TBI

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Causes of brain injury
road accidents, falls, stroke, tumour
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Define primary BI
Mechanical effects of applied forces
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What can cause a secondary BI
Compromised oxygen supply, swelling, raised intracranial pressure.
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Early Management actions
minimise factors to cause secondary BI, stabilise other injuries and needs, examine neurological status.
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Define recovery
A process of reinstatement and compensation for lost functions
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What scale is used to monitor recovery
Braintree scale. 1 = coma, 6 = social reentry
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Study showing progression through the brain tree scale even 4 years post TBI
Katz et al, 2009
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Two types of factors associated with outcome
Acute injury related outcomes, and person factors
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Injury related factors
Overall severity, CT markers like midline shift, raised ICP, mass of lesion
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Person factors
Age, Gender (female better), cognitive reserve, social support, premorbid psychiatric history and coping style.
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Define neruopsychological rehabilitation
amelioration of cognitive, emotional, psychosocial and behavioural deficits. Goal planning approach in a partnership
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Where does rehab happen?
Many places! Hospital, care facilities, community teams, clinics, specialist services, in the home.
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Wilson's principles of good rehab 7
Theraputic environment, functional and personally relevant goals, measured outcomes, shared understanding of process, include psychological interventions, compensatory and retraining, work with family and caregivers
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Types of assessment undertake in intensive post acute rehab
cognitive assessment, mental capacity assessment in relation to complex decision making, mood assessment, behaviour assessment
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Problem with mood assessment in PAR
Confounded by communication and cognitive impairment and objectively difficult circumstances.
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Types of rehabilitation that take place
Cognitive rehabilitation, psychotherapy - adjust to impairments. Working with family and carers,
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What do they do with family and carer
manage expectations, coping with changes and facilitating adjustment,.
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Examples of home adaptions in continuing care
Stairlift, downstairs bathroom, shower/bath adaptions, widen doorways,
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Describe holistic neuropsychological rehab?
>1 yr after injury. 6 weeks intensive phase, 6 weeks integration phase
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What is in the intensive phase?
groups for understanding brain injury, attention and memory, executive fucntion, communication and mood.
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what is in the integration phase?
group and induvidual sessions tailored for the induvidial need, often alongside work trials. consolidate learning and generalise to new and everyday situations.
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Cochrane Reveiw of rehab for brain injury
Turner Strokes 2005. In moderate BI, benefits and more intensive programmes are associated with earlier functional gains.
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Turner Strokes 2008
Late rehab results in gains 5-10 years after injury. Vocational rehan increases return to work. Early rehab reduces length of hospital stay.
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Two approaches to NR
Restoration or compensation - but the two levels may interact.
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A function that is a huge problem after BI
Prospective memory. Most goal directed behaviour has a PM componant, so it is an importnat rehab target
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Examples of PM
Remembering to do a task at a future point in time. Buy milk on the way home, post a card in time for birthday, pay bill before a fine
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How can we describe PM
A multiprocess model. including retreival, enactment, intention formation etc.
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Where in the brain is associated with PM
rostral frontal cortex - fMRI Burgess 2000
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Attempt to restore PM
Repeated practice - raise your arm when i ring a bell. Sohlberg, 1992. Laborious with no evidence of generalisation.
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Ways to compensate for PM problems
change job, living environment, gadgets like gas cutoff when you leave. Use of strategies like notebooks, pillboxes, doorganisers.
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A study showing neuropage is useful
Wilson, 2001. 85% showed a significant improvement.
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What is important for targetting PM interventions?
Identifying the locus of the problem. Is it retrieval, enactment, maintentance, intention formation etc.
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Study showing that a reminder cue helps the executive demands of PM
Fish 2007 - reminder cues sent 8x a day to remind them to make a phone call. Still not perfect but better.
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Case study of RP
Fish manly and wilson, 2008
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What deficit did RP have?
Struggle to put intentions into action.
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How was she helped?
Improvments in goal attainment specific to periods of pager use.
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Another area that can be lost in TBI
Retrospective memory
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Why is it an important area to target
increas well being and reduce anxiety by maintaining personal identity
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Ways to improve retrospective memory
episodic memory- reminiscence books, semantic relearning. Sensecam.
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A sensecam study
Mrs B. Berry et al, 2006. hippocampal damage following limbic encephalitis.
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Another sensecam study
Browne 2009 - improves QoL.
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Ways for improving new learning
Context effects, methods of loci, spaced retrieval, etc. chunking. (chase and erikson, 1981)
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Evidence for mental health problems in TBI
Teasdale, 2001. 4 times more likely to die by suicide after brain injury relative to general population.
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Another evidence for hopelessness after TBI
Simpson and Tate, 2007. 172 outpatients with TBI. 35% clinically significant hopelessness.
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How can we help this?
Build features of impact of brain injury into the standard CBT model.
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How have models of memory helped rehab
Recognising the interconnections. many supervisory attention system processes.
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What do we need to guide rehabilitation
theories combining behaviour and biology. More neuroscience basis.
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Card 2

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Define primary BI

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Mechanical effects of applied forces

Card 3

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What can cause a secondary BI

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Card 4

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Early Management actions

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Card 5

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Define recovery

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