Physical Medicine / Rehabilitation (2)

1. Physical Medicine / Rehabilitation (2) KNR 365

2. Porter & burlingame, 2006 • Traumatic Brain Injury • Pp. 142-145 • Spinal Cord Injury • Pp. 129-133

3. Traumatic Brain Injury (TBI)

4. 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

5. Glasgow Coma Scale

6. 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

7. 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

8. 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

9. 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

10. 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

11. Spinal Cord Injury (SCI)

12. Spinal Cord Injury (SCI)http://www.spinalinjury101.org/ 1. Introduction and about the video 2. Anatomy of the spinal cord and how it works 3. 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

13. 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%

14. SCI Classification of Injury • Spinal fracture • Can break back or neck and still not have a spinal cord injury • Bones around spinal cord break

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

16. American Spinal Injury Association Impairment Scale

17. 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

18. 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)

19. 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

20. 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

21. IRF-PAIhttps://www.cms.gov/InpatientRehabFacPPS/04_IRFPAI.aspIRF-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

22. 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

23. 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

24. 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

25. 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)

26. 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

27. 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

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

29. Additional Outcome Assessments • Rehabilitation Measures Database • http://www.rehabmeasures.org/default.aspx • Glasgow Coma Scare • ASIA • Rancho • Life Satisfaction Questionnaire • Community Integration Questionnaire • WHO Quality of Life – BREF (several languages)