Recovery from Traumatic Brain Injury: Stages, Scales, and Factors, Lecture notes of Communication

Download Recovery from Traumatic Brain Injury: Stages, Scales, and Factors and more Lecture notes Communication in PDF only on Docsity! Stages of Recovery 1 Stages of Recovery From Injury Toward Independence Stages of Recovery 2 After completion of this module, the learner will be able to: Identify: the basic stages of recovery. the steps in the rehabilitation continuum. major assessment tools used to communicate diagnosis & prognosis. factors which influence recovery. Explain: Factors which influence recovery: Plasticity. New Growth. Rerouting. Time. Healthy Living. The Team. The Individual. Stages of Recovery 5 Types of Traumatic Brain Injuries TBI Open Internal Closed Stages of Recovery 6 Traumatic Brain Injury Definition: “Brain Injury is an insult to the brain, not of degenerative or congenital nature, the result of either an external physical force or internal cause, that produces an altered mental status, which results in an impairment of behavioral, cognitive, emotional, and/or physical functioning.” [Vermont Division Disability and Aging Services] Statistically: A TBI occurs every 21 seconds. 1.4 million people sustain a TBI annually in the United States. 230,000 people hospitalized annually with TBI. After 1st TBI, risk for 2nd is 3 times greater. After 2nd TBI, risk for 3rd is 8 times greater. TBI injuries cost more than $48.3 billion annually. [Center for Disease Control, 2007] Stages of Recovery 7 Rehabilitation “Rehabilitation implies the restoration of the patient to the highest level of physical, psychological, and social adaptation attainable. It includes all measures aimed at reducing the impact of the disability and handicapping conditions. It also aims at enabling disabled people to achieve optimum social integration.” [World Health Organization, 1986] “The process of restoration of skills by a person who has had an illness or injury so as to regain maximum self in a normal or near as normal manner as possible.” [www.medterms.com] Facilities and Levels of Care: Emergency Room (ER) Intensive Care Unit (ICU) Acute Rehabilitation Subacute Rehabilitation Day Treatment (a.k.a. Day Rehab or Day Hospital) Outpatient Therapy Home Health Services Community Re-entry Independent Living Programs Stages of Recovery 10 Stages of Recovery – Newest Scale Disorders of Consciousness Scale (DOCS): Northwestern University – first truly reliable measure of neurobehavioral functioning during coma that predicts recover of consciousness up to one year after injury with 86% certainty. 8 subscales: social knowledge; taste and swallowing; olfactory; proprioceptive (perception of one’s body in space) and vestibular (balance); auditory; visual; tactile; and testing readiness. Accurately detected improvements, declines, and plateaus in neurobehavioral functioning of unconscious patients. Repeated use improved medical and rehabilitation management during coma recovery. Detected previously undetected secondary medical complication, which were successfully treated. Stages of Recovery 11 Stages of Recovery - Coma 15-point scale: I. Motor Response 6 – Obeys commands fully 5 – Localizes to noxious stimuli 4 – Withdraws from noxious stimuli 3 – Abnormal flexion, i.e. decorticate posturing 2 – Extensor response, i.e. decerebrate posturing 1 – No response II. Verbal Response 5 – Alert and Oriented 4 – Confused, yet coherent, speech 3 – Inappropriate words & jumbled phrases consisting of words 2 – Incomprehensible sounds 1 – No Sounds III. Eye Opening 4 – Spontaneous eye opening 3 – Eyes open to speech 2 – Eyes open to pain 1 – No eye opening Glasgow Coma Scale Stages of Recovery 12 Stages of Recovery - Coma Used to estimated and categorized outcomes of TBI on basis of overall social capability or dependence on others. Final score determined by adding I + II + III. Number communicates to medical workers 4 possible levels for survival (15 = best; 0 = worst). Levels: Mild (13 - 15) Moderate Disability (9 – 12) Severe Disability (3 – 8) Vegetative State (Less than 3) Persistent Vegetative State Brain Death Based on the severity of the coma, this scale does NOT indicate severity or sequelae of long-term impairments Glasgow Coma Scale Stages of Recovery 15 Stages of Recovery – On-going National Institute of Neurological Disorders and Stroke lists: 1. Coma: totally reliant on medical staff. 2. Post-Traumatic Amnesia: severe agitation, restlessness, confusion. 3. Conscious with Severe Deficits: attentional, problem-solving, social, and memory deficits; focused on orthopedic or physical injuries. 4. Awareness: frustration, irritability, anger, and beginning anxiety and depression due to cognitive deficits; feeling pressure to return to responsibilities; over-estimating abilities and under-estimating problems; emotional lability; lowered tolerance for frustration. 5. Success When Structured: experiencing success due to cognitive improvement; complexity exhausts coping skills; increased insightfulness leads to significant depression and anxiety. 6. Return to Responsibility: coming to terms emotionally with what has happened and the outcomes; taking on some old responsibilities; experiences failures and fatigue; rebuilding confidence and self-esteem; building new life for self. Stages of Recovery 16 Stages of Recovery – On-going American Speech-Language-Hearing Association lists: 1. Coma: unresponsive; eyes closed. 