Content for Exam 1 Flashcards
Eye opening GCS grades
(4 = spontaneous opening of eyes; 3 = opening in response to speech; 2 = eye opening to pain; 1 = no eye opening response)
verbal response GCS grades
(5 = verbal response demonstrate personal orientation to location; 4 = confused conversation is the best verbal response; 3 = inappropriate words in response to question; 2 = incomprehensible sounds; 1 = no verbal response)
motor response GCS grades
(6 = follows motor commands; 5 = localizes a painful stimulus; 4 = withdraws specifically from pain; 3 = abnormal flexion response to pain; 2 = abnormal extensor response to pain; 1 = no motor response)
Rancho Los Amigos Levels of Cognitive Function (LOCF)
Widely used in BI
To track cognitive and behavioral responses of pt
Level I (no response, coma) to Level X (purposeful, appropriate)
Coma Recovery Scale (CRS-R)
Better sensitivity for lower levels – coma<->veg state<->min cons state
Terminal Swing
Critical Events: Knee extension to neutral (or within 5 degrees)
Begins with vertical tibia
Ends with initial contact
Anterograde
inability to learn new material after injury
Retrograde
inability to remember things prior to brain injury
PTA (post-traumatic amnesia)
loss of memory of event surrounding brain injury and inability to process info after BI – length of PTA is a prognostic factor for recovery
Amnesia
deficits in memory
Agnosia
inability to recognize familiar objects, persons, sounds, shapes, or smells – visual, tactile (astereognosis), auditory
Dysarthria
Problems in oral motor aspects of articulation
Aphasia
loss of ability to understand or express speech due to brain damage, mostly in dominant hemisphere
Wernicke’s/receptive/fluent aphasia
deficits in auditory/written comprehension with well articulated speech marked by nonsense words or substitutions
Broca’s/expressive/non-fluent aphasia
deficits in expressing thoughts using speech, limited vocabulary, but comprehension relatively preserved.
Stereognosis
Ability to recognize form of objects by touching and feeling, without visual input
Objects like keys, comb, coins
Graphesthesia
ability to recognize letters, numbers or designs ‘written’ on skin
Barognosis
ability to distinguish weights of different objects by holding them
Assessment of Spasticity
Force/Velocity dependent increased resistance to stretch
Clasp-knife response
Modified Ashworth Scale (0-4 grades)
Sign of UMN lesion - pyramidal tracts
Assessment of Rigidity
Resistance to stretch is independent of force/velocity
Lead-pipe response - constant resistance
Cogwheel response – rachet-like jerkiness
Sign of UMN lesion – extra-pyramidal tracts, basal ganglia lesions like Parkinson’s.
Modified Ashworth Scale
Assessed during PROM with pt in supine
If testing a muscle that primarily flexes a joint, place the joint in a maximally flexed position and move to a position of maximal extension over one second
If testing a muscle that primarily extends a joint, place the joint in a maximally extended position and move to a position of maximal flexion over one second
put muscle in its shortened position
MAS scoring for assessing spasticity
0 No increase in muscle tone
1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension
1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM
2 More marked increase in muscle tone through most of the ROM, butaffected part(s) easily moved
3 Considerable increase in muscle tone, passive movement difficult
4 Affected part(s) rigid in flexion or extension
General Tone assessment
0 No response (flaccidity)
1+Decreased response (hypotonia)
2+ Normal response
3+ Exaggerated response (mild to moderate hypertonia)
4+Sustained response (severe hypertonia)
Hypotonia
Decreased or absent tone, flaccidity, limbs are floppy, hyper-extensible joints, stretch reflexes are dampened (hyporeflexia)