TBI

Question 1

Anterograde amnesia

Answer 1

• Loss of the ability to create new memories after the event
• Partial or complete inability to recall the recent past
• Long term memories before accident intact

Question 2

Retrograde amnesia

Answer 2

-Loss of memory before an injury or the onset of a disease.

Question 3

Working memory

Answer 3

• Holding and processing of new and already stored information
• Important process for reasoning, comprehension, learning and memory updating.

Question 4

Explicit memory

Answer 4

• Conscious, intentional recollection of previous experiences and information
• Ex: remembering appointment

Question 5

Procedural memory

Answer 5

-Part of the long-term memory that is responsible for knowing how to do things (motor skills)

Question 6

Orientation

Answer 6

-Use of memory and attention to identify oneself and to place oneself in time, place, and situation

Question 7

Confabulation

Answer 7

• Memory disturbance
• Production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive.

Question 8

Dyscalculia

Answer 8

-Severe difficulty in making arithmetical calculations, as a result of brain disorder

Question 9

Diffuse axonal injury

Answer 9

• Extensive lesions in white matter tracts occurs over a widespread area
• Very common TBI
• Major cause of unconsciousness and persistent vegetative state after head trauma

Question 10

Minimally conscious state

Answer 10

-Partial preservation of conscious awareness

Question 11

Persistent vegetative state

Answer 11

-Completely unresponsive to psychological and physical stimuli and displays no sign of higher brain function

Question 12

What two factors are the best predictors for long-term outcome following brain injury?

Answer 12

• Post-traumatic amnesia (PTA)

- Length of time in a coma

Question 13

What six areas are typically addressed by OT for patients at Rancho I-III?

Answer 13

• sensory stimulation
• bed positioning
• casting and splinting
• wheelchair positioning
• dysphasia management
• family and caregiver education
• GENERAL AIM is to increase individual’s level of response and overall awareness of self and environment

Question 14

What are the primary strategies used in ICUs for managing intracranial pressure?

Answer 14

• Monitor ICP, must be below 20 mm Hg
• Keep head elevated in bed
• Maintain nutrition
• Skull resection, if necessary
• Barbiturate paralysis, if necessary
• Emergency craniotomy
• Chronic: shunts

Question 15

How do OTs utilize procedural memory during inpatient treatment for brain injury?

Answer 15

Capitalizing on what they do remember (ADLs)

Question 16

What is agitation? How does it differ from aggression?

Answer 16

-Agitation: typically Rancho Levels 4-5, confused and adaptive attempt to explore environment, not purposeful

-Aggression: person begins to connect cause-effect,
beginning to make sense of the world.
Usually anything it takes to keep health care team away
-ex: don’t do the behavior they want

Question 17

Be able to describe strategies for managing agitation

Answer 17

• Consistent routine
• Calm demeanor/voice
• Unstimulating environment

Question 18

3 early assessment tools that are typically used with people who have emerged from coma. What do they measure?

Answer 18

• Rancho Los Amigos Levels of Cognitive Functioning
• Agitated Behavior Scale
• Orientation Log
• Galveston Orientation & Amnestic Test (GOAT) - not until they can engage, as agitation decreases

Question 19

Describe the primary behavioral differences among Rancho Levels 4, 5 and 6

Answer 19

Level 4: Non-purposeful, confused, agitated behaviors
OT usually begins inpatient treatment at this level

Level 5: Gross attention, requiring frequent cueing and re-direction for most tasks

Level 6: Independent self-care, but little carryover of new learning
Patient may be able to go home, but still requires supervision (safety concerns)

Question 20

Explain why consistency in treatment is important during inpatient brain injury rehab.

Answer 20

• Inconsistent situations can increase agitation and quickly lead into recalcitrant negative behaviors/aggressive tendencies
• Consistency helps fuel procedural memory
• Any change can cause a breakdown of function

Question 21

Explain the role of the 4 “S’s” in inpatient rehab

Answer 21

• Safety: for yourself (having an extra person in room if needed), and for patient
• Stability: posture/movement (vestibular difficulties, put them in their most comfortable positions for ADLs)
• Stimulus: environmental focus (consistency)
• Sequencing: organized step-by-step routine (important for morning routine, ex: brush teeth → wash face → comb hair)

Question 22

List several treatment parameters that should be considered when writing TBI treatment goals

Answer 22

-Level of cues/hand-over-hand
-Type of environment (ex: low-stim)
-Number of steps completed in task
-Use keywords like “simple,” “moderately complex,” and “familiar”
Ex: “Pt. will complete all steps of tooth-brushing task in low-stim environment with sequential set-up, verbal cues, and HOH guidance.”
Upgrade: “Pt. will complete all steps of tooth-brushing task in low-stim environment with sequential set-up and occasional verbal cues.”

Question 23

What are the components of a memory book?

Answer 23

1. Their name
2. where they belong
3. narrative that depicts exactly what happened to them
4. a list of all people that treat the person
5. any goals or documentation of previous treatments
6. hour-by-hour day planner
7. photos
8. calendar

Question 24

When can a memory book be used? What is the purpose of a memory book?

Answer 24

• When a person is able to read and attend briefly - as soon as they can respond to the GOAT (~Rancho Level 6)
• Professionals cue the person back to the memory book to refer to, usually calms them down and makes them feel less confused

Question 25

What is sun-downing?

