Disorders Of Conciousness Flashcards
Goals of disorders of consciousness treatment programs - consciousness and communication
- accurately assess the current level of consciousness
- address reversible causes of imparied consciousness
- trail interventions to enhance the level of conciousness
- establish communication system and environmental
Goals of disorders of consciousness treatment programs - neuromusculoskeletal and medical
- Minimize restrictions in range of motion
- Identify and augment residual voluntary movement
- Intensive mobilization and environmental enrichment
- Prevent and manage secondary medical complications
- Optimize basic bodily functions such as respiration, nutrition, elimination, and skin integrity
Goals of disorders of consciousness treatment programs - context of care
- provide. family education training and support
- establish a plan for after-care
- establish prognosis and goals of care
What is arousal
level of alertness, does not automatcially imply consciousness
What is awareness
awareness of self and/or environment constitutes consciousness
what are the two unconscious conditions
COMA and vegetative state (VS)
Coma definition
complete loss of spontaneous and stimulus induced arousal (eye, closed), self-limited state
Vegetative state definition
return of basic arousal (eyes open), state of wakeful unawareness
what functions do you have in the vegetative state
respiration, cardiac, digestion, elimination, etc
minimally conscious state (mcs) definition
return of awareness, but awareness may be minimal in degree and inconsistent in manifestation
what is mcs minus
presence of non-lingusitically mediated behavior only
what is mcs plus
presence of linguistically mediated behavior
emerged from mcs (eMCS)
return of functional object use and or functional communication
what are the two conscious states
minimally conscious state, conscious
Behaviors in a coma
response to pain: posturing
movement: reflexive
vision: eyes closed
Behaviors in a vegetative state
response to pain: flexion withdrawal
movement: patterned/involuntary
visual: startle
affective: random
vocal: non-contingent vocalization
Behaviors in a MCS
response to pain: localization
movement: nonreflexive/unpatterned
visual: fixation/pursuit
affective: contingent
vocal: intelligible verbalization
response to command: inconsistent
communication: unrelibale yes/no
object use: object manipulation
what do you need to do for an evaluation of DoC
serial assessments
multiple examiners experienced in DoC
different times
conditions of maximal arousal
family input
accounting for confounds
components of DoC evaluations
qualitative evaluation
formal assessments
motoric, cerebral, non-behavioral, behavioral
intervention methods to enhance the level of consciousness
general rehabilitation interventions, pharmacological agents, brain stimulation, biological therapies
what are the general rehabilitation interventions for LoC
sensory stimulation
mobilization (sitting, standing)
interpersonal interaction
what are the pharmacological agents for LoC
neruostimulants, GABA agonisits
what are the pharmacological agents of LoC
Electrical (deep brain stimulation, vagus nerve stimulation)
ultrasound (low intensity focused ultrasound)
what are the biological therapies of LoC
stem cell therapy
what are the 4 modes of communication and control DoC
motoric, ocular, sub-clinical motoric, non-motoric
What are some medical and neurological complications for someone with DoC?
Infections, venous thrombosis, skin breakdown, heterotopic ossification, paroxysmal sympathetic hyperactivity, seizures, endocrine/metabolic abnormalities.
What is a sensory modality and an intervention example for DoC?
Visual - mirror
Auditory - favorite music
Olfactory - fragrances
Gustatory - lemon swabs
Vestibular - moving the body
Tactile - preferred textures.
What are the sensory stimulation protocols for DoC?
Low distraction environment, present stimuli one at a time, allow time for response, vary stimuli, do not overstimulate.
What does no response (NR) mean in sensory stimulation response monitoring?
No discernable reflexive or volitional response.
What does generalized response (GR) mean in sensory stimulation response monitoring?
Non-purposeful and non-specific reflexive response.
What does localized response (LR) mean in sensory stimulation response monitoring?
Localized response that is not reflexive.
