Midterm Flashcards

Question

Common lines and drains in ICU | 6. Feeding tubes:

Answer 1

a) Nasogastric (NG) b) Percutaneous endoscopic gastrostomy (PEG) - While feeding make sure the head of the bed is raised 30 degrees to prevent aspiration

Answer 2

- Check to make sure there is an order for OT. Check every session.*** - Ask the nurse if the information is current - Review medical records: Is there a reason for holding the therapy: change in mental status, deep vein thrombosis, pulmonary embolism - Check the facility standards - Start with gross assessment of: - vital signs: if there is great discrepancy, report to the nurse - mental status - movement/strength

Answer 3

Monitor: - Vital signs (document before, middle and after treatment) - Changes in the neurological symptoms (posture, speech, pupils, ...) - Subjective complaints -f any problems happen: terminate the treatment and inform medical team immediately

Answer 4

-fill in later

Answer 5

- To increase trunk rotation | - To increase awareness of affected side

Answer 6

- Passively guide the affected side | - Increase awareness of affected side

Answer 7

- To avoid pressure on bony prominence in lower limbs - Position scapula in protraction - Use a roll towel under waist to give stretch to muscle - Used rolled towel in mid-thoracic spine to hold the position

Answer 8

- To strengthen the back and hip extensors | - To be used for transfers and dressing

Answer 9

- Early weight bearing stage on affected side - Patient needs help to start 6. Side lying on the unaffected side towards sitting

Answer 10

On back: pillow under affected arm and neck Lying on affected side: leg straight pillow under unaffected leg, pillow between affected arm and unaffected arm, pillow supporting back Lying on unaffected side: leg straight: pillows under affected leg, pillows under affected arm, pillows behind back for support

Answer 11

- in side lying - while sitting (arm partially extended) - infront of the sink - Stabilizing objects

Answer 12

- Bridging - Sitting at the edge of the bed, both feet on the floor - Early transfer when medically stable

Answer 13

- Raise the head of the bed gradually to 30 to 40 degrees and then to 80 degrees - Start activities like - ->grooming - ->feeding - ->leisure activities - ->upper body dressing

Answer 14

- To increase out of bed sitting tolerance - Use pillows - Watch shoulder alignment - Self-care, visual scanning, weight bearing

Answer 15

- Can be in crossed leg position - Head of bed is elevated but not touching the person's back - Pillows against the bed rail to protect the patient

Answer 16

- ***Safety first - ensure equal weight bearing - Postural control increases by touching the floor

Answer 17

- Ensure lines and IVs have enough length - Increase the bed height so the patient can get up easier - Ensure appropriate alignment of the limbs

Answer 18

- Early weight bearing - Weight shifting - Use arms

Answer 19

-Correct any biomechanical malalignment -Protect join integrity -Prevent muscle shortening Maintain skin integrity Develop wearing schedule - better at night than day time

Answer 20

- Resting hand splint - Cone splint - Adjustable inflatable splint (for patients with >1 stroke and increased muscle tone) - Blanket/towel roll (roll around elbow to prevent elbow flexion)

