Lecture 5 Disorders of Conciousness

Question 1

Acquired Brain Injury vs Traumatic Brain Injury

Answer 1

Acquired- not hereditary, degenerative, or induced by birth trauma

Traumatic- An insult to the brain caused by external physical force

Question 2

We should always assume our patients have a _______ surgery and use those precautions until we do a thorough chart review

Answer 2

Craniectomy (their head can look normal)

Question 3

What scores of the glasgow coma scale are severe brain injury

moderate?

mild?

Answer 3

3-8

9-12

13-15

Question 4

What is rancho level 1, 2, and 3?

Answer 4

No response

Generalzed response

Localized Response

Question 5

What is rancho level 4, 5, and 6?

Answer 5

4- Confused Agitated

5- Confused, inappropriate, nonagitated

6. Confused appropriate

Question 6

What is rancho level 7 and 8?

Answer 6

7- Automatic Appropriate

8. Purposeful Appropriate

Question 7

At what rancho level may begin to respond to yes/no questions?

Answer 7

3

Question 8

Can a patient have arousal without awareness?

Answer 8

Yes

Question 9

“Unresponsive wakefulness syndrome”

Reduced responsiveness with no evident cerebral cortical function

Answer 9

vegetative state

Question 10

conciousness severely altered but there are signs demonstrating self or environmental awareness

Answer 10

minimally concious state

Question 11

What are the 3 criteria to signal emergence from a minimally concious state

Answer 11

1. Awake most of the time, but confused
2. functional object use
3. functional accurate communication

Question 12

T or F: Vegetative state has arousal but not awareness

Answer 12

T

Question 13

Locked in syndrome is due to damage where?

Answer 13

Bilateral ventral pons usually due to basilar thrombosis

Question 14

How can PTs manage sympathetic storming

Answer 14

Monitor vitals and assess pt response to intervention

remove any noxious stimuli triggering the storming

management of tone/posture to reduce risk of skin breakdown or contractures

Question 15

How is the DRS (Disability rating scale) scored?

Answer 15

0-no disability

to

29- (Extreme vegetative state)

Question 16

What scale is best for identifying what disorder of conciousness someone has?

Answer 16

JFK coma scale

23 items scored 0-23

Question 17

Why is a standardized assessment for disorders of conciousness important

Answer 17

Because “expert consensus” can be wrong, up to 43% of patients are misdiagnosed as vegetative state

Question 18

When administered the Coma Rating Scale-revised,

how long do you observe the patient in order to record a baseline observation

Answer 18

1 minute

Question 19

Using the Coma Rating Scale- revised (CRS-R), if the patient has no eye opening then what should you do

Answer 19

preform the arousal facilitation protocol

deep pressure to face, neck, arm, hand, chest, leg, foot, and toes

Question 20

How long does a patient have to respond to each item on the CSR-R

Answer 20

10 seconds

Question 21

What scores in these categories indicate there is some level of conciousness on the CRS-R

Communication:

Visual:

Motor:

Auditory:

Oromotor:

Answer 21

Communication: 1

Visual: 2

Motor: 3

Auditory: 3

Oromotor: 3

Question 22

What are the 2 indicators of emergence (eMCS) on the CRS-R

Answer 22

Motor scale: functional object use

functional accurate communication