Physical Medicine / Rehabilitation (2) KNR 365
Dec 22, 2015
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)