Consiousness, Memory, Communcation Flashcards
What are the 7 levels of consciousness?
Alertness Lethargy Obtundation Stupor Coma Unresponsive vigilance (vegetative) state Minimally conscious state
What is the difference between alertness and lethargy?
Alertness = patient responds appropriately, can open eyes, look at examiner, respond fully and appropriately to stimuli
Lethargy = patient appears drowsy; can open eyes and look at examiner, respond to questions, but falls asleep easily.
What is the difference between obtundation and stupor?
Obtundation = patient can open eyes, look at examiner but responds slowly and is confused, demonstrates decreased alertness and interest in environment
Stupor = patient can be aroused from sleep with only painful stimuli; verbal responses are slow or absent; patient returns to unresponsive state when stimuli are removed; demonstrates minimal awareness of self and environment
What is the difference between coma and unresponsive vigilance (vegetative state)?
Coma = a state of unconsciousness from which a patient cannot be aroused, eyes remain closed; no response to external stimuli or environment
Unresponsive vigilance = a state characterized by the return to sleep/wake cycles, normalization of vegetative functions respiration, heart rate, BP, digestion) and lack of cognitive responsiveness can be aroused but is unaware).
When is a patient considered to be in a persistent vegetative state?
A state lasting > 1 year for TBI and > 3 months for anoxic brain injury
What is a minimally conscious state?
A state characterized by severely altered consciousness with minimal but definite evidence of self or environmental awareness
What elements of consciousness are assessed by the Glasgow Coma scale?
Relates consciousness to 3 elements of response:
Eye opening
Motor response
Verbal response
Explain the scoring categories for the Glasgow Coma Scale.
Score ranges from 3 to 15.
1-8 = severe brain injury 9-12= moderate brain injury 13-15 = minor brain injury
What test can be used to assess a patient’s attention span?
Digit span retention test (i.e. ability to recall 7 numbers in order presented)
What is the difference between sustained, divided, and focused attention?
Sustained = ability to attend to a task without redirection
Divided attention = ability to shift attention from one task to another
Focused attention = ability to stay on task in presence of detractors
What is perseveration?
Getting stuck on a task
Repeated performing the same task or repeating the same word/phrase without purpose
What is the purpose of the Mini Mental State Examination and what does it screen?
Purpose = screen for cognitive dysfunction
Screening items for orientation, registration, attention and calculation, recall and memory
Describe the scoring for the Mini Mental State Examination.
Maximum score of 30:
21-24 = mild cognitive impairment
16-20 = moderate impairment
15 or less = severe impairment
What is delirium?
A state of consciousness that is characterized by quiet behavior, confusion, agitation and loudness
What is the purpose of the Ranchos Los Amigos Scale?
Assess cognitive recovery from TBI
List the 8 levels of behavior on the Ranchos Los Amigos Scale.
I. No response II. Generalized response III. Localized response IV. Confused-agitated V. Confused-inappropriate VI. Confused-appropriate VII. Automatic-appropriate VIII. Purposeful-appropriate
Describe no response and generalized response on the Ranchos Los Amigos Scale.
No response = patient is completely unresponsive to any stimuli
Generalized response = Patient reacts inconsistently and non-specifically to stimuli
Describe localized response and confused agitated on the Ranchos Los Amigos Scale.
Localized response = Patient reacts inconsistently but specifically to stimuli.
Confused agitated = Patient is in heightened state of activity. Behavior is bizarre and non purposeful relative to immediate environment. Recall and attention span are poor.
Describe confused inappropriate on the Ranchos Los Amigos Scale. (3)
Able to respond to simple commands but not do complex tasks.
Verbalization is inappropriate
Memory is severely impaired
Describe confused appropriate on the Ranchos Los Amigos Scale.
Patient is dependent on external input but can perform consistently.
Memory is improved.
Describe automatic appropriate on the Ranchos Los Amigos Scale.
Can perform automatically and appropriately in structured environments.
Judgement remains impaired
Describe purposeful appropriate on the Ranchos Los Amigos Scale.
Patient acts appropriately though not perfectly.
Can have some problems in stressful or unusual circumstances.
What is anterograde amnesia?
Inability to create new memories
Anterograde memory is usually the last to recover after a comatose state. Contributing factors include poor attention, distractibility, and impaired perception of stimuli.
What is post traumatic amnesia?
The time between the injury and when the patient is able to recall recent events. The patient does not recall the injury or events up until this point of recovery. Used as an indicator of the extent of damage.
What is retrograde amnesia?
An inability to remember events prior to the injury.
Retrograde amnesia may progressively decrease with recovery.
What is aphasia?
An acquired neurological impairment of processing for receptive and/or expressive language.
What is fluent aphasia? Where is the lesion typically located in brain with this impairment?
Lesion = temporal lobe, Wernicke’s area or regions of the parietal lobe
- Word output and speech production are functional
- Prosody is acceptable, but empty speech/jargon
- Speech lacks substance, use of paraphasia
- Use of neologisms (substitution within a word that is so severe it makes the word unrecognizable)
What is non-fluent aphasia? Where is the lesion typically located in brain with this impairment?
Lesion = frontal lobe (anterior speech center) of the dominant hemisphere
- Poor word output
- Poor articulation and increased effort of speech
- Content is present, but impaired syntactical words
What are 2 types of fluent aphasia?
Wernicke’s aphasia
Conduction aphasia
What type of aphasia do Wernicke’s and conduction aphasia fall into?
Fluent aphasia
What type of aphasia do Broca’s and global aphasia fall into?
Non-fluent aphasia
Wernicke’s aphasia is also known as ______.
Receptive aphasia
What is Wernicke’s aphasia? Where is the lesion located?
Lesion = posterior region of the superior temporal gyrus
- Impaired comprehension, reading/writing, and naming ability
- Good articulation. use of paraphasias
- Motor impairment not typical due to the distance from Wernicke’s area to the motor cortex
What is conduction aphasia? Where is the lesion located?
Lesion = supramarginal gyrus, arcuate fasciculus
- Severe impairment with repetition
- Intact fluency, good comprehension
- Speech interrupted by word finding difficulties
- Reading intact, writing impaired
What are two types of non-fluent aphasia?
Broca’s aphasia
Global aphasia
Broca’s aphasia is also know as _____.
Expressive aphasia
What is Broca’s aphasia? Where is the lesion located?
Lesion = 3rd convolution of the frontal lobe
- Intact auditory and reading comprehension
- Impaired repetition and naming skills
- Frustration with language skill errors
- Paraphasias are common
- Motor impairment typical due to proximity of Broca’s area to the motor cortex
What is global aphasia? Where is the lesion located?
Lesion = frontal, temporal, and parietal lobes
- Comprehension (reading/auditory) is severely impaired
- Impaired naming, writing, and repetition skills
- May involuntarily verbalize, usually without correct context
- May use nonverbal skills for communication
What is verbal apraxia?
Impairment of prosody and articulation of speech
Verbal expression is impaired secondary to deficits in motor planning.
A patient is unable to initiate learned movement (articulation of speech) even though they understand the task.
What is dysarthria?
Impairment of speech production that is caused by an upper motor neuron lesion that affects the muscles that are used to articulate words and sounds.
Speech is often noted as slurred and there may also be an effect on respiration, articulation, phonation and movements of the jaw and tongue.