Answer 21

``` Cause: Blood clot or IV infiltrate Talk to nurse Edema management: -positional elevation -Extended limb above the heart level -Active and active assistive ROM -Note: Compression garments is not appropriate for IV related problems ``` Question: is raising foot rests of the wheelchair a good idea for managing edema in lower limbs: NO -unless it is a tilt chair and then the legs can be higher than the heart

Answer 22

1. Educate the team to avoid pulling on the extremity 2. Signage on the bed: (Please do not pull on patient's arm. Please contact occupational therapy at 555-555-5555 with questions and concerns 3. Supine: Suport shoulder in protraction and elbow and fingers in extension 4. Edge of the bed: support on bed side table 5. Out of bed in chair: support with pillows or an arm support 6. Active and passive ROM : make sure scapula is moving with passive and active movement (glenohumeral rhythm) Note 1: no use of slings in ICU as the person will not be moving Note 2: if using IV on radial artery avoid wrist flex and ext

Answer 23

- TV - Phone - Food - Bed position to face the hallway - Use bright coloured hand bands - Family pictures - More verbal cues - Use less verbal cues as the person improves

Answer 24

ICU psychosis: -Fluctuating state of consciousness-fatigue, distraction, confusion, disorientation, restlessness, fear, anxiety, excitement, hallucination and delusion Contributing factors: sleep problems, stress, sensory overload and underload, immobilization, not able to differentiate between day and night

Answer 25

- Gentle tactile and verbal stimulations - involvement of patient in care - Effective resting periods - Decreasing monotony (same thing day in and day out) - Mobilizing the patient - Educating family in orienting patient to time of day and date - Calendar and clock in view - Music - Massage

Answer 26

-Patient might be NPO (nothing but mouth), if not, you can start dysphagia screening

Answer 27

- Facial weakness - weak tongue movements - poor lip closure - Drooling - Coughing on secretions - Poor or wet voice quality - Residual food accumulate in mouth

Answer 28

Is there... - Facial asymmetry - Food pocket in the cheek - Gag reflex ... use tongue depressor Can the patient.... - Close lips (symmetrical?) - Blow air into his cheeks (symmetrical?) - Stick out tongue (symmetrical?) - Clear his/her voice - Demonstrate volitional cough - Manage secretions Check the soft palate when the person says "AH". Does the palate elevate?

Answer 29

Assessment (colour, temp, wet or dry) Intervention: reduce pressure

Answer 30

- Use communication boards (pictures and not letters), yes/no signals, eye blinking, ... - Avoid shouting - Speak slowly and directly to the patient's face - Reduce background noise - One person to communicate at a time - Be aware of signs of frustration - Glasses/hearing aid?

Answer 31

- Sitting with support - Finger feeding - Drinking from a cup - Brushing teeth - Washing face - Donning pullover shirt - Donning shorts in bed when bridging

Answer 32

- Sitting without back support - Feeding with utensils - Pouring liquid and drinking using a straw - Brushing and cleaning dentures - Washing face and upper body - Donning a button-down shirt - Donning pants with standing to pull up

Answer 33

-Patients who have sustained an acute stroke should receive rehabilitation services if their post-stroke functional status is below their prestroke status and there is a potential for improvement Acute -->Inpatient-->Outpatient

Answer 34

- medically stable - stamina to participate in the program demands/schedule - Able to follow at minimum one-step commands, with communication support if required - Sufficient attention, short term memory, and insight to progress through rehabilitation - Potential to make functional gains

Answer 35

- Golden time: first 1 to 3 months - Gradual improvement for 1 year - up to 5 years - most independent in basic ADL - many are unable to return to work (depends on other factors)

Answer 36

answer later

Answer 37

- Self-care - IADL - Roles and responsibilities, - Leisure

Answer 38

- Upper extremity function - Postural adaptation - Speech and language - Cognition - Psychological aspects - Visual function - Motor planning - Dysphagia

Answer 39

- somatosensory assessment - shoulder subluxation - shoulder-hand syndrome - Voluntary movement - Strength and endurance - Functional performance

Answer 40

- Roles - Self-care - IADL/Productivity - Leisure Measures: - COPM - FIM - Barthel index - Role checklist

Answer 41

- prepare or retrieve a simple meal - use safety precautions and exhibit good judgement - take medication - get emergency aid

Answer 42

- Somatosensory problems usually accompany motor problems - Test of sensation require attention, recognition and response to multiple stimuli - If receptive aphasia --> the test results might not be valid - If expressive aphasia --> use yes/no questions or written way of communication - If mild stroke + dexterity problems -->might do two point discrimination test

Answer 43

-Subluxation of glenohumeral joint because of weakness or spasticity in the muscles around it Types: - Inferior subluxation - Anterior subluxation - Superior Subluxation

Answer 44

-Starts with pain and continues to stiffness in shoulder and hand Shoulder: loss of ROM with abduction, flexion and external rotation Elbow: usually no signs or symptoms Wrist: intense pain during extension and dorsal edema tenderness during deep palpation Hand: edema over metacarpals, no tenderness Digits: moderate fusiform edema, intense. pain during flexion in MC and PIPs, loss of skin lines

Answer 45

*as the stages increase movement decreases - Pain and increased sensitivity to touch - Swelling and joint stiffness - Increased warmth and redness - Faster-than-normal nail and hair growth and excessive sweating

Answer 46

*as the stages increase movement decreases - Swelling is more constant - Skin wrinkles disappear - Cooler skin - Increases stiffness

Answer 47

-Rarely has pain or vasomotor changes but they have soft tissue dystrophy, contracture (frozen shoulder and claw hand), severe osteoporosis

Answer 48

- How are the movements: Reflexive or voluntary movement - Can proximal segments stabilize to facilitate distal movements? - Can movements happen unassisted? - Can make movements in isolated joints? - Are reciprocal movements in isolated joints? - Are reciprocal movement present? - Assessment tools?

Answer 49

-Answer later

Answer 50

- Rehab intensity - Task specific practice - Constraint induced movement therapy - Mirror therapy - Functional electrical stimulation - Virtual reality - Cognitive Orientation to occupation Performance

Answer 51

-Individual ability to remain upright against gravity for stability and during. changes in body position - Prerequisite to independence in ADLs - Maintained by an interplay between sensory, motor and cognitive systems.

Answer 52

- uneven weight distribution and increased postural sway - Unsteadiness and instability - Frequent falls

Answer 53

- Observe during: sitting, standing, transfers and self-care tasks - Berg balance test - Functional Reach Test

Answer 54

Head, neck: Forward, flexed to weak side and rotate away. from the weak side Shoulders: - Uneven height - involved side retracted Spine and trunk: - Curved from posterior - Thoracic Kyphosis - Shortened trunk muscles at one side Arms: - Use of strong arm - Increased or decreased muscle tone on affected side Pelvis: - Asymmetrical weight bearing - Posterior pelvic tilt Legs: - Hips in more extension, feet in front of the knees - Feet not flat on floor unable to weight bear

Answer 55

Goal: client will be able to complete lower body dressing independently Intervention: - Provide feedback on how the person is sitting by using mirror or by copying the therapist - Use varying postures and transitional movement into activities - Grade reaching activities - Use bilateral upper extremity activities to improve balance (sitting and standing)

Answer 56

- can speak but have problem auditory comprehension and understanding of language, Might have difficulty with reading and writing - Difficulty following instructions

Answer 57

- understands well but can not produce words | - Person can follow instructions

Answer 58

-Slurred speech, drooling and decreased facial expression

Answer 59

- Increased risk of cognitive impairments and dementia - Risk of dementia predicted by size and location of CNS damage - Risk is associated with increased age at the time of the stroke - Even mild strokes can have an effect on - ->learning and remembering new information - ->Generalizing - ->initiating actions - ->confusion in familiar places -Difficulties organizing thoughts and attention

Answer 60

Vision - visual field cuts - ->Hemianopsia - Oculomotor control Scanning - Neglect - Disorganized Pattern recognition, visual memory, Visual cognition Apraxia

Answer 61

- Depression 1. Organic causes 2. reaction to the change - Anxiety - Stress - Anger - Decreased insight vs Denial: Denial of need for rehab or unreasonable goals More in rehab phase than acute phase Importance of HOPE

Answer 62

- Coughing, throat clearing, or choking during or after meals - Shortness of breath - Altered voice quality: wet, gurgling, or weak voice - Difficulty moving food to start the swallow - Spitting food out - Poor lip closure, loss of food from mouth; Drooling - Pocketing food in cheeks, under the tongue or the side of the mouth - Slow, effortful chewing - Rapid, uncontrolled eating

Answer 63

->dry mouth, constipation, urinary tract infection, confusion, severe illness, or even death

Answer 64

--> weight loss, reduced energy, skin breakdown, impaired wound healing, and lower resistance tp infection

Answer 65

-entry of saliva, food, liquid, or refluxed stomach contents) -->respiratory problems, and pneumonia

Answer 66

blockage of airway by piece of food, making it difficult or impossible to breathe

Answer 67

- Sitting in chair or in bed (60 to 90 degrees) - Head in middle and flexed slightly forward - Encourage to stay upright about 30 min after meals

Answer 68

- Avoid clutter at the table - Quiet environment - no visitors at meal time - Taking medication before or after meal rather than during

Answer 69

- Small, frequent meals - Use teaspoon not a tablespoon - encourage them to swallow twice - Check for laryngeal elevation when swallowing which is the movement of the adam's apple up and down - Ensure the mouth is clear before introducing more food - Use thickened liquids/ soft or pureed foods

Answer 70

- Eat slowly, and never rush - Monitor slef-feeding with a mirror - Remove pocketed food with their tongue - Be aware of drooling and use a napkin if necessary - Cough to clear the throat - Wear loose-fitting clothes and avoid tight belts, to avoid reflux

Answer 71

- Facilitate mouth care after meals - remove dentures after each meal so food particles can't collect and cause irritation - Ask patients/caregivers to: - ->At least once a day, check that the person's mouth and tongue are pink and moist. If the mouth is dry with patchy white areas, or the tongue is white and coated, tell the team. - Encourage the person to get regular dental check-ups

Answer 72

- Discharge planning - Resuming roles and tasks - ->work - ->Leisure - ->sexuality - ->Driving - Community support and resources - Fatigue

Answer 73

_What the role of OT in regards to driving: Fill in later

Answer 74

at least one month

Answer 75

- Self-care - Productivity - ->Meal preparation, home management, work, community mobility - Leisure

Answer 76

Alteration in brain function or any evidence of brian pathology caused by an external force

Answer 77

External physical force; not congenital or degenerative diminished consciousness

Answer 78

There are different types of brain injuries; usually classified as mild, moderate, severe, and very severe

Answer 79

Emotional, cognitive, behavioural, and physica; impairment

Answer 80

- Acquired brain injury is the leading cause of death and disability for canadians under the age of 35 - TBI occurs in 500 out of 100,000 individuals yearly in Canada - 18,000 alone in ontario - Over 5,000 children in canada will be seriously injured - Every year in Canada, over 11,000 people die as a result of a traumatic brain injury - Each year over 6,000 become permanently disabled after a traumatic brain injury - Within the next hour, 6 Canadians will suffer a brain injury

Answer 81

- About 3,000 (50%) of these individuals will be left with physical, cognitive/and or behavioural consequences severe enough to prevent them from returning to pre-injury lifestyles. - The highest incidence of traumatic brain injury are men aged 16-24; men experience brain injury twice as often as women - Occurs at a rate of 100 times more than spinal cord injury

Answer 82

- Repeated vomiting - Unusual behaviour - Worsening headaches - Memory problems - Worsening Balance - Double vision or other vision changes - Decreased level of alertness - Increased disorientation - Seizures

Answer 83

1. Head struck by object or striking an object 2. Brain undergoing acceleration/deceleration movement - NO direct external trauma (ie. Head strike) 3. A foreign body penetrating the brain 4. Forces generated from blasts or explosions

Answer 84

-A TBI can be classified as either an open or closed head injury Open: Penetration into cranial cavity Closed: No penetration into cranial cavity

Answer 85

Focal: Occurs in a specific area Diffuse injury: occurs over a more widespread area -->Traumatic axonal injury (TAI): a type of diffuse injury that results in damage to axons Both(common in severe brain injury)

Answer 86

- concussion - Diffuse axonal injury - Blast - Abusive head trauma/shaken baby syndrome

Answer 87

Contusion Penetrating Haemotoma - Epidural - Subarachnoid - Subdural - Intraventricular - Intracerebral/intraparenchymal

Answer 88

If in anterior poles and inferior of frontal and temporal lobes - Impairments in memory, emotional regulation, and drive - Impulsivity - Usually no motor impairments - Usually no speech impairments If frontal-lateral cortex damage - ->hemiparesis - Impulsivity - Attentional impairment

Answer 89

- More common in motor vehicle accidents - Cognitive impairments - Diminished mental processing speed - Decreased Divided attention - Decreased higher level cognitive functions - Behavioural changes: impulsivity, irritability, exaggerated pre-injury traits, apathy, poor initiative

Answer 90

1. A cushion or buffer for the brain's cortex 2. A basic mechanical and immunological protection to the brain inside the skull 3. Clearing waste

Answer 91

- Nausea/vomiting - Headache - Sleep disturbance - Dizziness - Sensory motor problems - Visual difficulties - Balance problems - Fatigue - Sensitivity to light

Answer 92

- Disorientation - Concentration problems - Memory difficulties - Attention problems - Slowed thinking - Difficulty finding words

Answer 93

- Irritability - Mood changes - Anxiety - Depression

Answer 94

