Brain Injury and dementia/Alz Flashcards
Glasgow coma scale
used for initial evaluation and continuing assessment to determine someone’s level of consciousness after a head injury
15 total points
15 is best score (fully conscious)
3 is worst (deep coma or death)
<8 severe
9-12 moderate
>13 minor
Glasgow - Eye response (E)
1 - no eye opening
2 - eyes open to pain
3 - eyes open to speech
4 - eyes open spontaneously
Glasgow - Verbal response (V)
1 - none
2 - incomprehensible sounds (moaning)
3 - inappropriate words
4 - confused (coherent, but some disorientation)
5 - oriented (self, place, time, situation)
Glasgow - motor response (M)
1 - none
2 - extension to pain (decerebrate response)
3 - flexion in response to pain (decorticate response)
4 - withdraws from pain
5 - localizes to pain (purposeful movements)
6 - obeys commands
Rancho Los Amigos
levels of cognitive functioning - 10 levels
Level I
no response
total assistance
Level II
generalized response
total assistance
reflex to painful stimuli
non purposeful movement
Level III
localized response
total assistance
some purposeful movement - withdrawal, turning away, following objects
some consistency
Level IV
confused/agitated
maximal assistance
alert and in high state of activity, purposeful attempts to remove tubes etc
aggressive/flight behavior
Level V
confused, inappropriate, non agitated
max assistance
may wonder randomly, not oriented, brief attention, severely impaired memory and confusion, inappropriate use of objects
unable to learn new information
socially inappropriate, no censor
Level VI
confused, appropriate
moderate assistance
inconsistently oriented
attend to highly familiar tasks with redirection
assistive memory aid with max A
emerging awareness
follow simple directions
more socially appropriate
Level VII
automatic, appropriate
min A for ADLs
consistently oriented
*min A for new learning; demo carryover of learning
monitor accuracy of doing things familiar/routine
min A for safety
unaware of others feelings/abilities
Levels VIII, IX, X
purposeful, appropriate
stand by assistance
complete familiar tasks with distraction
recall past and recent events
over/under estimates abilities
awareness/think of consequences with min A
depressed, irritable, self centered
IX - self monitor and estimate abilities
X - modified independent
allen cognitive levels
used for populations with psychiatric disorders, acquired brain injury, and/or dementia
the person performs 3 leather lacing stitches progressing in complexity
ACL 1
awareness and automatic actions
cognition is profoundly impaired
fleeting attention
total assistance, 24/7
intervention: sensory stim
ACL 2
limited awareness: postural, gross body movements
max A
very impaired cognition
righting reactions
prevent them from transferring on their own/wandering
aimless walking and grabbing
create calm, sensory rich environment
ACL 3
manual and repetitive actions - spontaneous in response to tactile cues
max attn span 30 min
mod A
unpredictable, remove unsafe items
do repetitive actions with tactile cues and demonstration
distinguishing objects, using them
ACL 4
pt may live alone with assistance
familiar activities, goal directed
min A, visual cues
make a sandwich
walk to familiar places, make a small purchase
sequencing, completing a goal, personalizing, rote learning
ACL 5
new learning occurs
cognition is mildly impaired
SBA
better attention
exploratory, trial and error, general learning
impulsivity, poor judgment, unable to anticipate errors
discriminating between parts of an activity, self-directed learning, considering social standards, consulting with others/collaboration
ACL 6
planning new activities
conceptual
independent
anticipate, plan, reflect
occasionally seek guidance
stage 1 Alz
very mild –> mild cognitive decline
others might not know, but you begin to notice and worry
intervention: engage in wellness behavior and exercise to decrease anxiety and promote success
post its, calendars, appointment books
stage 2 Alz
mild –> moderate decline
begin to withdraw from social situations, more anxiety, hostility, paranoia
intervention: structure, routine, environmental supports, reality orientation (photos)
stretching, walking, balancing, volunteering (simple)
stage 3 Alz
moderately severe decline
“go away! who are you!”
agitated, paranoia, delusions, sleep disturbance, wandering behavior, not oriented
intervention: safety comes first (remove sharp objects, add lighting, ID bracelet) over learned tasks with 2-3 steps
caregiver instruction
stage 4 Alz
severe decline
patients cannot communicate, incomprehensible, most likely bed ridden, need nursing care
intervention: positioning in bed, instructing caregivers with transfers and skin, promote comfort, controlled sensory stimulation
dementia
name for a group of symptoms caused by a disorder of the brain
Alzheimers accounts for 75%
Reisberg’s 7 stages of dementia - 2 categories
pre-dementia stages: 1-3
dementia stages: 4-7
Reisberg’s 7 stages
Stage 1: no cognitive decline
Stage 2: very mild cognitive decline, forgetfulness
Stage 3: mild decline, others start to notice, deficits in social skills
Stage 4: moderate decline (mild dementia), clear cut deficits, has orientation but difficulty with all IADLs
Stage 5: moderately severe decline (moderate dementia), cannot live alone, cannot recall major relevant facts, disoriented to time and place
Stage 6: severe decline (moderately severe dementia), cannot speak in complete sentences, cannot follow simple 2-step commands, very irritable, incontinent
Stage 7: very severe decline (severe dementia), bed bound, unintelligible, secondary complications
Allen cog levels (sweet spot)
Level 3: running stitch – repetitive; can use their hands to manipulate objects and perform simple repetitive tasks – sanding wooden bookends
Level 4: whipstitch - visual cues
Level 5: cordovan – live alone with some A
emergent awareness deficits
difficulty/inability to recall and correct errors
ex: cooking a meal but not putting anything away or cleaning up after
Decreased memory, poor sequencing, ideational apraxia –> most effective teaching one handed dressing techniques
physical prompts to initiate the steps in dressing (because it helps with initiation and completion of the task)
Problem solving steps
recognize and define a problem, identify alternate plans for solving, select a plan, organize steps, implement, and evaluate the outcome (laundry)
cerebellar dysfunction
strengthen proximal muscles, improve postural responses and stability
client who has moderately severe cognitive decline secondary to Alzheimer’s disease
does not have the ability to use cognitive compensatory strategies but would benefit from environmental cues and modifications.
cognitive ability to provide consent for treatment
The OTR needs to assess the client’s decision-making skills in order to determine if the client has the cognitive ability
A patient with poor initiation will benefit
from a structured 1:1 intervention session that involves a client-centered and motivating activity
