Disorders of Consciousness Flashcards
Define consciousness
the process of knowing
- wakefulness and awareness
What are the characteristics of RLAS-R I/Coma?
no response to anything
- No eyes open
- cannot be awakened by noxious stim
- ONLY see reflexive responses - Hoffman’s and Babinski’s
What are the characteristics of RLAS-R II/Vegetative State?
- Generalized reflex response to noxious stimuli - non-purposeful
- Eyes open (spontaneously)
- improved vitals
- sleep/wake cycles on EEG
How will a level 2 respond to repeated auditory stimuli?
increased or decreased generalize activity
How will a level 2 respond to external stimuli?
- physiological changes generalized
- Gross body movements
- Non-purposeful vocalization
What generalized response is typically seen in level 2?
posturing
- Decorticate
- Decerebrate
What is meant by persistent vegetative state?
at least a year in vegetative state - odds of coming out of this state are slim after 1 year
At what level does localized response occur?
level 3
At what level do eyes open? What does this mean?
Level 2
- means reticular system has regained control of our wakefulness
- have brainstem control! - can regulate vitals, sleep/wake, etc
Are level 2 patients on a mechanical vent?
typically no because they have brainstem control (reticular formation) of vitals
What are the characteristics of RLAS-R III/Minimally Conscious State?
- beginning of partial conscious awareness
- withdrawal or vocalization to painful stimuli
- turns toward auditory
- blinks at strong light
- follows object passed withing visual field
- responds to commands - inconsistently
How long does coma/level 1 typically last? When do chances of coming out of it drop?
- rarely lasts longer than 2-4 weeks
- chances drop after 1 month
What type of injury can result in level 1/coma?
- brainstem injury to reticular formation - midbrain, pons
- cortical lesions with diffuse injury
At what level does awareness begin?
level 3
What are the diagnostic criteria of being diagnosed MCS?
1 or more of the following:
- simple command-following
- gestural or verbal yes/no responses (doesn’t have to be accurate)
- intelligible verbalization
- movements or affective behaviors in relation to stimuli and are not reflexive activity
Why does is matter that accurate diagnosis is made?
prognosis for MCS is significantly more favorable relative to VS
- Think about how family would make if patient was on life support and though only 3% chance to live (VS) vs 50% with MVS
What are the diagnostic criteria for emergence from MCS?
- functional interactive communication - verbal, writing, yes/no gestures, communication device
OR - functional use of 2 objects
What is functional use? What does it show?
perform the right task w/ an object
- if given toothbrush, you bring it to your mouth or if given a comb, you bring it to your hair
- shows cognitive awareness
What is the only outcome measure that directly incorporates the existing diagnostic criteria for coma, vegetative scale, and minimally conscious state and was created for the sole purpose of detecting subtle neurobehavioral function
JFK Coma recovery scale (CRS-R)
What is the general utility of the JFK CRS-R?
measures recovery from comatose through confusional states
- detects subtle but meaningful changes
What are the major functional scales the JFK CRS-R looks at as it relates to consciousness?
6
- Arousal
- Auditory
- Visual
- Motor
- Oromotor
- Communication
When is the CRS-R scale administered?
performed multiple times a day by multiple disciplines
What are the CRS-R levels of responsiveness? (6)
- no response
- tonic posture
- reflexive/automatic
- generalized
- localized
- purposeful
tonic postural response
abnormal movement patterns in forms of posturing
reflexive/automatic response
reflexive - no cortical involvement
generalized response
another part of body moves that is not affected by stimulus
localized response
body part affected by stimulus moves
- shows evidence patient knew where the stimulus came from
purposeful response
goal directed behavior
What is the prognostic utility of the CRS-R?
- visual tracing has better prognosis to recover consciousness within 12 months
- CRS changes over initial 4 weeks better functional outcome than GCS
- MCS diagnosis on admission vs VS had lower functional disability at 12 months
What is the Disorders of Consciousness Scale (DOCS)?
measures neurobehavioral functioning during coma recovery
difference between DOCS and JKF CRS-R?
DOCS has:
- social knowledge
- proprioceptive/vestibular
- tactile
- facial recognition
What are the major goals of DOC rehabilitation?
slowly increase tolerance to normal behaviors
- stim schedule
- developmental posturing
- out of bed tolerance
- family education/training