2. Vegetative State: no cognitive responses; gross wakefulness; sleep- wake cycles. 3. Minimally Conscious State: purposeful wakefulness; responds to some commands. 4. Confusional State: recovered speech; amnesic; severe attentional deficits; agitated; hyperaroused; possible labile behavior. 5. Post-Confusional, Evolving Independence: resolution of amnesia; cognitive improvement; achieving independence in daily self-care; improving social interaction; developing independence at home. 6. Social Competence, Community Re-entry: recovering cognitive abilities; goal-directed behaviors; social skills; personality; developing independence in the community; returning to academic or vocational pursuits. Stages of Recovery 17 Stages of Recovery – On-going Based on scales and subscales measuring: Arousability, Awareness, & Responsivity eye opening communication ability motor response Cognitive Ability to for Self-Care feeding toileting grooming Dependence on Others/ Level of Functioning Psychosocial Adaptability/ Employability 29-point scale to determine level of disability: 0 No Disability 1 Mild 2 – 3 Partial 4 – 6 Moderate 7 – 11 Moderately Severe 12 – 16 Severe 17 – 21 Extremely Severe 22 – 24 Vegetative State 25 – 29 Severe Vegetative State Disability Rating Scale for Severe Head Trauma Patients: Coma to Community: Stages of Recovery 20 Stages of Recovery - Grief Dr. Elizabeth Kubler- Ross’s Grief Cycle Applicable to the loss the survivor and family are experiencing regarding “the old self – pre-TBI.” 5 stages: can cycle often don’t always go in order Denial Depression Acceptance Anger Bargaining Starts Here Stages of Recovery 21 Factors in Recovery People: The individual. The family. The team. Brain Biology: Plasticity. New growth. Rerouting. Time. Stages of Recovery 22 Factors in Recovery Biological factors which can affect the extent and pace of recovery: Plasticity: ability of the brain to reorganize neural pathways based on new experiences and new learning. New growth: structural remodeling of neurons and their dendrites over time following death of neighboring neurons. Rerouting: implantation of wireless brain chip can create artificial connections between different parts of the brain. Stages of Recovery 25 Post-Quiz – Part 1 True or False. _T_ 1. No two people recover from TBI in the same manner. PG 9 _F_ 2. Rancho Los Amigos and Glasgow Coma Scale are the only two scales for measuring recovery from TBI. _T 3. An individual’s work ethic can affect his/her recovery. PG 23 _F_ 4. Recovery is measured by extent and pace. _T_ 5. Formal rehabilitation is time-limited regardless of the severity of the injury. PG 8 _F_ 6. Recovery happens in the six months after the injury. __T 7. Social integration is a major tenet of rehabilitation. _T_ 8. Rehabilitation begins in the emergency room and/or intensive care unit. PG7 _T_ 9. An individual with TBI experiences Kubler-Ross’s stages of grief in the loss of their “old self.” PG20 _F_ 10. Plasticity only applies to children’s brains. Stages of Recovery 26 Post-Quiz – Part 2 Put these levels of care in order beginning with care given immediately following the injury. __9__ a. Independent Living Program __4__ b. Sub-acute rehabilitation __6__ c. Out-patient therapy ___5_ d. Day treatment __1__ e. Emergency room ___7_ f. Home health services __2__ g. Intensive care unit __8__ h. Community re-entry __3__ i. Acute rehabilitation True or False. Indicate whether each of these items is a factor in an individual’s recovery. _T_ 1. quality of insurance coverage _T_ 2. sense of humor __T 3. communication within the team _T_ 4. insight into impairment(s) _T_ 5. ability to admit having a TBI _T_ 6. person-centered programming _T 7. knowledge of rehabilitation systems _T_ 8. pre-injury health _T_ 9. time ___ 10. blaming NEGATIVE FACTOR, NEED TO ADJUST QUESTION Stages of Recovery 27 Post-Quiz – Part 3 Explain: 1. how the following scales aid in measuring TBI recovery: a. Disorders of Consciousness Scale (DOCS REPEATED USE IMPROVED MEDICAL AND REHAB MANAGEMENT DURING COMA AND RECOVERY. DETECTED PREVIOUSLY UNDETECTED SECONDARY MEDICAL COMPLICATION, WHICH WERE SUCCESSFULLY TREATED. pg10 b. Rancho Los Amigos Scale (RLA): PROVIDES FEEDBACK TO MEDICAL STAFF ON EFFECTIVENESS OF REHAB. REHAB CAN BE IMPROVED IF THE TEAM RESPONDS TO CHANGES IN THE SCALE OVER TIME AND THERAPIES. Pg 14 c. Glasgow Coma Scale (GSC): USED TO ESTIMATE AND CATEGORIZE OUTCOMES OF TBI ON BASIS OF OVERALL SOCIAL CAPABILITY OR DEPENDENCE ON OTHERS. # COMMUNICATES TO MEDICAL WORKERS 4 POSSIBLE LEVELS FOR SURVIVAL pg12 d. Disability Rating Scale (DRS): 29 POINT SCHALE TO DETERMINE LEVEL OF DISABILITY - COMA TO COMMUNITY pg17 2. the emotional stages of recovery. There are 6 stages of emotional recovery. Confusion & agitation, denial, anger and depression, testing phase, uneasy acceptance, and coping pg 18 3. the family adjustment stages. 6 stages- shock, begin to recognize severity, start to get annoyed with the survivor, beginning realism, profound sadness, accept that person may never be the same. Pg 19 4. biological factors in recovery. Plasticity, new growth, rerouting pg 22 5. individual factors affecting recovery. Work ethic, sense of humor, unselfishness, insight, healthy living, co-operation with other members of medical and rehab team, ability to admit to having a brain injury, use of support groups to talk about frustrations, pre-injury health (physical, mental & emotional) pg 23