Disorder of consciousness after ABI - management Flashcards
Visual field assessment
- for CN 2,3,4,6
- confrontational visual test -> assess diff in visual field (sensory &/or perceptive) on the right left side
- automated perimetry test
CN1 assessment
Smell identification test (eg: hydroalcoholic gel -> do you know this smell?)
CN2 assessment
Swinging light test
- dilatation & constriction pupils
CN3,4,6 assessment
Swinging light
- accomodation reflex
- eye pursuit
- cover test
CN5 assessment
- LTT & PPT on forehead, cheek & jaw
- corneal reflex
CN7 assessment
mvt :
- Raised eyebrows
- closed eyes
- blown out cheeks
- smiling
- pursed lips
- closed lips
CN8 assessment
Gross hearing test
CN9,10 assessment
- Gag reflex
- observe uvula
- symmetry
- cough
- swallow
CN11 assessment
Resisted shoulder elevation
CN12 assessment
Protude tongue symmetry observation
Glascow coma scale (GCS)
- assessing 3 domains w/ pts, total from 3 pts= deep coma or death to 15 pts= fully alert & oriented
1. Eye opening
2. Best verbal response
3. Best motor response
/!/ always assessing the best response!
Glascow coma scale : Eye opening response
- Spontaneous -> 4pts
- To speech -> 3 pts
- To stimulation -> 2pts
- None -> 1 pts
Glascow coma scale : Best verbal response
- Oriented -> 5pts
- Confused -> 4 pts
- Inappropriate -> 3 pts
- Incomprehensible -> 2 pts
- None -> 1 pts
Glascow coma scale : Best motor response
- Request -> 6 pts
- Localizing -> 5pts
- Withdrawal -> 4 pts
- Flexing -> 3pts
- Extending -> 2 pts
- None -> 1 pts
FOUR assessment
= Full outline of unresponsiveness rating score
- to replace GCS bcause verbal response can not be assessed on intubated patients
- makes diff between UCS & MCS
- evaluate
1. Eye response
2. Motor Response
3. BSRS
4. Respiration
What does the BSRS in the FOUR test assess ?
- Pupil
- Corneal
- Cough
-> On a score to 0 to 4
CRS-R
= Coma recovery scale
- assesses auditory, visual, verbal & motor repsonses, BSRS & communication
Preventive goal : Why do you want to maintain or improve the ROM?
To avoid musculoarticular adaptation due to procedure or inadequate positioning
Preventive goal : Why do you want to maintain or improve the Skin integrity?
To avoid pressure ulcers & deep tissues injuries caused by inadequate positioning
Preventive goal : Why do you want to maintain or improve the Respiratory function ?
To avoid the dvlp of respiratory infections & complications related to the immobility, poor ventilation & inadequate positioning
Preventive goal : Why do you want to maintain or improve the cardiovascular function?
To avoid the dvlp of infections & complications related to the immobility, poor ventilation & inadequate positioning
Adaptative goal : Why do you want to promote the care giver education?
To Facilitate the understanding about the patient’s condition (coping) + Performance of rehabilitation exercise in the absence of therapy
Adaptative goal : Why do you want to promote the environmental accomodation?
To achieve Stimulatory context + Safe and comfortable environment
Rehabilitative goals : Why do you want to improve the level of consciousness?
- To improve the awarness of environment & self
- To improve responsivness
