physical medicine / rehabilitation (2) knr 365. porter & burlingame, 2006 traumatic brain injury...
TRANSCRIPT
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Physical Medicine / Rehabilitation (2)KNR 365
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Porter & burlingame, 2006
•Traumatic Brain Injury▫Pp. 142-145
•Spinal Cord Injury▫Pp. 129-133
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Traumatic Brain Injury (TBI)
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Traumatic Brain Injury (TBI)
•http://www.braininjury101.org/ ▫Shepherd Center DVD with 5 chapters
Introduction and about this video Brain injury basics and anatomy of the brain Understanding traumatic brain injury, its
causes, effects and classifications Understanding non-traumatic brain injury
and stroke, its causes, effects and classifications
Practical advice for coping with brain injury
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Glasgow Coma Scale
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Ranchos Los Amigos ScaleLevel of Cognitive Functioning / Recovery•I = No response, comatose
•II = Generalized response, nonpurposeful, inconsistent
•III = Localized response, inconsistent reaction to specific stimuli
•IV = Confused, agitated, nonpurposeful behavior, inability to process information
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Ranchos Los Amigos ScaleLevel of Cognitive Functioning / Recovery
•V = Confused, inappropriate, nonagitated behavior, alert, highly distractible, responds to simple commands
•VI = Confused but appropriate behavior, goal-directed, uses external input for direction
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Ranchos Los Amigos ScaleLevel of Cognitive Functioning / Recovery
•VII = Automatic, appropriate behavior, robot like compliance with routine, shallow recall, increased awareness of others
•VIII = Purposeful, appropriate behavior, alert, oriented, independent functioning
▫Newer version has 10 levels (mentioned in video) but Porter & burlingame (2006) recommended using 8 levels until further validity and reliability are established
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Recommended TR Interventions
•I, II, III = Sensory stimulation, passive stretching, art, movement to music, cognitive retraining, reality orientation
•IV, V, VI = Aquatic therapy, expressive arts, leisure education, horticulture, behavior management, stretching & flexibility exercises, table & board games
▫Carter, Van Andel, & Robb, 2003
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Recommended TR Interventions•VII, VIII = Computer games, Community
integration, expressive arts, social skills training
Carter, Van Andel, & Robb, 2003
•Porter & burlingame (2006) report additional interventions, pp. 144-145
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Spinal Cord Injury (SCI)
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Spinal Cord Injury (SCI)http://www.spinalinjury101.org/ 1. Introduction and about
the video2. Anatomy of the spinal
cord and how it works3. Understanding spinal
cord injury, its causes, effects, and classifications
4. Tests, surgery, post-op devices, secondary complications and prevention techniques
5.Levels of injury explained (C1-C4)
6. Levels of injury (C5-C8)7. Levels of injury (T1-T12)8. Practice advice for coping
with spinal cord injury
Sheppard Center
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SCI Classification of Injury• Tetraplegia
▫Ranges from C1-T1▫Loss of feeling &/or movement in head, neck,
shoulder, arms, &/or upper chest▫51%
• Paraplegia▫T2-S5▫Loss of feeling &/or impaired ability to move
lower parts of body (chest, stomach, hips, legs, feet)
▫46%
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SCI Classification of Injury
•Spinal fracture▫Can break back or neck and still not have a
spinal cord injury▫Bones around spinal cord break
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SCI Classification of Injury
•30.8% incomplete tetraplegia•26.6% complete paraplegia•19.7% incomplete paraplegia•18.6% complete tetraplegia
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American Spinal Injury Association Impairment Scale
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SCI Classification of Injury
•Level of injury (e.g., C2)•Type of injury (complete, incomplete)•American Spinal Injury Association
Impairment Scale (e.g., AIS D)•Syndrome (e.g., central cord syndrome)
▫When spinal cord is not completely severed, deficits depend on part of the cross-section of spinal cord that is damaged
◦ Porter & burlingame, 2006, p. 130
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CTRS Need Knowledge of….•Catheters (pp. 222-223)• Jejunostomy, ileostomy, colostomy (pp. 216-219)
▫Odor & leaking can be a problem for socialization
•Transfers (p. 653)•Self care in the community•Community problem solving•ADA education•Adaptive equipment•Others (see pp. 132-134)
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TR Interventions•Rehabilitation Institute of Chicago (#1 since
1991)▫http://www.ric.org/ ▫TR:http
://www.ric.org/conditions/specialized/therapeutic-rec/ Also Adaptive Sports & Fitness Program
•Kessler Institute for Rehabilitation, NJ (#2)▫http://www.kessler-rehab.com/▫RT:
http://www.kessler-rehab.com/patient-center/PatientActivities.aspx
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TR Interventions
•Shepherd Center, Atlanta, GA▫http://www.shepherd.org/ ▫Was TR Now RT:
http://www.shepherd.org/resources/therapeutic-recreation
•***Community Reintegration▫Community Integration Program,
Armstrong & Lauzen, 1994•Sports clinics•Accessibility
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IRF-PAIhttps://www.cms.gov/InpatientRehabFacPPS/04_IRFPAI.asp
•Medicare Inpatient Rehabilitation Facilities Patient Assessment Instrument (IRF-PAI)
•Started 2002/Manual 2012/Instrument 10/2014•Similar to long term care (RAI/MDS)•Collected on all Medicare Part A fee-for-service
patients (some use on other patients too)•Assessed on admission & discharge•Assessment & reimbursement rate•Uses FIM in clinical section
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FIM
•Functional Independence Measure (FIM)•Used in rehabilitation•Basic indicator of severity of disability•Can be administered quickly•Can be administered to groups•Discipline free
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FIM (cont.)
•7 level scale▫Dependence to independence▫Ability to carry out activities independently
What usually does not what could do or what performed once
If difference in environments, use lowest score
Do not leave any area blank
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FIM Areas• Eating• Grooming• Bathing• Dressing
▫ Upper body▫ Lower body
• Toileting• Bladder Management• Bowel Management• Transfers
▫ Bed, chair, wheelchair▫ Toilet▫ Tub, shower
• Locomotion▫ Walk, wheelchair▫ Stairs
• Comprehension• Expression• Social Interaction• Problem Solving
▫ See scale▫ https://
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/Downloads/IRFPAI-manual-2012.pdf
▫ Worksheet▫ Marianjoy handout
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Alexian Brothers
•FIM (Social Interaction)•RICFAS (Rehabilitation Institute of
Chicago Functional Assessment Scale)▫Domain: Community Integration
Recreation Resource Awareness Leisure Skills Community Recreation Reintegration
(similar to LCM)
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LCM
•Leisure Competence Measure (LCM)•Not an assessment•Standardized tool to measure outcomes•Summarize & categorize information
gathered from a variety of TR assessment sources▫Functional▫Leisure assessment▫Individual preferences
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LCM (cont.)•Looks at capabilities or readiness for
community reentry•And actual levels of engagement/performance
•Consistent with FIM
•7 levels of functioning▫7 = complete independence▫1 = total dependence▫5 and below = dependent functioning
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LCM Subscales
•Leisure awareness•Leisure attitudes•Leisure skills•Cultural/social behaviors•Interpersonal skills•Community integration skills•Social contact•Community participation
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Additional Outcome Assessments
•Rehabilitation Measures Database •http://www.rehabmeasures.org/default.as
px▫Glasgow Coma Scare▫ASIA▫Rancho▫Life Satisfaction Questionnaire▫Community Integration Questionnaire▫WHO Quality of Life – BREF (several
languages)