tbi treatment 6-8

• With Rancho 6 patients, assess orientation, mobility, and awareness of safety.
• When evaluating a rancho 6, note vitals, recognition of staff and family, and ability to perform automatic tasks.
• Awareness and management of interpersonal relationships, environment, and time parameters indicate how independent a person will be.
• Initiating the next step is an appropriate intervention for levels 5 and up.
• The goal of initiating the next step is to get the person to initiate moving on to the next step in a sequence. We are trying to see if they can do it without giving them the exact order.
• The intervention "what time is it?" is appropriate for levels 6 and up. The goal is to have the person attend to the time throughout the session and initiate scheduled activities.
• Rancho 7 and 8 patients will be challenged with high level communication, social interaction, problem solving, awareness, memory, and high level balance activities.
• PT typically only sees Rancho 7 or 8 patients for high level balance deficits.
• An intervention for rancho level 7 is moving around the room. The goal is to have the patient navigate their way around the room to carry out a variety of tasks. Similar to what would be performed in the mall.
• The minimum mobility requirement to perform the HiMAT is walking over 20 meters independently without gait aids. Orthoses are permitted.
• The two outcome measures for high-level TBI patients are the HiMAT and the community balance and mobility scale.
• The HiMAT is better than both the BERG and FGA in patients who are late-stage TBI.
• The best three interventions for high-level TBI patients are complex balance, fitness, and cognitive challenge.
• Dual task training is a great intervention for late-stage TBI. This may include path finding activities, community outings, or following a schedule.
• Before discharge, bring the patient to community outings to see how they integrate. You may also allow them to be modified independent, which means they can roam the inpatient unit as they best see fit.
• If you have a patient who cannot go home, but is still progressing in inpatient rehab, they should be discharged to a SNF or nursing home.
• When planning for discharge, consider the home environment, level of comfort with family, and whether or not the patient needs 24 hour supervision.
• A decrease in sodium, or hyponatremia, is a predictor of poor prognosis.
• Normal ICP is 5 to 15 mmHg.
• Normal CPP is 60 to 80 mmHg.
• The ICP monitor must be clamped in order to provide therapy services. It must be replaced correctly after therapy in the exact same place.
• Hydrocephalus is an abnormal collection of CSF in the ventricles of the brain.
• Signs and symptoms of hydrocephalus include mental status change, headache, nausea, and blurred vision.
• Treating hydrocephalus includes the input of a ventriculoperitoneal shunt, medications, and continuous monitoring for signs and symptoms.
• CSF leakage is a secondary complication of TBI. CSF leaks through a hole in the skull. This may be spontaneous or traumatic.
• The symptoms of CSF leakage include clear, watery drainage from the nose or ear, headache, and vision changes.
• Management of CSF leak includes bed rest or surgery.
• The halo effect of leaking is typically seen with CSF leaks. Blood is seen in the center and is surrounded by CSF.
• Seizures are a secondary complication from TBI. They are very common in the early stages, so most patients will be on preventative medication.
• Undiagnosed fractures and dislocations are common secondary complications of TBI. Orthopedic injuries are not the primary concern, so they are typically not noticed until the patient is evaluated by PT.
• If the patient has an organ injury, they may not be able to be mobilized early.
• Management of orthopedic and organ injuries includes protection of the injury, education on precautions, and change in home setup as early as possible.
• Heterotopic ossification is a secondary complication of TBI.
• Heterotopic ossification is the formation of bone in soft tissues caused by trauma. It is common after traumatic injuries to the CNS>
• The most common places for heterotopic ossification are the hips and elbows.
• The acute signs and symptoms of heterotopic ossification are rapid loss of ROM, swelling, and warmth.
• Management of heterotopic ossification includes stretching, medication, spasticity management, and surgery (if function is impeded).