``` Sequencing Decision Making Attention Personality Problem Solving -Verbal Expression Spontaneity emotions Voluntary initiation of movements ```

Answer 95

- Spoken language - Selective attention - Sexuality - Inhibitions - Aggression - Identification (identifying objects) - Categorization - Face Recognition - Object finding

Answer 96

- Object classification - Tactile Processing (what are their fingers telling them) - Academic skills - Cognitive ability - Directional understanding - Hand-Eye Coordination - Spatial Orientation

Answer 97

- Vision - Visual Field - Locating objects - Colour Identification - Hallucinations - Word blindness - Movement perception - Reading/Writing - Visual Processing

Answer 98

-control of gross and fine motor skills -Voluntary motor skills -Balance -Equilibrium (stand up and not fall over) -coordination Postural control -Eye movement

Answer 99

- Body Temperature - Heart Rate - Breathing - Balance - Movement - Swallowing foods and liquids - Vertigo - Nausea

Answer 100

- Disruption of autoregulation of cerebral blood flow, blood-brain barrier, vasomotor functions, increase in intracranial pressure, cerebral edema, intracranial hemorrhage, ischemic brain damage - Fractures - Cranial nerve damage

Answer 101

- Dysnomia -impaired sense of smell - Ansomia-Complete loss of smell - Prosmia- Sensation of smell without cause - Cosmia-Smelling an offensive odor that does not exist What OPIs can happen because of this damage - Can impact taste - Can impact safety (smelling smoke) - Impact cooking

Answer 102

-Seizures might happen even if the person is taking medication Triggers: - Fever - Drinking alcohol - Sick with flu or cold - Emotional upsets - Fatigue - Low blood sugar - Poor nutrition - Flashing lights such as in video games - Loud noises - Constipation - Menstruation

Answer 103

Focal or partial | -Generalized Seizures

Answer 104

-Personality, education, skills and personal history

Answer 105

-First few hours-diagnosis/triage Medical treatment

Answer 106

-Acute hospital care to discharge (occupational therapy starts)

Answer 107

-Education/training Rehab -occupational therapy

Answer 108

- Living a new phase - rehab - Occupational therapy establishing and living a new life Duration: decades/lifetime -Personal adjustment (abilities, deficits, personality, etc) -Social adjustment (family, friends, work, peers, etc) -Quality of life (productive, happy, engaged, etc)

Answer 109

-PROM/Positioning/tone management/splinting -Sensory stimulation -Reducing addiction -Family support and education `

Answer 110

- Medical stability - Reduction of physical impairments - Basic self-care skills

Answer 111

- Medical needs - Fundamental capacities - Basic skill acquisition - Community Integration

Answer 112

-Very similar to stroke -control of intracranial pressure (ICP) monitor for pupil changes, decreased neurological responses; abnormal brainstem reflexes; flaccidity; behavioural changes; vomiting; and changes in pulse rate, blood pressure, and respiration rate

Answer 113

- Similar to stroke: - Highly correlated with: - ->initial Glasgow Coma Score - ->Length of coma - ->Length of post traumatic amnesia (PTA)

Answer 114

Best Eye response (E) (opening eyes) (1-4) Best verbal response (V) (responding to questions) (1-5) Best Motor Response (M) (move body somehow) (1-6)

Answer 115

GCS Score 13-15 --> mild injury 9-12 --> Moderate injury 8 or below -->severe injury Don't just focus on the total but also subcategories (if they are very low in one category) 7-9 make for people that need oxygen

Answer 116

- Observations should be performed and recorded every 30 minutes until GCS equal to 15 achieved - If GCS = 15 observe every 30 minutes for 2 hours, then 1x hourly for 4 hours, then every 2 hours thereafter; - Should the individual with GCS equal to 15 deteriorate at any time after the initial 2-hour period, observations should revert to half-hourly

Answer 117

- A sustained (30 min drop) of one point in GCS level (greater weight should be giver to a drop of one point in the motor score of the GSC); - Any drop of 3 or more points in the eye-opening or verbal response score of the GCS 2 or more points in the motor response

Answer 118

smaller or equal to 1 hour mild 1-24 hours moderate 1-7 days severe more than a week very severe

Answer 119

- Length of Amnesia - Glasgow Coma Scale (GSC) - Rancho Los Amigos Cognitive Functional Scale

