Day 2 - Consciousness & Prognosis Flashcards
Define severity of TBI and what is the best acutre predector?
Motor response, particularly 2 weeks postinjury, is the best acute predictor of outcome.
Ref: ERABI
Mention the system that is responsible for consciousness state
- Reticular activating system (RAS)
- Thalamic and extrathalamic pathways.
- Cerebral cortex.
Mention disorders of consciousness 🔑
MINIMALLY CONSCIOUS STATE
- Patient is awake
- Evidence of awareness of self or environment
VEGETATIVE STATE
- Evidence sleep-wake cycle
- No awareness of self or environment.
COMA
- No sleep-wake cycles
- No awareness of self or environment.
List 6 descriptive features of patient who is Minimally Conscious State 🔑
- Evidence of self or environmental awareness.
- Reproducible (or sustained) purposeful behaviors.
- Simple command following
- Comprehensive verbalization
- Gestural or verbal yes/no responses
- Smooth pursuit tracking
- Visual fixation
- Emotional or motor behaviors with specific stimuli
When patient is considered off Minimally Conscious State?
- Interactive communication
- Functional object use
Etiology of Vegetative State and Coma. 🔑
Damage to consciousness center:
- Related to diffuse cortical injury
- Bilateral thalamic lesions
List 4 descriptive features of patient who is Vegetative State 🔑
Awake but not aware, GCS <8
- Evidence of sleep–wake cycle on EEG
- No awareness of self or environment
- Patient opens eyes (either spontaneously or with noxious stimuli).
- No purposeful behavior
- No evidence of language comprehension or expression
List 4 descriptive features of patient who is Comatose 🔑
Not awake nor aware, GCS <8
- Lack of wakefulness as evidenced by the lack of sleep wake cycles on EEG.
- No awareness of self or environment
- Patient’s eyes remain closed.
- No spontaneous purposeful movement or localization of noxious stimuli
- No evidence of language comprehension or expression
List 4 descriptive features of patient who is Comatose 🔑
Not awake nor aware, GCS <8
- Lack of wakefulness as evidenced by the lack of sleep wake cycles on EEG.
- No awareness of self or environment
- Patient’s eyes remain closed.
- No spontaneous purposeful movement or localization of noxious stimuli
- No evidence of language comprehension or expression
Decorticate vs Decerebrate Posturing. What is the clinical significance?
Decorticate
- Flexion of the upper limbs (elbows bent)
- Extension of the lower limbs
Decerebrate
- Opisthotonus: spasm of the muscles causing backward arching of the head, neck, and spine.
- clenched jaws
- stiff, extended limbs internal rotation of arms
- ankle plantar flexion
Decerebrate posturing is worse and indicates significant brain stem (midbrain) damages.
List 3 main prognostic indicators 🔑🔑
- Glasgow Coma Scale within 24 hours
- Duration of unconsciousness (LOC)
- Duration of posttraumatic amnesia (PTA)
List 3 main prognostic indicators 🔑🔑
- Glasgow Coma Scale within 24 hours
- Duration of unconsciousness (LOC)
- Duration of posttraumatic amnesia (PTA)
List 4 Parameters of ImPACT Trial for TBI severity.
- I = Injury severity
- P = Pupillary reactions
- A = Age
- CT = Midline shift
List 4 outcome measures for ABI patient.
- Glasgow Outcome Scale (GOS)
- Functional Independence Measure (FIM)
- Disability Rating Scale (DRS)
- Ranchos Los Amigos Scale (RLAS)
What does Posttraumatic Amnesia (PTA) patient look alike?
- Patient doesn’t remember his daily activities.
- He can’t think ahead.
- He goes robotically from place to place and from task to task as directed by her therapists.
- If he’s able to speak, he asks the same questions repeatedly because he can’t remember the answers.
Definition of PTA
State of generalized cognitive disturbance characterized:
- Confusion
- Disorientation
- Retrograde amnesia
- Inability to store new memories
- Sometimes agitation and delusions
ERABI Model 2
When is the end of Posttraumatic Amnesia? 🔑
Galveston Orientation and Amnesia Test (GOAT)
The end of PTA can be defined as the date when the patient scores 75 or higher in the GOAT for 2 consecutive days
List 2 scales to asses PTA in TBI patient.
- Galveston Orientation and Amnesia Test (GOAT)
- Orientation Log (O-Log)
List 2 general assessment tools for motor and sensory deficits.
- Berg (Balance) Scale: Score ≤45 indicates an increased risk of falling
- Modified Ashworth Scale (Spasticity)
- Functional Independence Measure
- Fugl-Myer for Assessment of Sensorimotor Function
- Six Minute Walk Test
What factors influence quality of life following injury?
- Severity of post-injury symptoms
- Depression and anxiety
- Self-esteem and self-awareness
What factors influence return to productivity?
- Better injury severity indicators
- Shorter duration of post-traumatic amnesia
- Shorter lengths of stay in hospital
- Better functional recovery
- Fewer cognitive deficits
- Younger age
- Higher level of education prior to injury
Write a plan for PT & OT for ABI patient.
- Static and dynamic balance
- Sit-to-stand
- Strength
- Gait training
- Fine motor skills (Meal preparation & Block assembly)
How to manage school in pediatric TBI patient?
Goal
- Minimizing absences
- Avoid social isolation, depression, and anxiety
More
- frequent breaks
- additional time to complete assignments
- preferential seating for better attention & focus
Less
- reduced workload
- modified assignments
- reduced auditory stimulation
- reduced visual stimulation.
- avoidance of electronic screens
- frequent visual breaks
- preprinted notes in large font, audiobooks, and oral teaching.
