disorder of cog - TBI Flashcards by VB VB

what is disordered cog

is a state where consciousness has been affected by damage to the brain

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what is a DOC program

is a specialized program designed to improve function and quality of life for patients who are minimally conscious

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what is the GCS, LOC, and rancho of a person with a severe brain injury

GSC: 3-8

LOC: >6 hr

ranch: I - III

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what is rancho 1 level

unconscious

they do not react to any stimuli

this can last for a varied amount of tome

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what is rancho 2 level

the person will react but the reaction of inconsistent and without purpose

reaction is often a broad body movement

the reaction is the same, regardless of the stimuli

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when is a reaction mostly seen in rancho level 2

with an painful stimulus

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what is the limitation with rancho and GCS

they have limited ability to objectivly measure change therefore a new category was created DOC

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what is a coma

a persistant state of unconsciousness

absent of spontaneous eye opening

sleep wake cycles

no purposeful response to the environment

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what is a vegetative state

persistent unconsciousness

intermittent arousal: periodic spon or stimulated EO

no sustained, reproducible purposeful responses

no voluntary movement

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what is min conscious

partial con

reproducible behavior and evidence of awareness of environment after simple commands

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what is emerged MCS

full con

consistent behavior of awareness of self or environment

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what is arousal

a state of wakefulness

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what is awareness

ability to interact with the environment in a purposeful manner

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normal con- A and A

highest level both

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coma - A and A

lowest level both

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vegetative state - A and A

arousal: high

awareness: lowest

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min con state: A and A

arousal: highest

awareness: lower

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locked in syndrome: A and A

higest for both

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how can pain be managed

positioning

education

meds

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how do we treat for DVT and PE

anticoagulants

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how is cere edema managed

meds and surgery

surgery: craniotomy

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what is a craniotomy

part of the brain is temporally removed

what is sympathetic storming

increase in activity of the sympathetic nervous system created by a disassociation or loss of balance between the sympathetic and parasympathetic nervous systems

how often does sym storming occur

15-33% of those with a GCS of 3-8

how long does sym storming last and when does it start

24 hr after injury lasts for weeks after

what are the sym of sym storming

alterations in level of consciousness, increased posturing, dystonia, hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and agitation

what is Dystonia

a movement disorder that causes the muscles to contract involuntarily

is storming thought to be a step forward or back

forward

what is used to treat storming

medication that suppress the CNS heating and cooling blankets used to regulate temp

storming and the ICU

the pt is not cleared to leave the ICU until storming is over

what is the coma scale used for

assist with differential diagnosis, prognosis, and treatment planning for those with DOC

what are the subscales of the coma scale

audiotory visual motor function oral motor function communication arousal

audiotory and vision in the coma scale is what in the neuro PT exam

cog and CN

motor in the coma scale is what in the neuro PT exam

cog sensation motor

oral motor function, communication, arousal in the coma scale is what in the neuro PT exam

motor and cog

what part of the neuro PT exam does the comma scale not cover

coordination balance function

when doing a cog eval do you have sitting or laying down

sitting laying down means that it is time to sleep

what is the purpose for a DOC program

to emerge from a stage of lower con

what are the interventions for DOC programs

functional mobility: tolerance to upright, transfers, BM, sitting balance, object manipulation arousal: multisensory stim cog: command following family education: HEP, positioning, preventing 2ndary complications

how do we manage spasticity

meds stretching program serial casting

meds for spasticity

botoc baclofen

stretching program for spasticity

this needs to be completed daily stretch splints: worn at night or scheduled throughout the day

serial casting and spasticity

provides a prolonged stretch - watch for skin breakdown once set allows for WB through the extremity

is spasticity common with TBI

yes

candiates for spasticity casting

severe spasticity low tolerance to stretch alerted function 2ndary to spat

contraindication of spat casting

fracture HO edema mod/severe vascular disease skin integrity

precuations for casting for spat

hyperhtermia elevated ICP Qol POC bony promiences

daily check with spat casting

temp toes cap refill dorsalis pedis pulse cast edges - skin and spaces look for bumps and cracks

serial spat casting

multiple applications molded cast in a sub max stretch

inhibitive spat casting

use of pressure point to decrease tone

cynlidrical spat casting

pro: constant stretch cons: limited access to skin, timely

bivalve spat casting

pro: use of joint outside of the cast, skin inspections con: more likely to have a misalignment

plaster spat cast

pro: mold to joint, does no dry quickly con: prone to indentations, high pressure areas, heavy messy

fiber glass spat cast

pro: dries quickly, light, faster application con: less moldable, splintering, sharp edges