures, stimulate all areas of visual fields  Olfactory: use patient’s favorite smells  Gustatory: apply cotton swab with flavored solution to the lips & gums. Avoid aspiration.  Tactile: use different texture  Vestibular: head movement (angular or rotational).  TBI- MANAGEMENT Sensory stimulation cont. ✓ Administer for short period & in an orderly manner. ✓ After every stimulus wait for a response ✓ For every response look for its: Latency: time between stimulus and response Consistency: number of times patient respond/number of time stimulus is presented Response Intensity Autonomic nervous system may be impaired watch for changes in vital signs.  TBI- MANAGEMENT 2. Rancho Los Amigos IV-VI (Confused agitated- Confused appropriate) ⚫ Get patient out of bed: focus on  ROM exercises  Transfer activities  Mat exercises (rolling, lying to sitting to standing).  Gait training or wheelchair training. Patient is more involved in the program Increase endurance Address specific problems  TBI- MANAGEMENT 2. Rancho Los Amigos IV-VI (Confused agitated-Confused appropriate) ⚫ Provide structure, prevent overstimulation for confused agitated patient: closed, reduced stimulus environment, daily schedules and memory logs, relaxation approaches. ⚫ Provide consistency: give clear feedback, clear short instructions. ⚫ Engage patient in task-specific training: limit activities to familiar, well-liked ones, offer options, break down complex tasks into component parts ⚫ Provide external cues: verbal or physical cues and assistance. ⚫ Control rate of instructions ⚫ Provide frequent orientation to time, place, your name and task.  TBI- MANAGEMENT 4. Rancho Los Amigos VII and VIII (Automatic appropriate purposeful appropriate) - Patient is in control (less structure, less destructions) - Patient is usually discharged at this stage. - Patient may still have memory and judgment impairment. - Specific program for any residual problems - Re-enter the real world, give feedback. - Promote independence in ADL in real life environment. - Encourage active lifestyle: Develop realistic fitness program - Improve postural control, balance and asymmetry - Robot syndrome: robot-like motion, excessive eating and sedentary activities.