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. 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 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

7. 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, goal- directed, uses external input for direction

8. 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

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/ 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/http://www.ric.org/ ▫TR:http://www.ric.org/conditions/specialized/th erapeutic-rec/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/http://www.kessler-rehab.com/ ▫RT: http://www.kessler-rehab.com/patient- center/PatientActivities.aspxhttp://www.kessler-rehab.com/patient- center/PatientActivities.aspx

20. TR Interventions Shepherd Center, Atlanta, GA ▫http://www.shepherd.org/http://www.shepherd.org/ ▫Was TR Now RT: http://www.shepherd.org/resources/therapeutic- recreation http://www.shepherd.org/resources/therapeutic- recreation ***Community Reintegration ▫Community Integration Program, Armstrong & Lauzen, 1994 Sports clinics Accessibility

21. IRF-PAI https://www.cms.gov/InpatientRehabFacPPS/04_IRFPAI.asp 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

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/Medicar e/Medicare-Fee-for-Service- Payment/InpatientRehabFacP PS/Downloads/IRFPAI- manual-2012.pdfhttps://www.cms.gov/Medicar e/Medicare-Fee-for-Service- Payment/InpatientRehabFacP PS/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)