Chapter 7 - Neurological System Disorders part 2

Question 1

Glasgow Coma Scale

Best Eye Response (E)

Answer 1

4 - Eyes opening spontaneously
3 - Eyes opening to speech
2 - Eyes opening in response to pain
1 - No eye opening

Question 2

Glasgow Coma scale

Best Verbal Response (V)

Answer 2

5 - Oriented (patient responds coherently and appropriately to questions such as age, name, where they are)
4 - Confused (patient responds to questions coherently but there is some disorientation and confusion)
3 - Inappropriate words (random speech, but no conversational exchange)
2 - Incomprehensible sounds (moans, no words)
1 - None

Question 3

Glasgow Coma Scale

Best Motor Response (M)

Answer 3

6 - Obeys commands
5 - Localizes pain (purposeful movements towards changing painful stimuli)
4 - Withdraws from pain
3 - Flexion in response to pain (decorticate)
2 - Extension to pain (decelebrate)
1 - No motor response

Question 4

ASIA - A

Answer 4

complete, no sensory or motor function is preserved in sacral segments S4-S5

Question 5

ASIA - B

Answer 5

incomplete, sensory but no motor function is preserved below the neurological level and extends through the sacral segments

Question 6

ASIA - C

Answer 6

Incomplete, motor function is preserved below the neurological level and the majority of key muscle groups below the neurological level have a muscle grade of less than 3/5

Question 7

ASIA - D

Answer 7

Incomplete, motor function is preserved below the neurological level and the majority of key muscle groups below the neurological level have a muscle grade greater than or equal to 3/5

Question 8

ASIA - E

Answer 8

Normal, Sensory and motor function are normal

Question 9

Central cord syndrome

Answer 9

Resulting from hyperextension injuries and presenting as more UE deficits than LE

Question 10

Brown-sequard syndrome

Answer 10

Ipsilateral paralysis, ipsilateral loss of position sense, ipsilateral loss of discriminative touch, contralateral loss of pain and contralateral loss of thermal sense

Question 11

Anterior Cord Syndrome

Answer 11

Caused by flexion injuries; motor function, pain, pinprick and temperature sensation are lost bilaterally below the lesion.
Propriocepition and light touch are preserved

Question 12

Posterior Cord Syndrome

Answer 12

Proprioceptive loss, pain, temperature and touch are preserved, motor function preserved to varying degrees

Question 13

Conus Medullaris

Answer 13

Injury to sacral cord and lumbar nerve roots

LE motor and sensory loss and areflexic bowel and bladder

Question 14

Cauda Equina

Answer 14

Injury at L1 and below resulting in LMN lesion - flaccid paralysis with no spinal reflex activity and areflexic bowel/bladder

Question 15

Spastic CP

Answer 15

Spasticity with flexor and extensor imbalance
Hypertonia - increased muscle tone
Hyperreflexia - increased intensity of reflex responses

Question 16

Dyskinetic CP

Answer 16

Fluctuations in muscle tone
Dystonia - inadequate muscle tone
Athetosis - Distal writhing involuntary movements
Chorea - proximal spasmodic involuntary movements

Question 17

Ataxic CP

Answer 17

Hypotonia and ataxia movements

Described by GM and manual ability classifications

Question 18

Gross Motor Function Classification System

For Ataxic CP

Answer 18

I - Walks without restrictions; limitations in more advanced gross motor skills
II - Walks without assistive devices; limitations walking outdoors and in the community
III - Walks with assistive mobility devices; limitations walking outdoors and in the community
IV - self-mobility with limitations; transported or use power mobility outdoors and in community
V - Self-mobility is severely limited; even with the use of assistive tech

Question 19

Manual Ability Classification System

For Ataxic CP

Answer 19

I - handles objects easily and successfully
II - handles most objects but with somewhat reduced quality and/or speed of achievement
III - handles objects with difficulty; needs help to prepare and/or modify activities
IV - handles a limited selection of easily managed objects in adapted situations
V - does not handle objects and has severely limited ability to perform even simple actions

Question 20

Rancho Level I

No response: Total Assistance

Answer 20

Complete absence of observable change in behavior when presented visual, auditory, proprioceptive, vestibular or painful stimuli

Question 21

Rancho Level II

Generalized Response: Total Assistance

Answer 21

Demonstrates generalized reflex response to painful stimuli
Responds to repeated auditory stimuli with increased or decreased activity
Responds to external stimuli with physiological changes generalized, gross body movement and/or not purposeful vocalization
Responses noted above may be same regardless of type and location of stimulation
Responses may be significantly delayed

Question 22

Rancho Level III

Localized response: Total A

Answer 22

Withdraws or vocalizes painful stimuli
Turns toward/away from auditory stimuli
Blinks when light passes visual field
Follows moving object within visual field
Responds to discomfort by pulling tubes etc.
Responds inconsistently to simple commands
Responses directly related to type of stimulus
May respond to some people but not others