Answer 120

I - No response: total assistance The brain injured patient looks as if they are in a very deep sleep and does not wake up even when you talk to them or stimulate them. Your loved one may be in the Intensive Care Unit and may be attached to a machine to help with breathing II- Generalized response: total assitance The patient seems to be asleep most of the time. They may wake up slowly to noises, movement or touch. The patient may make a face or groan when touched, such as when a nurse gives a needle, or takes blood pressure. The patient may start to do simple things spontaneously or when you ask of them, such as “close your eyes”, “stick out your tongue” or “squeeze my hand”. These are good signs, but you should ask the nurse or therapists about better ways to judge if the patient is consistently following commands III - Localized response: total assistance The patient is more awake for longer periods during the day. The ability to respond to stimuli and to move the limbs and body are happening more often. For example, this might mean moving an arm or leg in response to pain, following a command when asked, or reacting to a sound or patient. At this level, responses may not be the same every day, so the important thing to look for is consistency. IV - Confused/ agitated; maximal assistance V - confused, inappropriate: non-agitated: maximal assistance VI - Confused, appropriate: moderate assistance VII. - Automatic appropriate: minimal assistance for daily life skills VIII - Purposeful, appropriate: stand by assistance IX - Purposeful, appropriate: stand by assistance on request x - Purposeful, appropriate: modified independent

Answer 121

- A traumatic brain injury diagnosis - Medical stability - The ability to improve through the rehab process - The ability to learn and engage in rehab

Answer 122

- Knowledge about managing TBI - + mental health - +substance abuse

Answer 123

- Awareness of impairments - Attention - Learning and memory - Executive function - Visual Spatial function - Detection/expression of emotion - Language, social communication

Answer 124

- COPM - Agitated Behavioural Scale - The Mini Mental Status Exam (MMSE) - Orientation Log (O-long) - Test of Everyday Attention (TEA) - Rivermead Behavioural Memory Test (RBMT) - Behavioural Assessment of the Dysexcutive syndrom (BADS) - The Multiple Errands Test - AMPS

Answer 125

- Personal factors - Pre-injury conditions - Injury-related factors

Answer 126

- A quiet and consistent environment and avoid overstimulation - Low-stimulation rooms - Evaluate the impact of visitors, assessment and therapy - Minimize the use of restraints while facilitating the use of alternate measures in order to allow the person to move around freely - Consistent healthcare professionals - Establish the most reliable means of communication - Provide frequent ressurance - Present familiarizing information as tolerated by the person - Help family members understand PTA and how to minimize triggering agitation

Answer 127

- Acute rehabilitation (Intensive medical management) - Inpatient rehabilitation - Community rehabilitation (post-acute rehabilitation)

Answer 128

Time of inactivity or underactivity Goal: develop responses to sensory inputs and increase frequency, rate, variety and quality of responses - Talk in calm, slow, normal voice, reassuring tone - Do not expect the person to remember things you said - Tell the person who you are (every time), date, time of day - Explain what you are going to do - Talk about familiar people - Use radio and music (not all the time) - Provide education to family member Ask family: - To keep a journal - To take care of themselves (sleep well, eat well. etc.)

Answer 129

Attention: - Methylphenidate - Dextroamphetamine - Amantadine Memory - Rivastigmine - Donepezil

Answer 130

As the brain improves, it begins to “wake up” and may have difficulty controlling the level of response to the environment. This is called “agitation.” You will see the patient will have poor memory and be confused most of the day. At this level, the safety of the patient is the biggest priority. The team may suggest certain ways to decrease the risk of falls and pulling at medical tubes.The patient may cry, yell or scream, wave their arms around, or move about in bed as they react to their environment- even after the stimulus is removed. They may hit out at others or may try to remove tubes or try to climb out of bed. Either they are awake and active or asleep. This can be scary for you and the patient. At this time, the patient would benefit from a routine to help to manage the behaviour. The patient cannot focus on tasks for a long time. If there is too much happening, such as many visitors, the patient may become more confused or agitated. The only memories they have are for things that happened before the head injury. If the patient is able to speak, they may use the wrong words, mix up the order of words or tell stories that do not make sense. They are not able to find the right words as they are not yet able to think before they act. Can be frightening for the family Ask family - Remind time , day and place - Limit the number of visitors (NOT in a group) - One thing at a time - Use a way of communicate if the person cannot talk - When agitated: do not walk out - Reassurance - Touch - Soft music

Answer 131

LEVEL 5: CONFUSED – INAPPROPRIATE – NON-AGITATED The patient may be more awake and can respond to simple commands. They are able to focus longer, but will need to be told what to do several times. The patient is easily distracted so may need to be asked several times to finish a task. They have memories of events in the past but they will not have clear memories of events since the injury. For example, they may not recall what you told them five minutes ago. They may be able to do simple tasks that they have done in the past, like eating and dressing. They are not able to learn new information, and may seem to have lost their manners. They may show inappropriate behaviour, such as sexual comments or actions, or may eat their meals with poor manners. LEVEL 6: CONFUSED - APPROPRIATE The patient follows simple directions most times they are asked. Your loved one is able to recall how to do things like feeding, dressing and bathing. Memory for events since their injury is still poor, so learning new information is hard. The patient is more aware of time and place. Their attention can sometimes be held for as long as 30 minutes. During that time they will talk and behave more appropriately, although they may act like a machine and give the same answers every time. They may still be confused at times. They are not safe to leave the unit alone as they do not remember the way back to their room. They may seem selfish and care only about themselves. Teach family - Person may laugh and cry easily - Be patient, repeat information - Help with activities - Provide structure for basic tasks - Use everyday situation as a learning experience - Slowly increase independence

Answer 132

The person can now do daily routines with little or no confusion, but may not know what they have been doing. They usually have poor judgment, find it hard to find solutions to problems and make poor decisions about the future. They often do not realize they are having these problems (poor insight). They can now learn new information, but at a slower speed and with more difficulty than before the injury. They may need someone to be with them as they are not safe to be alone. They are able to take part in and enjoy more recreation and social activities. - Can complete most tasks - Limited insight and judgement Teach the family - ->to be patient - Talk about safety issues

Answer 133

Memory has improved but memory for recent events may still be a little impaired. Following severe brain injury, a person may be slow to figure out situations and problems, deal with stress or use good judgment in emergencies or unusual situations. Their behaviour is more appropriate and good enough for the person to function in most social situations. Any problems remaining with thinking and behavour might only be noticeable to close family and friends. - Can complete most tasks day to day activities ADLs and IDLs - Might remember past events but not recent events - better stress tolerance - can take care of medications Teach family -More in house activities

Answer 134

- Can recall events and learn new tasks such as job training | - Can start a return to work processes

Answer 135

-Can complete tasks but might need more time and assistance -People might think they are all better but we need. to avocate for time Family : emotional support -Let the person make their choices

Answer 136

- ROM exercise - positioning - Tone management - Splinting - Sensory stimulation (on case to case basis) - ->train families on how to provide stimulation - Family support and education

Answer 137

- Keep head in 30 degrees elevation - Do not turn head to one side - ask nursing - Gentle touching, quiet talking, stroking - Supported sitting as soon as tolerated with doctor approval - Watch person's blood pressure

Answer 138

-Familiar objects, photographs, quiet environment, orientation, information, normalize interactions

Answer 139

- Devices that maximize freedom of movement - Gross motor activities - Change activity if needed - Be calm, confident, and accepting -mittens with no thumbs be flexible

Answer 140

- Optimize motor functions - Optimizing cognitive functions - Optimizing visual and visual-perceptual function - Restoring competence in self-care tasks - Contributing to behavioural and emotional adaptation - Supporting the family

