disorder of cog - TBI Flashcards
what is disordered cog
is a state where consciousness has been affected by damage to the brain
what is a DOC program
is a specialized program designed to improve function and quality of life for patients who are minimally conscious
what is the GCS, LOC, and rancho of a person with a severe brain injury
GSC: 3-8
LOC: >6 hr
ranch: I - III
what is rancho 1 level
unconscious
they do not react to any stimuli
this can last for a varied amount of tome
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
when is a reaction mostly seen in rancho level 2
with an painful stimulus
what is the limitation with rancho and GCS
they have limited ability to objectivly measure change therefore a new category was created DOC
what is a coma
a persistant state of unconsciousness
absent of spontaneous eye opening
sleep wake cycles
no purposeful response to the environment
what is a vegetative state
persistent unconsciousness
intermittent arousal: periodic spon or stimulated EO
no sustained, reproducible purposeful responses
no voluntary movement
what is min conscious
partial con
reproducible behavior and evidence of awareness of environment after simple commands
what is emerged MCS
full con
consistent behavior of awareness of self or environment
what is arousal
a state of wakefulness
what is awareness
ability to interact with the environment in a purposeful manner
normal con- A and A
highest level both
coma - A and A
lowest level both
vegetative state - A and A
arousal: high
awareness: lowest
min con state: A and A
arousal: highest
awareness: lower
locked in syndrome: A and A
higest for both
how can pain be managed
positioning
education
meds
how do we treat for DVT and PE
anticoagulants
how is cere edema managed
meds and surgery
surgery: craniotomy
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
