Brain Injury and dementia/Alz

Question 1

Glasgow coma scale

Answer 1

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

Question 2

Glasgow - Eye response (E)

Answer 2

1 - no eye opening
2 - eyes open to pain
3 - eyes open to speech
4 - eyes open spontaneously

Question 3

Glasgow - Verbal response (V)

Answer 3

1 - none
2 - incomprehensible sounds (moaning)
3 - inappropriate words
4 - confused (coherent, but some disorientation)
5 - oriented (self, place, time, situation)

Question 4

Glasgow - motor response (M)

Answer 4

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

Question 5

Rancho Los Amigos

Answer 5

levels of cognitive functioning - 10 levels

Question 6

Level I

Answer 6

no response
total assistance

Question 7

Level II

Answer 7

generalized response
total assistance

reflex to painful stimuli
non purposeful movement

Question 8

Level III

Answer 8

localized response
total assistance

some purposeful movement - withdrawal, turning away, following objects
some consistency

Question 9

Level IV

Answer 9

confused/agitated
maximal assistance

alert and in high state of activity, purposeful attempts to remove tubes etc
aggressive/flight behavior

Question 10

Level V

Answer 10

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

Question 11

Level VI

Answer 11

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

Question 12

Level VII

Answer 12

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

Question 13

Levels VIII, IX, X

Answer 13

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

Question 14

allen cognitive levels

Answer 14

used for populations with psychiatric disorders, acquired brain injury, and/or dementia
the person performs 3 leather lacing stitches progressing in complexity

Question 15

ACL 1

Answer 15

awareness and automatic actions
cognition is profoundly impaired
fleeting attention
total assistance, 24/7
intervention: sensory stim

Question 16

ACL 2

Answer 16

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

Question 17

ACL 3

Answer 17

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

Question 18

ACL 4

Answer 18

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

Question 19

ACL 5

Answer 19

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

Question 20

ACL 6

Answer 20

planning new activities
conceptual
independent
anticipate, plan, reflect
occasionally seek guidance

Question 21

stage 1 Alz

Answer 21

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

Question 22

stage 2 Alz

Answer 22

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)

Question 23

stage 3 Alz

Answer 23

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

Question 24

stage 4 Alz

Answer 24

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

Question 25

dementia

Answer 25

name for a group of symptoms caused by a disorder of the brain
Alzheimers accounts for 75%

Question 26

Reisberg’s 7 stages of dementia - 2 categories

Answer 26

pre-dementia stages: 1-3
dementia stages: 4-7

Question 27

Reisberg’s 7 stages

Answer 27

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

Question 28

Allen cog levels (sweet spot)

Answer 28

 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

Question 29

emergent awareness deficits

Answer 29

difficulty/inability to recall and correct errors
ex: cooking a meal but not putting anything away or cleaning up after

Question 30

Decreased memory, poor sequencing, ideational apraxia –> most effective teaching one handed dressing techniques

Answer 30

physical prompts to initiate the steps in dressing (because it helps with initiation and completion of the task)

Question 31

Problem solving steps

Answer 31

recognize and define a problem, identify alternate plans for solving, select a plan, organize steps, implement, and evaluate the outcome (laundry)

Question 32

cerebellar dysfunction

Answer 32

strengthen proximal muscles, improve postural responses and stability

Question 33

client who has moderately severe cognitive decline secondary to Alzheimer’s disease

Answer 33

does not have the ability to use cognitive compensatory strategies but would benefit from environmental cues and modifications.

Question 34

cognitive ability to provide consent for treatment

Answer 34

The OTR needs to assess the client’s decision-making skills in order to determine if the client has the cognitive ability

Question 35

A patient with poor initiation will benefit

Answer 35

from a structured 1:1 intervention session that involves a client-centered and motivating activity