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Neuro III > Disorders of Consciousness and Physical Therapy > Flashcards

Disorders of Consciousness and Physical Therapy Flashcards

1
Q

Consciousness

A

a state of awareness of self and environment that requires alertness and arousal

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2
Q

Arousal

A

Level of conciousness

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3
Q

Awarness

A

Content of conciousness

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4
Q

What are the goals of a consciousness assessment?

A
  1. provide accurate diagnosis
  2. develop appropriate treatment Plan
  3. give accurate prognosis
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5
Q

What are some consciousness assessments

A

Behavior assessment
bedside neurological assessment
electrophysiologic studies
Neuroimaging

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6
Q

What is the Coma Recovery Scale Revised?

A

determine diagnosis
establish prognosis and projected disposition needs
determine level of arousal
facilitate selection of appropriate commands
help differentiate volitional from coincidental movement
monitor progress over time
CRS-R assists with:
-differential diagnosis
-prognostic assessment
-treatment planning

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7
Q

Who is appropriate for CRS-R?

A

rancho level II to V

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8
Q

Begin to respond to stimuli but slow, inconsistent, or delayed
Responses tend to be similar irrespective to stimulation

A

Level II: generalized response

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9
Q

Increased movements and react more specifically to stimuli
May begin to respond inconsistently to commands and yes/no questions

A

Level III: Localized response

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10
Q

Auditory Function Scale
Visual Function Scale
Motor Function Scale
Oromotor/Verbal Functional Scale
Communication Scale
Arousal Scale

A

CRS-R subscales

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11
Q

Coma is rancho level what?

A

Rancho Level-1

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12
Q

Vegetative state is rancho level what?

A

Rancho Level 2

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13
Q

Minimally Conscious State rancho level what?

A

Ranch Level 3

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14
Q

Symptoms/signs of Coma

A

No eye opening
Absence of sleep/wake cycle
Unable to follow instructions
No speech or other forms of communication
No purposeful movement
Behavior limited to reflexive activity

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15
Q

PT roles at COMA level 1

A

consult- speaking around loved one normally
Provide supportive care
bed and mattress
Positioning in bed
Pulmonary needs
Contracture prevention
Skin protection
ROM initiation with caregiver education

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16
Q

Symptoms/Signs at Vegetative state (unresponsive wakefulness syndrome)

A

Return of sleep-wake cycle with periodic eye opening and eye closing
May moan or make other sounds
May cry or smile or make facial expressions without apparent cause
May briefly move eye toward persons or objects
May react to loud sounds with startle response
Unable to follow instructions
No speech or other forms of communication

No evidence of sustained reproducible, purposeful or voluntary behavior response to stimuli

17
Q

Why the switch from vegetative state to unresponsive wakefulness syndrome?

A

less negative connotation
demonstrates wakefulness (eye opening) but no voluntary motor responses
Can be transitory or permanent

18
Q

De-Corticate Posturing

A

Flexed UE

19
Q

De-Celebrate Posturing

A

Extended UE

20
Q

RL Level II Generalized Response PT Role

A

Consult
Provide supportive care
Bed and mattress
Positioning in bed
Pulmonary Needs
Contracture Prevention
Skin Protection
ROM initiation with caregiver education
Coma Stimulation: Sensory stimuli introduced

21
Q

Sometimes follows instructions
May communicate yes or no by talking or gestures
May speak some understandable words or phrases
May respond to people, things, or other events by:
-Laughing crying
-making sounds
-reaching for things
-keeping eyes focused on people or things for a sustained period of time

A

Minimally conscious state

22
Q

People in a minimally conscious state do these things ______ which makes it difficult to distinguish between vegetative state and MCS.

A

Inconsistently

23
Q

Rancho Level III localized response PT role

A

Purposeful- showing pics of family
Provide an enriched environment
Positioning, ROM, Sensory stimulation
Mobilization
Combine Positioning with exercise

24
Q

When a pt is emerging from Minimally Conscious State what happens

A
  1. communication
  2. following instructions consistently
  3. demonstrating functional use of an object
  4. almost always experience confusion
25
Q

What are indicators of emergence?

A

Functional object use
and/or
Functional accurate communication

26
Q

What differentiates MCS (+) and MCS (-)

A

based on the presence or absence of language comprehension and or expression

27
Q

Of patients that recovered consciousness _____% recovered within first 3 months

A

90%

28
Q

Visual fixation and visual pursuit most common early signs of MCS

A

true

29
Q

How should an environment be set up for a patient after TBI or DOC

A

low stimulation
minimal interruptions
salience

30
Q

What are PT goals for DOC

A

assess level of consciousness
positioning in wheelchair and bed
spasticity management
standing programs
equipment trials
establishing a home program
family training
manage medical issues with medical team

31
Q

What are some PT interventions for DOC

A
  1. pain assessment
  2. spasticity management
  3. head/trunk control
  4. identifying movements for command protocol
  5. positioning programs
  6. standing program
  7. promote increased arousal and consciousness
32
Q

How often do patients need repositioned in bed?

A

every 2 hours

33
Q

What can you uses to help reposition a patient

A

foam position devices, casts/bivalves, splints

34
Q

examples for Conservative management for spasticity

A

casting and splinting
stretching
inhibitive techniques

35
Q

Medical management for spasticity

A

when conservative management is not adequate
oral medications
injections/neurolytics
Intrathecal baclofen pump

36
Q

Study states that patient experience increased arousal at ___degrees on a tilt table vs supine

A

85 degrees

37
Q

Tilt tables also shown to _____ the occurrence of orthostatic hypotension in the DOC population

A

decrease

38
Q

what are some benefits of the body weight supported treadmill for DOC

A

increased repetition of a task-specific activity
earlier opportunities for weight bearing
improved strength
reduced spasticity
decreased burden on therapist allowing for focus to be on facilitating various components of gait

Neuro III (23 decks)

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