Coma

Question 1

Coma

Answer 1

• <8 on GCS
• completely unresponsive
• no eye or purposeful movement
• no arousal
• no sleep-wake cycle on EEG
• starting point of SEVERE TBI, closest to death

Question 2

unresponsive wakefulness syndrome (UWS)

Answer 2

• previously known as vegetative state
• awake but unaware (lights on no one home)
• does NOT follow commands or track
• autonomic functions work!! respiration, digestion, sleep wake cycle
• brainstem fx with reflexes

Question 3

minimally conscious state (MCS)

Answer 3

• > 12 on GCS
• eye contact
• yes/no with gestures or verbalization
• purposefully behaviors
• MCS plus has verbal and MCS does not

Question 4

why is visual pursuit (tracking) important?

Answer 4

first sign of social interaction, it’s intentional engagement

Question 5

drug induced coma

Answer 5

medically induced

brain rest and decrease swelling

Question 6

role of OT

Answer 6

info from family
prevent secondary injury (PROM, splinting, positioning)
sitting upright, sensory stimulation
assess discharge plan
education

Question 7

Glascow coma scale

Answer 7

scores 3-15
visual, motor, verbal sections
<8 coma
>9 not in coma

E(score) + M(score) + V(score or I) =

Question 8

decerebrate rigidity

Answer 8

abnormal extension

more serious

Question 9

decorticate rigidity

Answer 9

abnormal flexion

Question 10

poor outcome GCS

Answer 10

initial score of 3-5 with no improvement

deterioration of score by 2+ points between field and ER

Question 11

better outcome GCS

Answer 11

less than 65 yrs old
duration of coma under 4 weeks
command following before 28 days
score greater than 8

Question 12

Galveston Orientation and Amnesia Test (GOAT)

Answer 12

basic questions like “what is your name”
count errors and subtract from 100
76+ on 3 consecutive occasions = PTA resolution

Question 13

Post traumatic amnesia

Answer 13

unable to process new info

Question 14

retrograde amnesia

Answer 14

unable to recall events prior to TBI

Question 15

rancho los amigos

Answer 15

level I - no response
level II - generalized response
level III - localized response

Question 16

Coma Recovery Scale

Answer 16

• most widely used assessment
• tracks progress
• 6 sub scales: auditory, vision, motor, promoter/verbal, communication, arousal

Question 17

Disability Rating Scale

Answer 17

• tracks an individual from coma to community
• 3 WHO categories addressed: impairment, disability, handicap
• one time thing, no progression measured

eye opening, communication, motor, feeding, toileting

Question 18

Coma/near coma scale

Answer 18

• measures small changes with severe TBI
• 11 items that indicate severity of sensory, perceptual, and primitive response deficits

has different stimuli (bell ringing etc)

Question 19

who is appropriate for sensory stimulation?

Answer 19

unwakeful/minimally conscious state

coming out of the coma

Question 20

basic principles of sensory stim

Answer 20

look at handout

*not covered by many insurance