Answer 141

- Cognitive remediation activities and exercises - memory strategy training - group treatment

Answer 142

- Clearly define intervention goals - ->Selection of and training of goals that are relevant to the person with TBI (i.e., ecologically valid) - Allow sufficient time and opportunity for practice - Integrate methodologies that allow for breaking down tasks into smaller components such as task analysis when training multistep procedures - Teach strategies using variations in the stimuli/information being presented (e.g., multiple exemplars, practical tasks). - Promote strategies that allow for more effortful processing of information/stimuli (e.g., verbal elaboration, visual imagery) - Use teaching strategies that constrain errors (e.g., errorless, spaced retrieval) when acquiring new or relearned information and procedures - Consider group-based interventions

Answer 143

- population increasing - Hidden symptoms - Personality changes - Disagreement about persistence of cognitive problems after mild TBI - Little consensus about the best intervention

Answer 144

-Contingent reward techniques were most effective at increasing adherence and compliance while interventions enabling clients' active participation in rehabilitation appeared to increase engagement and motivation A lot of ppl were not engaged in rehab and didn’t have great outcomes Tried some behavioural approaches Sent reminders - reduce need to remember the sessions - Responded really well Behavioural contract to sign - Attendance - Types of behaviours they would focus on in their participation Most effective - Using contingent rewards - Rewarding positive behaviours instead of disciplining neg behavior - Tokens Interventions that enabled the client active participation increased engagement in rehab process - Providing tailored info about their condition - better understanding - Education and ability to direct their own goal setting - Equipping them self management skills so they could have some independence in the rehab process

Answer 145

- optimizing cognitive function - Optimizing visual and visual-perceptual function - Restoring competence in self-maintenance roles - Restoring competence in leisure and social participation - Restoring competence in work - contributing to behavioural and emotional adaption - supporting the family

Answer 146

- ADL training - Community re-entry skills training - Environmental adaptation Access to interval care is needed even after discharge. The need for internal care is determined on the client's needs, goals and the potential benefit of services

Answer 147

- Relationships - Community Access - Acceptance - Occupation - Being at home - Picking up life again - Heighten risks and vulnerability To help design community integration programs for ppl with brain injury Relationships - Imp to foster both existing and new relationships - Imp of relationships and social support as they return to the comm Sense of belonging in the community and being able to return to meaning community activities Feeling valued by others and having a personal sense of belonging with yo - Often feel like they can't offer as much to their family as they could - Finding ways they can contribute Need to engage in meaningful activity and choose how time was spent - Independence Individuals wanted to do ordinary things at home Feel at home and comfortable in their home env Resuming previous roles and having confidence to take one new roles What role imp before, what is imp going forward -Thinking of big picture - goals and dreams Acknowledging that there are additional risks What are some safeguards we can put in place to reduce these risks

Answer 148

-Person centred approaches and planning -Relationships -Working together -Development of skill -Service setting and atmosphere -Support for service users Service setting and atmosphere Measure based on framework in the last slide Evaluate community programs to support community integration for ppl injury Scoring system: Person centred approaches and planning - Program understands needs of users - Focuses on strengths and abilities rather than limitations - Individualized Does this service support new and existing relationships? Does it understand importance of relationships? How it works with individuals themselves, with family, among teams How it collabs with other agencies in the community Do the services provide opportunities for development of skills If it has links and strong network within the community Is it help in a typical community setting - appropriate Are staff appropriately trained, able to offer specialty support e.g. couns return to work Is the program welcoming, accessible, appropriate for users needs Needs more research about higher scores yielding better rehab outcome

Answer 149

-Effective RTW interventions for patients with ABI are a combination of work-directed interventions, coaching/education and/or skills training longer they are away from work the harder it is for them to return

Answer 150

- A start date - An indication of how to increase hours and days - limitations and restrictions - recommended accomodations What they will need to success in the work env Be explicit with employers from the start That it is a proposed plan and that things may not go as expectations and modifications will need to be made along the way Increased breaks Built in breaks More frequent breaks shorter work days modified hours, tasks written list of work tasks Less distractions if in a busy environment A quieter work area Reduced workload Quiet environment education for other staff members, with permission from client Technology? Like computer screens communication device Permission from the client

Answer 151

who has shorter return to work time? -Men or women?? 40% were able to return to work within 2 years Those with mild returned sooner than moderate RTW tends to be one of the most prominent rehab goals But there is struggle and fear bc of their limitations Find balanced approach - working toward RTW within overwhelming them Maslow hierarchy of needs - Needs to focus on things like self care before jumping not work Managerial roles took longer to get back to their roles people with one impairment Women return faster

Answer 152

- Practice setting: private practice; services funded through auto-insurance funding system - Referral sources and referral time post-injury vary greatly - Initial assessment (ideally in the home environment) takes holistic approach - consider self-care, productivity, and leisure activities - emphasis on understanding pre-accident life vs present status

Answer 153

- Chronic pain -headache and/or pain related to other sustained injuries - Fatigue Physical, cognitive, psychosocial - Depressive and anxiety symptoms - > example of stressors - ->change in abilities/coping with new limitations - ->unable to work/financial stress - ->Concerns related to accident circumstances - Concerns related to long-term impact of impairments - Change in family role Cognitive symptoms - impaired memory and attention, "brain fog" -->onset of headaches or worsening cognitive symptoms when completing cognitive activities

Answer 154

``` #1 Occupation centered goal: Client will be able to complete daily self-care and engage in 4 hours of work each day. Process goal: Client will learn and regularly apply two pain management strategies (i.e., pacing, planning, prioritizing) to address energy conservation and pain management within three months to allow for appropriate balance between self-care, leisure and productivity (work) tasks. ``` ``` #2 Occupation centered goal: Client will report sleeping for 7 hours 5 out of 7 nights within 3 months. Process goal: Client will learn and apply at least two sleep hygiene and positioning techniques to support improved sleep quality within three months. ```

Answer 155

Pacing -use of points system or colour coding system (i.e Parkwood Pacing Points System) - Goal Setting Use of SMART goals - Use of FitBIt for activity tracking/goal setting/monitoring heart rate - Mindfulness/meditation - Use of apps (i.e, Insight Timer) - Use of Brain Injury Workbook by Trevor Powell (along with functional cognitive activities) - Worksheets from coping strategies to Promote Occupational Engagement and Recovery - ->developing daily routines, goal setting, stress coping strategies, self-esteem builders, assertive communication

Answer 156

• Clients often working with rehabilitation team that can include: o Mental health provider (i.e., psychology, psychotherapy, psychiatry) o Physiotherapist / massage therapy (if appropriate) o Kinesiology or personal trainer o Family physician, various medical specialists (i.e., neurology) o Speech-language pathology o Case manager o Other specialized treatments – i.e., vision therapy, aquatic therapy • May need to complete referrals as required – important to understand roles of other professionals with respect to TBI rehabilitation • Consider available community resources

Answer 157

``` Brain Injury Association of Ottawa Valley (BIAOV) http://biaov.org/ • Peer Support Group • Family Support Group • Peer Mentoring Program • Concussion Support Group • Step Up Work Centre Program •ArtisticExpressionsWorkshopProgram ```

Answer 158

refers to the remediation of neurological impairments, such as return of movement to a paralyzed limb.

