Lecture 5 Disorders of Conciousness Flashcards
Acquired Brain Injury vs Traumatic Brain Injury
Acquired- not hereditary, degenerative, or induced by birth trauma
Traumatic- An insult to the brain caused by external physical force
We should always assume our patients have a _______ surgery and use those precautions until we do a thorough chart review
Craniectomy (their head can look normal)
What scores of the glasgow coma scale are severe brain injury
moderate?
mild?
3-8
9-12
13-15
What is rancho level 1, 2, and 3?
No response
Generalzed response
Localized Response
What is rancho level 4, 5, and 6?
4- Confused Agitated
5- Confused, inappropriate, nonagitated
- Confused appropriate
What is rancho level 7 and 8?
7- Automatic Appropriate
- Purposeful Appropriate
At what rancho level may begin to respond to yes/no questions?
3
Can a patient have arousal without awareness?
Yes
“Unresponsive wakefulness syndrome”
Reduced responsiveness with no evident cerebral cortical function
vegetative state
conciousness severely altered but there are signs demonstrating self or environmental awareness
minimally concious state
What are the 3 criteria to signal emergence from a minimally concious state
- Awake most of the time, but confused
- functional object use
- functional accurate communication
T or F: Vegetative state has arousal but not awareness
T
Locked in syndrome is due to damage where?
Bilateral ventral pons usually due to basilar thrombosis
How can PTs manage sympathetic storming
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
How is the DRS (Disability rating scale) scored?
0-no disability
to
29- (Extreme vegetative state)
What scale is best for identifying what disorder of conciousness someone has?
JFK coma scale
23 items scored 0-23
Why is a standardized assessment for disorders of conciousness important
Because “expert consensus” can be wrong, up to 43% of patients are misdiagnosed as vegetative state
When administered the Coma Rating Scale-revised,
how long do you observe the patient in order to record a baseline observation
1 minute
Using the Coma Rating Scale- revised (CRS-R), if the patient has no eye opening then what should you do
preform the arousal facilitation protocol
deep pressure to face, neck, arm, hand, chest, leg, foot, and toes
How long does a patient have to respond to each item on the CSR-R
10 seconds
What scores in these categories indicate there is some level of conciousness on the CRS-R
Communication:
Visual:
Motor:
Auditory:
Oromotor:
Communication: 1
Visual: 2
Motor: 3
Auditory: 3
Oromotor: 3
What are the 2 indicators of emergence (eMCS) on the CRS-R
Motor scale: functional object use
functional accurate communication
