Rehabilitation Sciences 3060A/B Final: TBI Case answers
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Department
Rehabilitation Sciences
Course Code
Rehabilitation Sciences 3060A/B
Professor
Thomas Overend

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Description
RS3060a: Marie and her TBI over Time Impairment Time after injury category 6 weeks (admit to acute rehab) 13 weeks (still in rehab) 5 months (20 weeks)now at homewith husbandin day hospital Cognitive not able to track auditory or visual exhibits shortterm memory loss oriented to person, time and place all the time stimuli inconsistently disoriented to time and place some improvement in shortterm memory and new does not respond to verbal oriented to person at all times learning, but still impaired commands can follow 2 and 3 step commands when in can follow 45 step commands does not vocalize or make any a closed environment (not distracted) performs best in a highly structured environment attempt to communicate otherwise easily distracted in open environment, easily distracted, needing otherwise can follow 1step commands in verbal cues open environment insight and safety awareness improved but still can attend to tasks for 5 minutes at most impaired impaired safety awareness still requires supervision (not physical assistance) decreased insight into her deficits with transfers Neuromuscular abnormal tone full and close to N strength and ROM in muscle tone N in all 4 extremities varying levels of strength in arms right arm and leg coordination is better now with slow movements and legs increased tone in left leg only and worse with faster ones, and still a problem in all 4 full assistance sit at side of bed impaired coordination in all 4 extremities extremities minimal assistance to maintain head can sit independently a little weaker on the left side control can react to challenges to her position can sit independently unable to stand (dynamic balance) with moderate reaching demonstrates normal dynamic balance control in requires full assistance to roll in bed ability sitting and standing and transfer bed to chair can stand for 35 minutes with minimal can move normally in bed (i.e. rolling) stage 3 decubitus ulcers both heels assistance gait aids can move normally from lying to sitting in bed moderate assistance to transfer to standing independent in a wheelchair at home walking inside (supervision only); outside requires some assistance Swallowing gastrostomy tube in place still using gastrostomy tube independent with eating; doing well with soft diet working with speech pathology for continues with speech pathology dysphagia Communication does not vocalize or make any exhibits expressive aphasia (Brocas non moderate expressive aphasia persists attempt to communicate fluent aphasia) but able to make basic needs known using verbal language has severe word retrieval deficits but normal receptive language skills
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