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Neuro PT > Lecture 6: PT Management for Individuals with Disorders of Consciousness > Flashcards

Lecture 6: PT Management for Individuals with Disorders of Consciousness Flashcards

1
Q

an injury to the brain that’s not hereditary, congenital, degenerative or induced by birth trauma. Injury that occured after birth

A

acquired brain injury

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2
Q

an insult to the brain not of degenerative or congential nature but caused by external physical force that may produce a diminished or altered state of consciousness, which results in impairment of cognitive abilities or physical functioning

A

Traumatic brain injury (TBI)
vary tremendously based on area and extent of neuro damage

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3
Q

GCS

A

3-8 SEVERE injury
9-12 MOD injury
13-15 MILD injury

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4
Q

Rancho level 1

A

no response (to any stimuli)
coma

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5
Q

rancho lvl II

A

generalized response
- limited and inconsistent and non-purposeful
- generalized reflex response often to pain only
- physiological, gross body mvmt and nonpurpuoseful vocalizations

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6
Q

rancho lvl III

A

Localized response
- increased movement, reacting more specifically to stim (will turn towards sound or withdraw from pain, watch someone move aroudn room)
- may begin inconsisten response to commands

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7
Q

“SEVERE” TBI

A

ranch lvls I-III
GCS 3-8
(referring to pt with disorders of consciousness)

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8
Q

arousal

A

being awake or responsive to stimuli. body’s level of alertness or activation (e.g., how awake or energetic a person feels).

NOTE: A person can be aroused without being aware, as seen in cases of a vegetative state.

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9
Q

awareness

A

ability to consciously perceive, think, and respond to the environment or one’s internal state.
Allows a person to have a sense of self and surroundings.

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10
Q

T/F arousal requires awareness

A

F (awareness of self or environement requires arousal and alertness)

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11
Q

a collective term to describe conditions where consciousness or arousal has been affected by brain dmg

A

DoC

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12
Q

examples of disorders of consciousness

A

coma
vegitative state
minimally conscious state

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13
Q

2 levles of unconsciousness
2 levels of consciousness

A

unconscious: vegitative state, coma

conscousness: minimally conscious state, conscous

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14
Q

coma

A

compete paraylysis of cerebral function or state of unresponsivness

no sleep-wake cycle

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15
Q

unresponsive wakefulness syndrome refers to?

A

vegetative sate
when youre wakeful but less responsivenss with no evident cerebral cortical function

now have sleep-wake cycle but still not aware of surrounding

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16
Q

consciousness severely altered but there are signs demonstrating self or enviornmental awareness

A

minimally conscous state

17
Q

emergence from MCS

A
  • awake most of time but confused
  • functional objec use
  • functional accurate communicaiton
18
Q

TABLE ON SLIDE 18

MEMORIZE AND UNDERSTAND

A
19
Q

locked in syndrome

A

damage to B ventral pons d/t basilar thrombosis

easily misdiagnosed as a disorder of conscousness

20
Q

T/F locked in syndrome is NOT a disorder of consciousness

A

True

21
Q

T/F a patient will most likely have a multi-system invovlement

A

true

22
Q

clinical presentation after brain injury: PRIMARY impairments

A

neuromuscular
sensory and perceptual
communication
cognition
behavior/personality

read more info slide 22

23
Q

clinical presentation after brain injury: secondary impariments

A

musculoskeletal
cardiopulmonary
integumentary

24
Q

sympathetic storming; S&S

A

agitation
diaphoresis
hyperthermia
HTN
tachycardia
tachypnea
posturing
pupillary dilation

25
Q

when there’s dysfunction of autonomic centers in the diencephalon or their connections to cortical, subcortical and brainstem loci that mediate autonomic function, this causes

A

autonomic instability following TBI

26
Q

PT implications for patients with sympathetic storming (in severe TBI)

A
  • MONITOR VITALS
  • noxious stimuli may trigger storming
  • mgmt of tone/posturing to reduce risk fo skin breakdown or contracture
27
Q

PT Exaimination for DoC

A
  1. knowledge of neuroanatomy (imaging and how we will expect them to preset)
  2. knowneldge of pathophysiology
  3. pt history
  4. review of systems
  5. PERCAUTIONS!! and moi? vitals like ICP
  6. test and measures (activity domain v participation domain)
28
Q

what’s a participation domain outcome measure for DoC?

A

disability rating scale (DRS)

coma to community patients
0 is no disabiltiy and 29 is extreme vegitative state

29
Q

what are activity domain scales for DoC?

A
  • functional assessment measure (FAM)
  • FIM
30
Q

what are body function and structure domains for DoC?

A
  • GCS
  • Rancho
  • disorders of consciousness scale (DOCS)
  • JFK coma recovery scale revised (CRS-R)
  • Modified ashworth sclae (MAS)
31
Q

what are general goals for patients with DoC

A
  • try increasing their arousal/alertness
  • upright posture
  • reducing secondary complications risk (skin, pulm, contracture)
  • family care
  • maximize ability to recover
  • i.d. appropriate lvl of care
32
Q

general ways to treat DoC

A

Choosing activites that will acitivate their Reticular System
- early mobilization
- organized sensory stim
- reduce secondary compliations
- family/caregiver education
- collab with interdisciplinary team

33
Q

a very good PT intervention is ____ in the beginnig but you need to be mindful of things such as autonomic (hypo/hypertension), pressure ulcers, too much stretching and head control activity

A

endurance/upright tolerance

34
Q

which state of DoC is it better for patient to do an organized sensory stimulation? (i.e. auditory, tactile, visual, olfactory, gustatory, kinesthetic, vestibular)

A

MCS rather than vegitative state

35
Q

ways to manage spasticity

A

prolonged stretching
WB
Encouraging active mvmt
bed/wheelchai positioning
casting/splints
meds

36
Q

family/caregivied education for rancho lvl I, II, III

A
  • Keep room quiet
  • short, simple commands
  • only 2-3 visitors in room
  • allow pt time to respond
  • pictures of family and their favorite items/hobby
  • engage person in familiar activites
37
Q

what can we as PT teach family?

A
  • minimizing caregiver burden
  • stimulation technique
  • PROM, stretching and positioning
  • transfer training using appropriate bodymechanics/technique
38
Q

prevent secondary impairments such as

A

pressure ulcers
contractures

Neuro PT (8 decks)

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