Chapter 15 - Cognitive Systems and Motor Function Flashcards
Cognitive behavioural functional competence
integrated processes of cognitive, sensory, and motor systems
What systems get manifested through the motor network?
behaviours that appropriate to human activity
Full Consciousness
state of awareness of oneself and appropriate responses to environment
What are the two components of consciousness?
arousal and awareness
Arousal
state of awakeness
Awareness
content of thought
How are structural alterations divided?
by their location of dysfunction
Where do supratentorial disorders affect?
above the tentorium cerebelli
What do supratentorial disorders produce change in?
arousal
Where do infratentorial disorders affect?
below the tentorium cerebelli
What do infrantentorial disorders do?
produce decline of arousal by RAS dysfunction
Metabolic alterations produce a ________ in arousal by altering…
decline; delivery of energy substrates
How many patterns of neurological functions are critical to evaluation process?
5
Which function is the most critical index of nervous system function?
level of consciousness
Changes in level of consciousness indicate _________ or _________
improvement or deterioration
What are characteristics of highest level of consciousness?
when the person is alert and orientated to oneself, others, place, time
What does level of consciousness diminish to?
confusion, then disorientation, then coma
Normal breathing is a __________ pattern
rhythmic
Diminished consciousness leaves breathing responding to changes in _________ levels
PaCO₂
Cheyne-Stokes Respirations
altered period of tachypnea and apnea related directly to PaCO₂
Apneusis
prolonged inspiratory time and a pause before expiration
Ataxic Breathing
complete irregularity of breathing with increased periods of apnea
What does pupillary reaction indicate?
presence and level of brainstem dysfunction
Where is the brainstem area that controls pupils?
adjacent to the areas controlling arousal
How does ischemia affect the pupils?
makes them dilated/fixed
What causes pinpoint pupils?
hypothermia or opiates
Oculomotor Responses
resting, spontaneous, and reflexive eye movements
Normal Oculomotor Response
eyes move together to side opposite from turn of head
Abnormal Oculomotor Response
eyes do not turn together
Absent Oculomotor Response
eyes move in the direction of head movement
What is the caloric ice water test used to measure
oculomotor response
How does the caloric ice water test work?
ice water is injected into the ear canal
Normal Caloric Ice Water Test Response
eyes turn together to side of head where ice injected
Abnormal Caloric Ice Water Test Response
eyes do not move together
Absent Caloric Ice Water Test Response
no eye movement
What do motor responses tell us about brain dysfunction?
severity and which side of the brain is damaged
Motor response patterns may be ________, __________, or _____________
- purposeful
- inappropriate
- not present
Paratonia
form of hypertonia with an involuntary variable resistance during passive movement
Slide 13 - § Motor signs indicating loss of cortical inhibition
= decreased consciousness / associated with the
performance of primitive reflexes and rigidity
(paratonia)????
Dysfunction of the medulla oblongata may manifest as?
compulsive/repetitive vomiting, yawning, hiccups
Alterations in arousal may result in ________ (morbidity) or _______
disability or mortality
Outcomes of arousal alterations depend on the ________, _________, ________ of the coma
cause, damage, duration
What are the two forms of neurological death?
brain death and cerebral death
Brain Death = ________ brain death
total
NDD
neurological determination of death
Brain death is _______
irreversible
Brain death occurs when the brain cannot maintain __________
homeostasis
What is the criteria for NDD in Canada?
- unresponsive coma
- no brainstem functions
- no spontaneous respiration (apnea)
Cerebral death = ___________ coma
irreversible
Which part of the cerebral hemisphere is not involved in cerebral death?
brainstem and cerebellum
With cerebral death it is possible for the brain to continue __________ maintenance
homeostasis
With a persistent vegetative state the person is completely _________ of their self or environment.
unaware
What are 3 factors in a persistent vegetative state?
-no speech
-no cerebral function
-yes sleep-wake cycles
3 factors of a minimally conscious state (MSC)
-follow simple commands
-manipulate objects
-give yes/no responses
Locked in syndrome involves the complete paralysis of voluntary muscles except for…
eye movement
With locked in system the person is fully ________
conscious
How do people with locked in syndrome communicate?
blinking
Awareness encompasses all _________ function
cognitive
What mediates awareness?
executive attention networks (EAN)
Executive Attention Networks (EAN)
selective attention and memory involving abstract reasoning, planning, decision making, judgement, self-control
Selective Attention
ability to select specific information and focus on related task
Initial Executive Attention Deficit Detection
person fails to stay alert and orientate to stimuli
Mild Executive Attention Deficit Detection
grooming and social graces are lacking
Severe Executive Attention Deficit Detection
motionless, no response, no reaction to surroundings
Attention Deficits are characterized by an inability to maintain __________ attention and set ________
sustained; goals
Memory
recording, retention, retrieval of information
Amnesia
loss of memory
Retrograde Amnesia
difficulty retrieving past memories
Anterograde Amnesia
inability to form new memories
Data-Processing Deficits
problems associated with recognizing and processing sensory information
Agnosia is a defect of _________ recognition
pattern
Agnosia is characterized by the failure to recognize ______ and ______ of objects
form and nature
Agnosia only affects _____ sense most times
one
Agnosia Example
can’t identify a safety pin by touching it but can name it when looking at it
Agnosia is associated with _______________ accidents
cerebrovascular
Dysphasia
impairment of comprehension or production of language
Expressive Dysphasia aka _____ dysphasia
Broca
Expressive dysphasia results in the lost ability to…
produce spoken or written language
With expressive dysphasia, ________ comprehension is usually present
verbal
Receptive dysphasia aka ___________ dysphasia
wernicke
Receptive dysphasia results in the inability to…
understand written or spoken language
People with receptive dysphasia are fluent with speech but the words have no __________
meaning
Which artery is responsible for the pathology of dysphasia?
middle cerebral artery
How many major arteries supply blood to the brain?
3
Transient (acute) disorders of awareness have _______ or _______ onset
sudden or gradual
What causes transient awareness disorders?
-drug intoxication
-alcohol withdrawal
-post anesthesia
-electrolyte imbalance
Acute Confusion and Delirium result from disruption of the _____, ________, ________, and _________
thalamus, cortex, RAS, limbic system
Delirium aka ___________ Acute Confusional State
Hyperactive
Where does delirium most commonly occur?
critical care units over 2-3 days
Hyperactive Delirium results from a disruption of which neurotransmitters?
acetylcholine and dopamine
Excited Delirium Syndrome aka _________ delirium
agitated
Agitated delirium is hyperkinetic and can lead to…
sudden death
How does excited (agitated) delirium syndrome manifest?
-rapid breathing
-high pain tolerance
-superhuman strength
Acute Confusional States and Delirium Manifest as:
-terrifying dreams
-hallucinations
-gross alteration of perception
-insomnia
How is delirium evaluated?
CAM-ICU - Confusion Assessment Method for Intensive Care Unit
Dementia
the deterioration or progressive failure of many cerebral functions
What are some possible causes of dementia?
-cerebral neuron degeneration
-atherosclerosis
-genetics
Is there a cure for dementia?
no
With dementia it is important to maximize ____________ capacities
remaining
