Ch 5: Disorders Of Consciousness Flashcards
What does DOC stand for?
Disorder of consciousness
How many individuals in the US are classified in a vegetative state annually?
4,200
How many people in the US present with a DOC annually?
315,000
Of those, 35,000 are in a vegetative state and 280,000 are minimally conscious
What are the three continuum stages of DOC?
- Coma
- Vegetative state
- Minimally conscious state
**Lowest to highest functioning
Arousal
Primitive, involuntary responsiveness to the world, as demo’d by reflex (generalized) responses to both internal and external stimuli.
The reticular activation system (RAS), a collection of primitive structures and nerve pathways within the brain, is responsible for maintaining arousal
Awareness
Refers to an individuals ability to receive and process sensory info and use that info to relate in an intentional way to the outside world
Required for voluntary responses to stimuli and is regulated by the higher cortical areas in the cerebrum
Minimally conscious state
Condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demo’d.
Intermittent/inconsistent behavioral reactions that demo conscious awareness
Localized responses
May remain at this level for extended period of time
Coma
No behavioral evidence of arousal and demonstrates no voluntary response to internal or External stimuli; reflexes may be observed.
Eye opening absent No sleep/wake cycle Resolves within 2-4 weeks (either pass away or progress) Impaired spontaneous breathing Impaired brainstem reflexes No vocalizations > 1hr
Vegetative state
Complete absence of behavioral evidence for awareness of self and environment, with preserved capacity for spontaneous or stimulus induced arousal
Responses to stimuli are generalized, nonpurposeful and nonspecific
+sleep/wake cycle
No visual pursuits
Persists for months to years w/o measurable improvement
Emergence from DOC
Given at least one of the criteria:
- Fxal communication as demo’d by verbal or gestural yes/no response
- Fxal use of 2 or more objects (ie: cup, hairbrush)
Complications
Central apnea
Autonomic dysfunction syndrome
Metabolic distress
Dystonia
Common medical challenges associated w/ DOC
Skin breakdown
Respiratory
Bowel/bladder dysfunction
Autonomic dysfunction syndrome
Autonomic dysfunction syndrome
Occurs in 15-33% of severe TBIs who score < or equal to 8.
Imbalance in the autonomic nervous system, located in the medulla- regulates automatic bodily functions (respiration, HR)
Symptoms: dystonia, agitation, tachycardia, diaphoresis, hyperthermia, HTN, tachypnea
Tx: Environmental control and Pharmacological intervention
Pharmacological neuromodulation
The use of medication to affect arousal and awareness.
Stimulate the CNS
Antidepressants, dopaminergic agents, and drugs for ADHD
Neurobehavioral assessement
Systematic review of neurobehavioral assessments available to practitioners who eval individuals with DOC.
Coma/near coma scale (CNC)
Coma recovery scale- revised (CRS-R)
The disorders of consciousness scale (DOCS)
Sensory modality assessment and rehab technique (SMART)
Sensory stimulation assessment measure (SSAM)
Wessex head injury matrix (WHIM)
Western neuro sensory stimulation profile (WNSSP)
