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Neuro 1 > Disorders of Consciousness > Flashcards

Disorders of Consciousness Flashcards

1
Q

Define consciousness

A

the process of knowing

- wakefulness and awareness

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2
Q

What are the characteristics of RLAS-R I/Coma?

A

no response to anything

  • No eyes open
  • cannot be awakened by noxious stim
  • ONLY see reflexive responses - Hoffman’s and Babinski’s
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3
Q

What are the characteristics of RLAS-R II/Vegetative State?

A
  • Generalized reflex response to noxious stimuli - non-purposeful
  • Eyes open (spontaneously)
  • improved vitals
    • sleep/wake cycles on EEG
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4
Q

How will a level 2 respond to repeated auditory stimuli?

A

increased or decreased generalize activity

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5
Q

How will a level 2 respond to external stimuli?

A
  • physiological changes generalized
  • Gross body movements
  • Non-purposeful vocalization
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6
Q

What generalized response is typically seen in level 2?

A

posturing

  • Decorticate
  • Decerebrate
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7
Q

What is meant by persistent vegetative state?

A

at least a year in vegetative state - odds of coming out of this state are slim after 1 year

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8
Q

At what level does localized response occur?

A

level 3

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9
Q

At what level do eyes open? What does this mean?

A

Level 2

  • means reticular system has regained control of our wakefulness
  • have brainstem control! - can regulate vitals, sleep/wake, etc
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10
Q

Are level 2 patients on a mechanical vent?

A

typically no because they have brainstem control (reticular formation) of vitals

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11
Q

What are the characteristics of RLAS-R III/Minimally Conscious State?

A
  • 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
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12
Q

How long does coma/level 1 typically last? When do chances of coming out of it drop?

A
  • rarely lasts longer than 2-4 weeks

- chances drop after 1 month

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13
Q

What type of injury can result in level 1/coma?

A
  • brainstem injury to reticular formation - midbrain, pons

- cortical lesions with diffuse injury

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14
Q

At what level does awareness begin?

A

level 3

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15
Q

What are the diagnostic criteria of being diagnosed MCS?

A

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
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16
Q

Why does is matter that accurate diagnosis is made?

A

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

17
Q

What are the diagnostic criteria for emergence from MCS?

A
  • functional interactive communication - verbal, writing, yes/no gestures, communication device
    OR
  • functional use of 2 objects
18
Q

What is functional use? What does it show?

A

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
19
Q

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

A

JFK Coma recovery scale (CRS-R)

20
Q

What is the general utility of the JFK CRS-R?

A

measures recovery from comatose through confusional states

- detects subtle but meaningful changes

21
Q

What are the major functional scales the JFK CRS-R looks at as it relates to consciousness?

A

6

  • Arousal
  • Auditory
  • Visual
  • Motor
  • Oromotor
  • Communication
22
Q

When is the CRS-R scale administered?

A

performed multiple times a day by multiple disciplines

23
Q

What are the CRS-R levels of responsiveness? (6)

A
  • no response
  • tonic posture
  • reflexive/automatic
  • generalized
  • localized
  • purposeful
24
Q

tonic postural response

A

abnormal movement patterns in forms of posturing

25
Q

reflexive/automatic response

A

reflexive - no cortical involvement

26
Q

generalized response

A

another part of body moves that is not affected by stimulus

27
Q

localized response

A

body part affected by stimulus moves

- shows evidence patient knew where the stimulus came from

28
Q

purposeful response

A

goal directed behavior

29
Q

What is the prognostic utility of the CRS-R?

A
  • 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
30
Q

What is the Disorders of Consciousness Scale (DOCS)?

A

measures neurobehavioral functioning during coma recovery

31
Q

difference between DOCS and JKF CRS-R?

A

DOCS has:

  • social knowledge
  • proprioceptive/vestibular
  • tactile
  • facial recognition
32
Q

What are the major goals of DOC rehabilitation?

A

slowly increase tolerance to normal behaviors

  • stim schedule
  • developmental posturing
  • out of bed tolerance
  • family education/training

Neuro 1 (11 decks)

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