Disorders of Consciousness and Physical Therapy Flashcards
Consciousness
a state of awareness of self and environment that requires alertness and arousal
Arousal
Level of conciousness
Awarness
Content of conciousness
What are the goals of a consciousness assessment?
- provide accurate diagnosis
- develop appropriate treatment Plan
- give accurate prognosis
What are some consciousness assessments
Behavior assessment
bedside neurological assessment
electrophysiologic studies
Neuroimaging
What is the Coma Recovery Scale Revised?
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
Who is appropriate for CRS-R?
rancho level II to V
Begin to respond to stimuli but slow, inconsistent, or delayed
Responses tend to be similar irrespective to stimulation
Level II: generalized response
Increased movements and react more specifically to stimuli
May begin to respond inconsistently to commands and yes/no questions
Level III: Localized response
Auditory Function Scale
Visual Function Scale
Motor Function Scale
Oromotor/Verbal Functional Scale
Communication Scale
Arousal Scale
CRS-R subscales
Coma is rancho level what?
Rancho Level-1
Vegetative state is rancho level what?
Rancho Level 2
Minimally Conscious State rancho level what?
Ranch Level 3
Symptoms/signs of Coma
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
PT roles at COMA level 1
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
Symptoms/Signs at Vegetative state (unresponsive wakefulness syndrome)
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
Why the switch from vegetative state to unresponsive wakefulness syndrome?
less negative connotation
demonstrates wakefulness (eye opening) but no voluntary motor responses
Can be transitory or permanent
De-Corticate Posturing
Flexed UE
De-Celebrate Posturing
Extended UE
RL Level II Generalized Response PT Role
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
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
Minimally conscious state
People in a minimally conscious state do these things ______ which makes it difficult to distinguish between vegetative state and MCS.
Inconsistently
Rancho Level III localized response PT role
Purposeful- showing pics of family
Provide an enriched environment
Positioning, ROM, Sensory stimulation
Mobilization
Combine Positioning with exercise
When a pt is emerging from Minimally Conscious State what happens
- communication
- following instructions consistently
- demonstrating functional use of an object
- almost always experience confusion
What are indicators of emergence?
Functional object use
and/or
Functional accurate communication
What differentiates MCS (+) and MCS (-)
based on the presence or absence of language comprehension and or expression
Of patients that recovered consciousness _____% recovered within first 3 months
90%
Visual fixation and visual pursuit most common early signs of MCS
true
How should an environment be set up for a patient after TBI or DOC
low stimulation
minimal interruptions
salience
What are PT goals for DOC
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
What are some PT interventions for DOC
- pain assessment
- spasticity management
- head/trunk control
- identifying movements for command protocol
- positioning programs
- standing program
- promote increased arousal and consciousness
How often do patients need repositioned in bed?
every 2 hours
What can you uses to help reposition a patient
foam position devices, casts/bivalves, splints
examples for Conservative management for spasticity
casting and splinting
stretching
inhibitive techniques
Medical management for spasticity
when conservative management is not adequate
oral medications
injections/neurolytics
Intrathecal baclofen pump
Study states that patient experience increased arousal at ___degrees on a tilt table vs supine
85 degrees
Tilt tables also shown to _____ the occurrence of orthostatic hypotension in the DOC population
decrease
what are some benefits of the body weight supported treadmill for DOC
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