Answer 25

Primitive fight-or-flight response to evening coming on. | -If not addressed, can lead to sleepless night (also common in elderly w/ dementia)

Question 26

What are some strategies for managing sun-downing?

Answer 26

- treat with meds - family at bedside - orientation cues - gentle reassurance

Question 27

What is the role of “antecedent management” in brain injury rehabilitation?

Answer 27

-Arrange situations and organize activities so that triggers for agitation/behaviors are minimized, thus stopping behaviors before they occur; e.g. building therapeutic milieu

Question 28

Describe the Clubhouse model

Answer 28

- Members work together to support each other in the pursuit of personal goals - Encourages community re-entry, the rebuilding of social relationships and the training of skills required to return to productive activity - Divided into four main areas: Work Ordered Day, (which consists of Units such as Kitchen and Business), Employment, Education and Evening/Weekend activities

Question 29

Describe day rehabilitation centers

Answer 29

Full-day therapy program that is structured like a regular school day. It is available from 9 a.m. to 3 p.m. Monday through Friday. The focus of the program is the return of the functional skills necessary for continuing recovery and school re-entry.

Question 30

What home management recommendations would you make to family caregivers as they prepare for a loved one with a brain injury to return home from hospital?

Answer 30

-Learning how to manage environment, tasks, memory issues, and behaviors De-clutter/manage environmental stim Allow extra rest time Ensure maintenance of sleep routine Limit caffeine intake Keep grooming & bedside materials in same place Maintain daily routine Provide adequate lighting Avoid unnecessary trips to unfamiliar surroundings Avoid ambiguity, don’t present too many choices Just-right challenge :) -Home visits with & w/o patients to assist with mods and adaptations

Question 31

What are the MOST COMMON FUNCTIONAL IMPAIRMENTS AFTER TBI?

Answer 31

- Slowed cognitive processing (brain processes slower than actions → impulsive) - Transfer of learning to varied tasks and settings (generalizing) - Insight, judgment, and denial (of need for rehab)

Question 32

Describe some strategies for addressing psychosocial deficits after brain injury

Answer 32

- relaxation techniques/stress training, anger diary - family counseling group, individualized therapies; group cognitive-behavioral modules - BIP (school) - teach communication alternatives - focus on antecedents, not consequences

Question 33

List and describe at least 3 ecologically valid community-based cognitive-behavioral assessment tools.

Answer 33

- Rivermead Behavioral Memory Test - predict everyday memory problems in people with acquired, nonprogressive brain injury and to monitor their change over time - Test of Everyday Attention - Measure selective attention, sustained attention and attentional switching Multiple Errands Test - evaluates the effect of executive function deficits on everyday functioning through a number of real-world tasks -Cambridge Test of Prospective Memory - assesses deficits of prospective memory

Question 34

What brain injury related deficits may have an impact on a driving evaluation?

Answer 34

- Slowed cognitive processing - Disorientation - Poor attention - Deficits in decision-making - Impaired safety awareness - Lack of judgment/awareness of deficits - Difficulty in planning, sequencing

Question 35

Describe a strategy for remembering names and faces

Answer 35

-Make positive, can exaggerate, use humor, rude is funny, vivid and colorful images are good, use all sense to code information (e.g., sounds, smell), bring movement into it Ex: George is a ginger. (similar sounds)

Question 36

List at least five concussion symptoms

Answer 36

- Attention difficulties - Memory impairment - Irritability - Anxiety - Dizziness - Diplopia - Insomnia, Hypersomnia - SECONDARY symptoms: headache, fatigue, depression, slow cognitive processing, symptoms fluctuate

Question 37

What are the basic return-to-play guidelines for the management of youth sports concussions?

Answer 37

1. No Activity 2. Light Aerobic Exercise (walking, swimming, stationary cycling) HR

Question 38

Following concussion, when should an athlete return to the playing field?

Answer 38

After using the Graduated Return to Play Protocol and are symptom free for 24 hours after last step (contact practice).

Question 39

What is the one common cognitive factor among people who have brain injuries?

Answer 39

Slow cognitive processing

Question 40

Describe in lay terms what happens to body fluids and the brain in a blast-related concussion

Answer 40

-Blast-Related Concussion: All of the following 3 can occur together Can have a direct blow to the head, brain bounces inside skull (looks like a concussion) Penetrating head injury: the brain doesn’t like to be exposed to the world, get infected Shock wave blasts through whole body, including the brain. Your cells in your body fluid & brain are moved out of the way (compression), then they bounce back (vacuum wave).

Question 41

List at least 5 symptoms of PTSD

Answer 41

- Upset thoughts or images about traumatic event when you did not want them - being overly alert - bad dreams about traumatic event - feeling distant or cut off from people around you - feeling emotionally numb - having trouble falling or staying asleep - feeling irritable or having fits of anger

Question 42

Describe how “graduated exposure” therapy is conducted

Answer 42

- Identify personal tolerance (with regard to time and intensity) for self-selected activities pertinent for role function and functional goals for social interaction and community reentry. - Create a schedule of gradually increased engagement in assigned activities. - Client self-assesses exposure using SUDS (subjective units of disturbance scale). - Grade up to next step. Review and collaborate on supports needed.