Physical Medicine /
Rehabilitation (2)
KNR 365
Porter & burlingame, 2006
• Traumatic Brain Injury
▫ Pp. 142-145
• Spinal Cord Injury
▫ Pp. 129-133
Traumatic Brain Injury (TBI)
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
Glasgow Coma Scale
Ranchos Los Amigos Scale
Level 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
Ranchos Los Amigos Scale
Level of Cognitive Functioning / Recovery
• V = Confused, inappropriate, nonagitated
behavior, alert, highly distractible, responds to
simple commands
• VI = Confused but appropriate behavior, goaldirected, uses external input for direction
Ranchos Los Amigos Scale
Level 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
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
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
Spinal Cord Injury (SCI)
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 (C1C4)
6. Levels of injury (C5-C8)
7. Levels of injury (T1-T12)
8. Practice advice for coping with
spinal cord injury
Sheppard Center
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%
SCI Classification of Injury
• Spinal fracture
▫ Can break back or neck and still not have a spinal
cord injury
▫ Bones around spinal cord break
SCI Classification of Injury
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30.8% incomplete tetraplegia
26.6% complete paraplegia
19.7% incomplete paraplegia
18.6% complete tetraplegia
American Spinal Injury Association
Impairment Scale
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
CTRS Need Knowledge of….
• Catheters (pp. 222-223)
• Jejunostomy, ileostomy, colostomy (pp. 216219)
▫ Odor & leaking can be a problem for socialization
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Transfers (p. 653)
Self care in the community
Community problem solving
ADA education
Adaptive equipment
Others (see pp. 132-134)
TR Interventions
• Rehabilitation Institute of Chicago (#1 since
1991)
▫ http://www.ric.org/
▫ TR:http://www.ric.org/conditions/specialized/th
erapeutic-rec/
 Also Adaptive Sports & Fitness Program
• Kessler Institute for Rehabilitation, NJ (#2)
▫ http://www.kessler-rehab.com/
▫ RT: http://www.kessler-rehab.com/patientcenter/PatientActivities.aspx
TR Interventions
• Shepherd Center, Atlanta, GA
▫ http://www.shepherd.org/
▫ Was TR Now RT:
http://www.shepherd.org/resources/therapeuticrecreation
• ***Community Reintegration
▫ Community Integration Program, Armstrong &
Lauzen, 1994
• Sports clinics
• Accessibility
IRF-PAI
https://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
FIM
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Functional Independence Measure (FIM)
Used in rehabilitation
Basic indicator of severity of disability
Can be administered quickly
Can be administered to groups
Discipline free
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
FIM Areas
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Eating
Grooming
Bathing
Dressing
▫ Upper body
▫ Lower body
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Toileting
Bladder Management
Bowel Management
Transfers
▫ Bed, chair, wheelchair
▫ Toilet
▫ Tub, shower
• Locomotion
▫ Walk, wheelchair
▫ Stairs
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Comprehension
Expression
Social Interaction
Problem Solving
▫ See scale
▫ https://www.cms.gov/Medicar
e/Medicare-Fee-for-ServicePayment/InpatientRehabFacP
PS/Downloads/IRFPAImanual-2012.pdf
▫ Worksheet
▫ Marianjoy handout
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)
LCM
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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
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
LCM Subscales
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Leisure awareness
Leisure attitudes
Leisure skills
Cultural/social behaviors
Interpersonal skills
Community integration skills
Social contact
Community participation
Additional Outcome Assessments
• Rehabilitation Measures Database
• http://www.rehabmeasures.org/default.aspx
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Glasgow Coma Scare
ASIA
Rancho
Life Satisfaction Questionnaire
Community Integration Questionnaire
WHO Quality of Life – BREF (several languages)
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Physical Medicine / Rehabilitation (2)