Answer 159

entails regaining the ability to perform meaningful activities, tasks, and roles without full restoration of neurological function, such as using the unaffected hand for dressing or walking with a cane or walker.

Answer 160

the ability to (1) prepare or retrieve a simple meal, (2) use safety precautions and exhibit good judgement, (3) take medication, and (4) get emergency aid,

Answer 161

The patient will gain competence in valued and nec- essary BADL and IADL in order to perform at the highest level of independence possible in the desired postdischarge setting. ● The patient will improve postural control in order to perform daily living tasks requiring balance and changes in body position. ● The patient will gain increased somatosensory percep- tion and/or will employ compensatory strategies in order to perform ADL safely. ● The patient and/or caregiver will demonstrate appro- priate management techniques for the hemiparetic upper extremity to prevent pain and other secondary mechanical or physiological movement restrictions. ● The patient will gain the necessary strength, endur- ance, and control of movement of the involved upper extremity in order to use the involved upper extremity spontaneously during the performance of ADL. ● The patient will gain visual function or will employ compensatory strategies in order to safely resume pre- viously performed ADL. ● The patient will improve motor planning ability in order to relearn old methods or learn new methods of performing ADL. ● The patient and/or caregiver will demonstrate appro- priate strategies for improving or compensating for cognitive deficits during the performance of ADL. ● The patient and/or caregiver will be able to verbalize the reality and impact of emotional reactions to stroke and identify coping strategies or resources to help ad- just to living with a stroke. ● The caregiver will demonstrate appropriate methods and problem-solving strategies for assisting the patient with ADL and with home activities to improve/preserve performance skills. ● The patient will gain competence in tasks and activities necessary to resume valued roles or to assume new meaningful roles in the community

Answer 162

the patient’s stage of recovery, intervention setting, living environment, extent of impairment, and personal goals and preferences *Safety of the patient, during and after treatment, is a concern during all phases

Answer 163

- Impaired postural adaptation, bilateral integration - Impaired mobility - Decreased independence in any or all basic activities of daily living (BADL) and instrumental activities of daily living (IADL)

Answer 164

- Decreased awareness of environment, decreased ability to adapt to environment - Impaired ability to read, write, navigate during mobility, recognize people and places, drive; can affect all BADL and IADL

Answer 165

- Impaired speech and comprehension of verbal or written language; inability to communicate, read, or comprehend signs or directions - Decreased social, community involvement; isolation

Answer 166

Slurred speech, difficulty with oral motor functions such as eating, altered facial expressions

Answer 167

Increased risk of injury to insensitive areas Impairment of coordinated, dexterous movement

Answer 168

- Loss of independence in toileting | - Increased risk of skin breakdown Decreased social, community involvement

Answer 169

- At risk for aspiration | - Impaired ability to eat or drink by mouth

Answer 170

Decreased independence in any motor activity (ADL, speech, mobility), decreased ability to learn new tasks or skills

Answer 171

Decreased independence in BADL and IADL, decreased ability to learn new techniques, decreased social interactions

Answer 172

Decreased motivation, participation in activity; decreased social interaction

Answer 173

consciousness, vision, extraocular movements, facial palsy, limb strength, ataxia, sensation, speech, and language

Answer 174

- developed to be a more comprehensive measure of outcomes for stroke survivors - The scale is a self-report interviewer-administered measure with questions pertaining to higher level functions of affected limbs, memory and thinking, mood and emotions, communication skills, home and community mobility, typical daily activities, and participation in meaningful life roles.

Answer 175

is an observed measure that ranks quality of per- formance of activities such as using a telephone, managing medications, and handling finances.

Answer 176

though: seated and standing and during self-care tasks such as dressing, transfers, and bathing BUT can also use tests like Berg Balance Test, The functional Reach Test

Answer 177

increased risk of falls, contracture and deformity, diminished sitting and standing endurance, decreased visual feedback and swallowing effectiveness secondary to head and neck misalignment, and impaired ability to interact with the environment

Answer 178

As a result, the patient must devote increased effort to remaining upright, with decreased ability to focus on purposeful tasks. When engaging in a challenging activity, the hemiplegic patient often resorts to compensatory strategies to help maintain stability, such as using upper extremities for support

Answer 179

- somatosensory (these types of tests on its own require attention, recognition, and response to many stimuli) -->observe reactions - ->tests that could be used two point discrimination, and Moberg Pick-up Test - Mechanical and physiological components - ->muscle tone, pain - ->ask if this was pervious or new - ->Shoulder Subluxation - Voluntary Movement - -> reflexive movement - ->DO proximal stabilize to provide support - ->can you perform isolated actions Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) -describe upper extremity motor impairment - Strength and Endurance - Methods used to quantify muscle strength after stroke include assessments of motor performance (e.g., Fugl-Meyer), manual muscle testing, dynamometry to measure grip strength, and measurements of active range of motion - Functional Performance - One difficulty in measuring function after stroke results from the normal differences in performance ability between dominant and nondominant arms. Eating with utensils, combing hair, and writing, for example, are normally performed by the dominant arm; testing the abil- ity of a hemiparetic nondominant arm to perform these tasks is not relevant or useful to a patient. - The Functional Test for the Hemiplegic/Paretic Upper Extremity

Answer 180

- standardized test developed by occupational therapists specifically to evaluate patients’ ability to use the hemiplegic upper extremity for purposeful tasks. - 17 tasks divided into seven functional levels that range from absence of voluntary movement to selective and coordinated movement

Answer 181

- Postural Adaptation - Upper extremity function - Motor Learning ability

Answer 182

Visual function - homonymous hemianopsia - hemi-neglect or unilateral neglect. - ->most challenging IADL were driving, shopping, financial management, and meal preparation, all requiring one or more of the performance skills of mobility, reading, or writing Speech and Language - Aphasia - Dysarthria Motor Planning - Failure to orient the head or body correctly to a task, --> also hand - ->difficult initiating - ->hesitation and preservation - -> does not follow command unless similar object Cognition - decreased safety awareness and difficulty learning new techniques for performing tasks. - performance-based assessments: focusing on the adaptive abilities of planning, initiation, organization, sequencing, judgment, and problem solving are more predictive of real-world ability Psychosocial Aspects - denial, frustration, anger, impatience, irritability, overdependence, apathy, aggression, insensitivity to others, and rigid thinking - decreased social participation, and eventual isolation

Answer 183

Early Mobilization and Return to Self-Care Lowering Risk for Secondary Complications - Skin care - ->proper transfers, bed and seating positions, seating selection (appropriate wheelchair), watching for signs - maintaining soft tissue length - -> Proper positioning and soft tissue and joint mobilization. - fall prevention - ->detecting and removing environmental hazards, scheduled routine toileting, optimizing motor control, recommending appropriate adaptive devices, and teaching safety measures to the patient and family. - patient And Family education - ->realistic understanding of the causes and consequences of stroke and the process, goals, and prognosis of rehabilitation

