Physical Medicine / Rehabilitation (2)KNR 365

Porter & burlingame, 2006•Traumatic Brain Injury

▫Pp. 142-145

•Spinal Cord Injury▫Pp. 129-133

Traumatic Brain Injury (TBI)

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

Glasgow Coma Scale

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

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

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

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

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

Spinal Cord Injury (SCI)

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

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%

SCI Classification of Injury•Spinal fracture

▫Can break back or neck and still not have a spinal cord injury

▫Bones around spinal cord break

SCI Classification of Injury•30.8% incomplete tetraplegia•26.6% complete paraplegia•19.7% incomplete paraplegia•18.6% complete tetraplegia

American Spinal Injury Association Impairment Scale

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

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)

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

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

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

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

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

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

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)

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

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

LCM Subscales•Leisure awareness•Leisure attitudes•Leisure skills•Cultural/social behaviors•Interpersonal skills•Community integration skills•Social contact•Community participation

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)