Rancho Level I:

No response, total assistance

Rancho Level II:

Generalized response, total assistance

Rancho Level III:

Localized response, total assistance

Rancho Level IV:

Confused-agitated response, maximal assist

Rancho Level V:

Confused- inappropriate response, maximal assist

Rancho Level VI

Confused-appropriate response, moderate assist

Rancho Level VII

Automatic-appropriate response, minimal assistance

Rancho Level VIII

Purposeful - appropriate response, SBA

Rancho Level VIIII

Purposeful - appropriate - SBA / on request

Rancho Level X:

Purposeful - appropriate, MOD I

mTBI

Mild Traumatic Brain Injury aka concussion

Diffuse Axonal Injury

Most common structural damage in mTBI

mTBI Causes

Transfer of kinetic (mechanical) energy into the soft tissues of the brain which lead to either adverse chemical changes in the brain or direct damage to physical structures

mTBI criteria

confusion or disorientation, LOC for 30 minutes or less, PTA less than 24 hours, GCS of 13-15 post-injury

Post Traumatic Amnesia (PTA)

Mild TBI Classification

Normal structural imaging LOC: 0-30 AOC: from a moment to 24 hours PTA: 0-1 day GSC: 13-15 post-injury

Moderate TBI Classification

Normal to abnormal structural imaging LOC: >30min and <24 hour AOC: >24 hours PTA: >1 and <7 days GCS: 12-9

Severe TBI Classification

Normal to abnormal structural imaging LOC: >24 hours AOC: >24 hours PTA: > 7 days GCS: 8-3

Causes of Persistent Post Concussive Symptoms

mTBI; however, older than 40, female, injury mechanism related to trauma (DV), low economic status, substance misuse, pending litigations, and previous psych dx like anxiety and depression

Second Impact Syndrome (SIS)

When an athlete or individual sustains n initial concussion and then sustains a second head injury before symptoms from the first incident fully recover.

Chronic Traumatic Encephalopathy (CTE)

A degenerative disease of the brain that's likely cause by repeated blows to the head or concussions

Rehab Phases: Acute Rehab

Hospital based tx; ER, ICU, Surgical unit, polytrauma

Rehab Phase: Post Acute

Subacute rehab, comprehensive inpatient rehab, residential tx (home care)

Rehab Phase: Community Reintegration

Outpatient/Day tx serviced, home and community-based services, school and vocational services

Thalamus

Very top of the brain stem, "major relay station" for input and output information

Corpus Callosum

Located in the back of the brain, exchanges information between both hemispheres

Cerebellum

Back of the brain, controls balance and movement

Hippocampus

Part of the Limbic system known for storing memories/memory

Hypothalamus

Part of the Limbic system known as the "control center" for thirst, hunger, temp regulation or "fight or flight"

Cerebral Cortex

2 Hemispheres dedicated to the highest forms of thinking

Medulla

Lowest part of the brain stem, controls involuntary functions ex: breathing, bp, HR, swallowing

Pons

Middle of the brain stem, above the medulla, essential for facial movements, sensation, and hearing

Midbrain

Smallest part of the brain stem, involves elementary forms of seeing and hearing "alertness and arousal"

Anterior Cord Syndrome

Common anterior 2/3 of the cord controlled by 1 artery ex: loss of control, pain, temp sensation

Brown Sequard Syndrome

Ipsilateral paralysis on the side of the lesion and pain and sensation lost on the contralateral side

Posterior Cord Syndrome

Rare, but usually seen in operations in the spine, the person has strength, but no body awareness below level of damage

C.O.L.D.E.R -> C

Character - identify the sensation

C.O.L.D.E.R -> O

On set - Does anything off set the headache? any prior hx of H.A./migraines

C.O.L.D.E.R -> L

Location - identify where pain and sensation is

C.O.L.D.E.R ->D

Duration and Frequency - When was the H.A. noticed? how many days?

C.O.L.D.E.R -> E

Exacerbation - is there anything that causes the H.A.?

C.O.L.D.E.R -> R

Relief - Does anything help relieve or resolve it?

Ballismus

Quick failing movements

Choreiform

Continuous rapid, unpredictable movements

Dystonia

Extreme tone

Ataxia

Lack of muscle coordination during voluntary movements.

Selective Attention

Maintain attention in presence of competing distractors.

Divided Attention

Respond simultaneously to multiple task demands while maintaining speed and accuracy

Sustained Attention

Maintain attention with accuracy and efficiency over a period of time

Focused Attention

Perceive and respond to internal and external stimuli

Semantic Memory

Knowledge of facts, names, and general world knowledge

Working Memory

Ability to temporarily hold and active manipulate information

Episodic Memory

Memory of personal experiences and specific events that

Procedural Memory

Memory for skills and sequences "how to"

Role of Frontal Lobe

Primary region for executive functioning like planning, judgement, and adapting to novel situations

Metacognition

Awareness of one's own cognitive strengths and weaknesses

Anosognosia

Lack of insight into deficits and how they impact functions

Consequence-Based Behavior Change Procedure: Positive Re-enforcement

Adding stimulus to increase behavior

Consequence-Based Behavior Change Procedure: Negative Re-enforcement

Removing stimulus to increased behavior

Consequence-Based Behavior Change Procedure: Positive Punishment

Adding stimulus to decreased behavior

Consequence-Based Behavior Change Procedure: Negative Punishment

Removing stimulus to decreased behavior