Answer 184

Treatment to improve performance of Occupational Tasks - ADLs and IADLs - -> IADL tasks such as homemaking, home management, and community mobility involve greater interaction with the physical and social environment and require higher level problem- solving and social skills than BADL tasks Treatment to Improve Performance Skills and Client Factors - Postural adaptation - Upper extremity function - Motor learning abilities

Answer 185

- Joint and soft-tissue integrity - Voluntary movement and function of involved upper extremity - Somatosensory perception - Visual-Perceptual skills - Cognitive skills

Answer 186

-->providing feedback, using various postures standing rather than sitting (grading the activity), reaching, bimanual activities so they have to sit or stand unsupported

Answer 187

somatosensory - safety concerns, impaired grasp and manipulation skills in the affected hand, reduced ability to regain skilled movements necessary for ADL, and impaired spontaneous use of the affected hand, frequently leading to learned nonuse - The patient is encouraged to use the involved hand in ADL as soon as possible and use different textures (e.g., foam, terry cloth, and Velcro®) on weight-bearing surfaces or on the holding surfaces of commonly used utensils, such as cups, forks, and pens. Mechanical and Physiological Components of Movement. -Alternative positioning methods and devices for shoulder support include taping of the shoulder and scapula (Ridgway & Byrne, 1999), wheelchair lapboards and armrest troughs, use of a table while seated or standing, putting the hand in a pocket or under a belt, and using an over-the-shoulder bag while standing reaching -frequent changes of position to prevent contractures and pain and recognize that if a patient is only moving his affected arm during therapy sessions, then therapy alone may not provide sufficient soft-tissue lengthening to maintain full ROM -self-managed ROM include bilateral activities such as having the patient clasp his or her hands while leaning forward to reach for the floor or pushing both hands forward with arms supported on a towel on a table Voluntary Movement and Function: -Treatment should progress from unilateral activities, in which the patient can concentrate fully on control of the hemiparetic arm, to bilateral simultaneous activities, in which both arms perform the same movement together (such as lifting and carrying a box and catching and throwing a large ball), to bilateral alternating activities, in which the two arms perform different movements at the same time (such as sorting and assembling nuts and bolts) Task-Specific and Task oriented Intervention -->target a meaningful occupation Constraint-Induced Movement Therapy Emerging Techniques and Technologies.

Answer 188

Visual Dysfunction - (1) establish or restore the person’s performance skills or (2) modify the context of the activity and/ or environment - visual scanning ability using functional activities to increase the speed and accuracy of visual search to the area of the VFD or by training in the compensatory skill of turning the head to the left - simplifying activity demands, such as locating all items needed for grooming in one drawer; simplifying task sequence, such as installing a speed dial feature on a phone; or altering the built environment to eliminate clutter and obstacles Speech and Language Disorders - promote proper posture to aid respiration and eye contact important to speech. - (counting repetitions of an activity or naming objects used) or addressing functional reading and writing tasks (reading signs and recipes or writing checks). Motor Planning Deficits. Cognitive Deficits - retraining of specific component skills, teaching compensation techniques or substitution of intact abilities, and adaptation of the environment - prompts or cues to shape desired behavior; providing feedback on performance with suggestions and strategies for improvement; providing visual aids, such as memory logs, checklists, maps, or diagrams for deficits of memory, sequencing, or organization; and simplifying the environment and grading tasks for patients with attention deficits. Psychological adjustments -reinforce the efforts of the rehabilitation team and encourage patients and families to talk about their reactions to stroke and their comprehension of its progression and prognosis. -recognize the signs and symptoms of depression and inform appropriate team members if treatment has not been initiated develop coping strategies, including problem-solving strategies, social support, information seeking, and engagement in activities, helps decrease the impact of psychological distress

Answer 189

-Avoid unnecessary noise: -Do not speak to the patient or request speech when he or she is engaged in a physical activity -Allow enough time for the patient to respond; -Never assume that the person with aphasia cannot understand what is being said; -Speak slowly and clearly using simple, concise language; Use demonstration, visual cues, and gestures as needed to help with comprehension.

Answer 190

Discharge planning - discharge setting; training the patient, family, and caregiver in essential skills; and arranging for continuity of care with community services Patient, Family and Caregiver Education - techniques and problem-solving strategies for use after rehabilitation - demonstration, experiential sessions, and written instructions Resuming valued roles - work: appropriate work-readiness training should be encouraged - interventions to address return to work must focus on the individual (e.g., adjustment to disability), work (physical and psychological demands of a client’s job), and community (e.g., access to transportation)—emphasizing the person-environment-occupation fit rather than impairments after stroke. - Leisure: many report decreased energy, motivation, or time for leisure pursuits because of fatigue, depression, and/or the increased demands of self-care - may give up golf rather than play at a reduced level of performance -Sexuality: reassure their clients that these problems are common and that sexual activity after stroke is not contraindicated - Driving - -> (1) a pre-driving evaluation battery to test for visual scanning, visual attention, higher level visual-cognitive skills, distractibility, mental slowness, problem solving, and ability to follow directions; (2) a driving simulator evaluation; and (3) a road test, both on a protected course and in traffic - Community support and resources - ->facilities maintain current inventories of community resources, provide this information to stroke survivors and their caregivers, and offer assistance in obtaining needed services -Post-discharge continuity of Care

Answer 191

It helps clinicians to communicate about a patient’s level of cognitive function among themselves and with families and to develop appropriate rehabilitation strategies

Answer 192

Agitated behavior Scale: --> Measure of agitation that can be used to measure changes in agitation level over time (Center for Outcome Measurement in Brain Injury [COMBI], 2011). Consists of 14 items. Total score reflects overall agitation, with subscales specific to disinhibition, aggression, and lability. Disability Rating Scale --> Provides quantitative information on recovery from severe traumatic brain injury (TBI) from coma to community (COMBI, 2011). Consists of eight items in four categories: arousal and awareness; cognitive ability to handle self- care functions; physical dependence on others; and psychosocial adaptability for work, housework, or school. JFK Coma Recovery Scale-Revised -->Detects subtle changes in neurobehavioral status to differentiate between vegetative and minimally conscious states and identifies emergence from minimally conscious state (COMBI, 2011). Twenty-three items in six areas: auditory, visual, motor, oromotor-verbal, communication, and arousal. Specific stimuli are administered to elicit specific responses with responses criterion referenced. Western NeuroSensory Stimulation Profile (Ansell & Keenan, 1989) -->Assesses cognitive function in severely impaired adults (Rancho levels II–IV) and monitors change in noncomatose patients who are slow to recover. Battery consists of 32 items related to arousal, attention, response to stimuli, and expressive communication and results in a profile of six subscales that summarize individual patterns of responses.

Answer 193

brain injury was able to follow a verbal command to squeeze her hand. The protocol began with the therapist performing passive range of motion (PROM) to the patient’s right hand, placing the patient’s hand in hers, and then waiting 1 minute. There were three conditions: (1) correct command (“Squeeze my hand”), (2) incorrect command (“Tie your shoes”), and (3) observation period (equal duration, but no command given).