Question 23

Rancho Level IV

Confused/Agitated: Max A

Answer 23

Alert and in heightened state of activity
Purposeful attempts to remove tubes etc. or crawl out of bed
May perform motor activities (sitting, reaching walking) but for no purpose other than being asked to
Brief moments of unpurposeful sustained alternative and divided attention
Absent ST memory, unable to cooperate with treatment efforts
May cry out to stimulus - out of proportion
May exhibit aggressive or flight behavior
Mood swing from good to bad with no relationship to what is going on
Verbalizations are frequently incoherent/inappropriate to activity/envinroment

Question 24

Rancho Level V

Confused, Inappropriate non-agitated: Max A

Answer 24

Alert, not agitated, may wander randomly/vaguely intend to go home
May become agitated in response to external stimulation
Not oriented to person, place, or time
Frequent brief periods of non-purposeful sustained attention
Severely impaired recent memory, with confusion of past/present
Absent goal-directed, problem solving, and self-monitoring behavior
Inappropriate use of objects without cues
May perform previously learned tasks when structured with cueing
Unable to learn new information
Able to respond appropriately to simple commands with cues
Responses to simple commands without external structure are random and non-purposeful in relation to command
Able to converse on a social, automatic level for brief periods with structure and cuing
Verbalizations about present events become inappropriate without cues and structure

Question 25

Rancho Level VI

Confused, Appropriate: Mod A

Answer 25

Inconsistently oriented to person, time and place
Able to attend to highly familiar tasks in non-distracting environment for 30 min without Mod redirection
Remote memory has more detail than recent memory
Vague recognition of some staff
Supervised for old learning (self care)
Able to use assistive memory aide with Max A.
Emerging awareness of appropriate responses to self, family, and basic needs
Mod A. to problem solve barriers to task completion
Shows carry-over for relearned familiar tasks
Max A for new learning with little to no carry over
Unaware of impairments, disabilities, or safety risks
Consistently follows simple directions
Verbal expressions are appropriate in highly familiar and structured situations

Question 26

Rancho Level VII

Automatic, Appropriate: Min A for ADL

Answer 26

Consistently oriented to person/place within familiar environment, mod A for orientation to time
Able to attend to highly familiar tasks in a non-distraction environment for 30 min with min A to complete tasks
Min Supervision for new learning
Demonstrates carryover of new learning
Initiates and carries out steps to complete routine, but has shallow recall of what they’r doing
Unrealistic future planning
Uncooperative
Overestimates abilities
Able to monitor accuracy of ADL routine and modify it with min A
Min Supervision for safety in routine activities
Unable to think about consequences or recognize inappropriate social behavior
Unaware of others’ needs/feelings
Superficial awareness of condition, but unaware of impairments and limits they place on safety and function

Question 27

Rancho Level VIII

Purposeful, appropriate: Stand-by A

Answer 27

Consistently oriented to person, place, and time
Independently attends to and completes familiar tasks for 1 hour in distracting environment
Able to recall and integrate past and recent events
Uses assistive memory decide with stand-by A.
Self-centered, depressed, irritable, and argumentative
Low frustration tolerance
Uncharacteristically dependent/independent
Over/underestimates abilities
Thinks about consequences with min A
Acknowledges others’ feelings/needs and responds appropriately with min A
Able to recognize and acknowledge inappropriate social interaction and takes corrective action with min A
Requires no assistance once new task is learned
Initiates and carries out routines with stand-by A to modify
Aware of impairments but requires stand-by A to take appropriate corrective action

Question 28

Rancho Level IX

Purposeful, appropriate: Stand-by A as requested

Answer 28

May still be depressed, irritable, or have low frustration tolerance
Able to self monitor appropriateness of social interaction with stand-by A.
Acknowledges others’ needs and responds appropriately with stand-by A.
Accurately estimates abilities but requires stand-by A. to adjust task demands
Able to think about consequences with A if requested
Independently shifts back and forth between tasks and completes them accurately for at least 2 consecutive hours
Uses assistive memory aids w/ A. if requested
Initiates and carries out familiar routines independently, unfamiliar routines with A if requested
Aware of and acknowledges impairments and takes appropriate corrective action, but requires stand-by A. to anticipate a problem before it occurs and take action to avoid it

Question 29

Rancho Level X

Purposeful, appropriate: Mod I

Answer 29

Periodic depression may occur
Social interaction behavior is consistently appropriate
Able to recognize the needs’ of others and automatically respond in appropriate manner
When under emotional stress, can have low frustration tolerance and be irritable
Accurately estimates abilities and independently adjusts to task demands
Able to handle multiple tasks in all environments but may need breaks
Able to independently create/maintain assistive memory devices
Independently initiates and carries out familiar/unfamiliar routines, but may require increased time and strategies
Anticipates impact of impairments and takes action to avoid problems but may require increased time and strategies
Able to independently think about consequences, but may require increased time and strategies to select appropriate action