Clinical Manifestations - Lecture 14 Flashcards
measures of arousal, cognition and memory
orientation
glasgow coma scale
rancho los amigos level of cognitive fxning scale
testing orientation
A+O *4
A+O*4
alert and oriented
self
location
date
situational awareness
glasgow coma scale (GCS)
defines severity of TBI w/in 48-72 hrs
simple, reliable, correlates well with outcomes
what can the outcome of a pt be associated w/
best response in their first 24 hrs after injury
grading
GCS 3-8
GCS 9-12
GCS 13-15
GCS 3-8
severe injury
GCS 9-12
moderate injury
GCS 13-15
minor injury
what is the critical score
8
GCS score 8
90% of pts less than or equal to 8 are in a coma
50% die at 6 hrs
pts with greater than or equal to 9
typically not in a coma
pts with higher levels
better outcomes at 6 hrs
eye opening = 1 in 5 chance of good recovery
w/o eye opening = 1 in 10 chance
no motor response
3% chance of good recovery
show flexion = better than 15% chance
no noise
8% chance of recovery
groan = 30% chance
GCS =
highest score for correct prediction of outcome
Rancho los amigos scale
defines the severity of deficit in cognitive fxning
how many levels does ranchos los amigos have
10
level 1
no response
total assistance
level 1 details
complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive, vestibular or painful stimuli
level 2
generalized response
total assistance
level 2 response to painful stimulus
generalized reflex response
inconsistent and non-purposeful
responses may be –> level 2
the same regardless of type and location of stimuli
significantly delayed
level 3
localized response
total assistance
level 3 details
localized withdrawal or vocalization (inconsistently) to stimuli (pain, simple commands)
level 4
confused/agitated
maximal assist
level 4 –> state of activity
alert and heightened
what does a level 4 pt exhibit
agitation and aggressive behavior
mood swings
attention span of a lvl 4 pt
brief
short term memory of a lvl 4 pt
absent
level 4 pts also have
confabulation
confused, with incoherent/inappropriate verbalizations
level 5
confused, inappropriate non-agitated
maximal assist
level 5 pts are
alert and confused
but not oriented
what do level 5 pts respond to
simple commands
fairly consistently
when may level 5 pts become agitated
in response to external stimulation or lack of structure
attention of a lvl 5 pt
gross attention to environment
highly distractible
memory of a lvl 5 pt
severely impaired recent memory
other details of a level 5 pt
absent goal-directed, problem solving, self-monitoring behavior
inappropriate use of objects
unable to learn new info
level 6
confused, appropriate
mod assist
level 6 orientation
inconsistently oriented
consistently follows simple commands
what can level 6 pts do
attend to highly familiar tasks in non-distracting environment for 30 min with moderate redirection
level 6 behavior
goal directed
but depending on external direction
level 6 pts carry over
relearned tasks
but not new tasks
what do level 6 pts use
assistive memory aide with max assist
level 6 pts verbal expressions
appropriate in highly familiar and structured situations
level 7
automatic, appropriate
min assist
how are level 7 pts oriented
consistently except to time
what do level 7 pts attend to
highly familiar tasks for over 30 min w/ min assist to complete tasks
level 7 supervision
minimal
carryover of new learning
minimal supervision for safety in routine activities
level 7 recall
shallow
superficial awareness of his/her condition
what are level 7 pts unable to do
think about consequences of a decision or action
they overestimate their abilities
unable to recognize inappropriate social interaction behavior
what are level 7 pts unaware of
others needs and feelings
level 8
purposeful, appropriate
stand by assist
level 8 pts are consistently
A&O*3
1 hour attention in distracting environments
level 8 pts can complete
familiar routines with stand-by assist
level 8 pts can also
recall and integrate past/recent events
carryover of new learning
level 8 pts use
assistive memory devices with stand by assist
level 8 pts require no
assistance once new tasks or activities are learned
level 8 pts are aware of
impairments but require stand by assist to correct
what do level 8 pts think about
consequences of a decision with min assist
level 8 pts acknowledge
others needs/feelings and response appropriately with min assist
what do level 8 pts recognize
inappropriate social interaction and corrects w/ min assist
level 9
purposeful, appropriate
stand by assist on request
level 9 pts are able to
shift attn and sustain it for more than 2 consecutive hours
level 9 pts are aware of
impairments and takes appropriate corrective action
requires standby by assist to anticipate a problem before it occurs and takes action to avoid it
level 9 thinks about
consequences of decisions w/ assist when requested
what can lvl 9 pts accurately estimate
abilities but requires stand-by assist to adjust to task demands
level 9 pts acnkowledge
others needs and feelings
responds appropriately with stand-by assist
what may continue in level 9
depression and irritability/ low frustration
level 9 self monitors
appropriateness of social interaction with stand-by assist
level 10
purposeful, appropriate
mod 1
what can lvl 10 pts handle
multiple tasks simultaneously
level 10 pts can independently
create/maintain own assistive memory devices
complete familiar and unfamiliar tasks
–> but may require extra time and/or compensator strategies
what do lvl 10 pts anticipate
impact of impairments and avoid problems before they occur
may require extra time and or compensatory strategies
what do lvl 10 pts independently think about
consequences of decisions
–> may require extra time and or compensatory strategies to select appropriate action
level 10 pts may have
periodic depression and irritability when sick, fatigue and or under emotional stress
level 10 social interaction
consistently appropriate