Answer 194

- include both preventative and restorative strategies - minimize or avoid pulmonary and urinary tract infections; skin breakdowns; and muscle, tendon, and soft-tissue contractures - fostering alertness and goal-directed behavioral responsiveness and may include pharmacotherapy with centrally activating medications, thalamic deep brain stimulation, and sensory stimulation procedures - Positioning - Side-lying or semiprone in bed, if permitted, with good body alignment is preferable to supine if the patient has abnormal posture - small pillow, should be in neutral alignment with the trunk; the bottom upper extremity should be in moderate scapular protraction and humeral external rotation; the top upper extremity should be in scapular protraction, slight shoulder flexion, and resting on a pillow to avoid horizontal adduction; the bottom elbow should be flexed; the top elbow should be extended; wrists should be in extension; and cones should be placed in the hands to decrease spasticity and maintain thumb web spaces. - Passive Range of Motion - Splinting and Casting - Sensory Stimulation - ->promote arousal from coma, appropriate patterns of movement, and interaction with the environment - ->response to tactile, vestibular, olfactory, kinesthetic, proprioceptive, auditory, and visual stimuli - Management of agitation (see below) - Family Support and Education

Answer 195

for pupil changes; decreased neurological responses; abnormal brainstem reflexes; flaccidity; behavioral changes; vomiting; and changes in pulse rate, blood pressure, and respiration rate. Fluids may be restricted, or the patient’s head may be positioned in neutral at 30° of elevation in an attempt to regulate ICP.

Answer 196

Determine what factors are contributing to the problem. Clinicians examine the following variables: - Client: Extent and location of brain damage; state of bodily dysfunction, including pain; and pre-morbid factors such as intellect, personality traits, and coping style - Social: Persons present during maladaptive behavior; reinforcers - Physical Environment: The primary aim of behavior management at this phase is to avoid inadvertent reinforcement of undesirable behaviors while ensuring the continuation of medically necessary treatment and doing as little as possible to impede the natural course of recovery

Answer 197

- Ask family members to bring in familiar objects -quiet environment with minimal distracters -Provide orientation information and maintain a predictable daily structure and routine. Introduce yourself at each session, telling the patient where he or she is and what you are going to do

Answer 198

- maximize freedom of move- ment along with safety. Mittens without separations for the thumb may keep patients from pulling out tubes - Engage the patient in gross motor activities such as face washing, catching a ball, hitting a balloon, and putting on simple clothing, if he or she is able. Physical activity, walking, or even being wheeled in the wheelchair may help decrease agitation - Be prepared to change activity or take a break at the first sign that the patient is becoming restless or agitated. - Exude calm, confidence, and acceptance.

Answer 199

- screening vision, visual perception, and cognition - Clinicians must determine the extent to which patients can scan, attend, follow, and retain instructions to interpret performance on other traditional assessments, including upper extremity strength and function and activities of daily living (ADL)

Answer 200

Optimizing Motor Function. - optimizing motor, visual-perceptual, and cognitive functions; restoring competence in fundamental self-maintenance task - engaging them in gross motor activities that they can perform almost automatically, such as playing catch or hitting a punching bag. Such activities minimize the demands on weakened cognitive functions Optimizing Visual and Visual-Perceptual Function. -identify possible visual impairments as early as possible Optimizing Cognitive Function - Card or board games, puzzles, and paper-and-pencil tasks such as word recognition or letter or number cancellation drills, and computer programs - Occupational therapists also strategically place familiar pictures and objects, calendars, and clocks in the patient’s room to optimize orientation. Restoring Competence in Self Maintenance Tasks. - Bathing, dressing, hygiene, and eating. - Graded activities Contributing to Behavioral and Emotional Adaptation. -avoid placing patients in situations that are fraught with frustration and failure and instead structure experiences that reinforce patients’ confidence that they still have the potential to accomplish things Supporting patient family 1) the full spectrum of possible TBI outcomes to enhance realistic expectations; (2) the effects of TBI on family systems and possible alterations in family dynamics post discharge; (3) the benefits, challenges, and responsibilities of care- taking and supervision post discharge; and (4) resources available for postacute rehabilitation

Answer 201

Designed for interdisciplinary postacute rehabilitation; covers broad range of observable attributes, such as physical function, cognitive capacity, emotional status, social behavior, self-care, work, and driving (Center for Outcome Measurement in Brain Injury [COMBI], 2011). Patient’s status on 30 items is rated on a four- category scale: no impairment, impairment on clinical examination but does not interfere with everyday function, impairment does interfere with everyday function, or complete or nearly complete loss of function.

Answer 202

Twenty-two–item observational scale of attention-related behavior following TBI (COMBI, 2011). Items, which include behaviors indicative of good as well as impaired attention, are rated on a 5-point Likert-type scale.

Answer 203

Twenty-seven–item clinical rating scale measures common cognitive, behavioral, and emotional disturbances associated with TBI; used to track neurobehavioral recovery and measure behavioral change in response to intervention.

Answer 204

Thirty-item self-report measure to evaluate self-awareness following TBI (COMBI, 2011). The patient’s responses are compared to the ratings of a relative or therapist to identify discrepancies indicating overestimation of abilities. Domains include activities of daily living, behavioral and emotional function, cognitive abilities, and physical function.

Answer 205

Twenty-six–item measure of participation in five categories: (1) domestic life; (2) major life activities; (3) transportation; (4) interpersonal interactions and relationships; and (5) community, recreational, and civic life (COMBI, 2011). For each item, the person is asked about level of participation (objective), satisfaction with that level of participation (subjective), and how important that particular activity is to satisfaction with life (subjective). Objective and subjective responses contribute to total score.

Answer 206

Optimizing Cognitive Function (usually in Rancho level VII or VIII) - impairments in short- and long-term memory, reasoning, conceptualization, comprehension, abstract thinking, information-processing speed, organization of information, simplification of problems, judgment, and problem solving - environment to optimize occupational functioning - compensatory cognitive strategies, such as paper or electronic calendars/organizers, cueing devices, smart phones, and problem-solving schemata, in the context of personally relevant real-world tasks Optimizing Visual and Visual-Perceptual Function -ENVIRONMENTAL CHANGES: changes in lighting for reading and writing, oculomotor exercises, and strategy training, Restoring Competence in Self-maintenance Roles -homemaking tasks, such as cleaning, meal preparation, and laundry, occupational therapy addresses community reentry skills (IADLS) Restoring Competence in Leisure and Social Participation. -Social skills retaining: instruction and modeling of the social skill, practicing the skill with feedback, and shaping the skill until it is used correctly Restoring Competence in Work. -prevocational programs that focus on work behaviors and habits, such as punctuality, thoroughness, response to feedback, and ability to take and use notes. Supporting the Client’s Family. (1) the protracted nature of TBI recovery, (2) the experience of recovery from the patient’s perspective, (3) adjustment to and possible management of behavioral and personality changes (4) sexuality issues, (5) community resources, and (6) home adaptation.

Answer 207

1. Recommend that a life care plan be prepared for survivors of moderate to severe TBI 2. Promote to possible referral sources what you are able to do to enhance community integration and quality of life for persons with TBI. 3. Establish the kind of therapeutic relationship with clients and family members that will make them want to return to you for help 4. Make sure that the discharge from outpatient occupational therapy incorporates plans for follow-up and clear information regarding possible circumstances in the future when further occupational therapy services may be helpful.

Midterm Flashcards

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