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TBI

QuestionAnswer
Decorticate rigidity UE spastic flexed position with internal rotation and adduction LE spastic extended with internal rotation and adduction
Decerebrate rigidity UE and LE spastic extension, adduction, internal rotation Wrist and fingers flex Plantar portions of feet flex and invert Trunk extends Head retracts
Midbrain damage impaired righting reflexes
Basal ganglia damage absence of equilibrium reactions and protective extension
Peripheral nerve or plexus injury muscle weakness with absence of tone
Cerebellar damage ataxia
Coma No response to environmental stimuli No sleep-wake cycle Eyes don't open to stimuli or spontaneously
Vegetative state No awareness or ability to interact with self or env no sustained, reproducible, voluntary or behavioral response to sensory stim no language/expression sleep-wake cycles vary ability to regulate temp, breathing, circ incontinent onset w/i 1 month
Minimally conscious state definite behavioral evidence of awareness of self, environment, or both discernible reproducible behavior in one or more of the following: ability to follow commands, gesterual or verbal yes-no, intelligble verbalization, purposeful movement
Glasgow coma scale Scores below 8: severe Between 9 and 12: moderate 12 and up: minor Assesses motor response, verbal response, eye opening
Glasgow: Motor response in response to pain No response 1 point Rigid and extended response to pain (decerebrate) 2 points flexion (decoritcate) 3 points Pull part of body away 4 points purposeful movement 5 points obeys commands to perform various movements 6 points
Glasgow: Verbal No response 1 point incomprehensible speech 2 points inappropraite words 3 points confused conservation but able to answer questions 4 points oriented to person, place, time 5 points
Glasgow: Eye opening No response 1 point to pain only 2 points when asked with loud voice 3 points spontaenous opens eyes on own 4 points
Ranchos Level 1 no response, completely unresponsive
Ranchos Level 2 Generalized response inconsistent and nonpurposeful reactions to stimuli
Rancho Level 3 Localized response reacts specifically to stimuli inconsistenly
Rancho Level 4 Confused/agitated Heightened state of activity with severely decreased ability to process information
Rancho Level 5 Confused, inappropriate nonagitated alert with fairly conssitent reactions increased complexity of commands causes more random response IPR Level 5 and up
Rancho Level 6 Confused, appropriate goal directed behavior but is dependent on external input for direction
Rancho Level 7 automatic appropriate behaves appropriately and is oriented to palce and routine but displays shallow recall
Rancho 8-10 purposeful and appropriate A and O able to recall and integrate past and recent events 8-10 varying level of assist for ADL
Acute phase of TBI intervention positioning, PROM, splinting, sensory stimulation, agitation management
Optimizing motor function skill acquisition, motor learning, exercise Begin with gross motor movements
Ataxia intervention weighting body parts and utensils
apraxia intervention hand over hand to repair damaged pathways
expressive aphasia intervention conversation exercises with OT recognizing errors and asking client to verbalize what they meant
Feeding adaptive equipment rocker knife, plate guard, nonspill mug
 

 



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