Lecture 6: PT Management for Individuals with Disorders of Consciousness Flashcards
an injury to the brain that’s not hereditary, congenital, degenerative or induced by birth trauma. Injury that occured after birth
acquired brain injury
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
Traumatic brain injury (TBI)
vary tremendously based on area and extent of neuro damage
GCS
3-8 SEVERE injury
9-12 MOD injury
13-15 MILD injury
Rancho level 1
no response (to any stimuli)
coma
rancho lvl II
generalized response
- limited and inconsistent and non-purposeful
- generalized reflex response often to pain only
- physiological, gross body mvmt and nonpurpuoseful vocalizations
rancho lvl III
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
“SEVERE” TBI
ranch lvls I-III
GCS 3-8
(referring to pt with disorders of consciousness)
arousal
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.
awareness
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.
T/F arousal requires awareness
F (awareness of self or environement requires arousal and alertness)
a collective term to describe conditions where consciousness or arousal has been affected by brain dmg
DoC
examples of disorders of consciousness
coma
vegitative state
minimally conscious state
2 levles of unconsciousness
2 levels of consciousness
unconscious: vegitative state, coma
conscousness: minimally conscious state, conscous
coma
compete paraylysis of cerebral function or state of unresponsivness
no sleep-wake cycle
unresponsive wakefulness syndrome refers to?
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
consciousness severely altered but there are signs demonstrating self or enviornmental awareness
minimally conscous state
emergence from MCS
- awake most of time but confused
- functional objec use
- functional accurate communicaiton
TABLE ON SLIDE 18
MEMORIZE AND UNDERSTAND
locked in syndrome
damage to B ventral pons d/t basilar thrombosis
easily misdiagnosed as a disorder of conscousness
T/F locked in syndrome is NOT a disorder of consciousness
True
T/F a patient will most likely have a multi-system invovlement
true
clinical presentation after brain injury: PRIMARY impairments
neuromuscular
sensory and perceptual
communication
cognition
behavior/personality
read more info slide 22
clinical presentation after brain injury: secondary impariments
musculoskeletal
cardiopulmonary
integumentary
sympathetic storming; S&S
agitation
diaphoresis
hyperthermia
HTN
tachycardia
tachypnea
posturing
pupillary dilation
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
autonomic instability following TBI
PT implications for patients with sympathetic storming (in severe TBI)
- MONITOR VITALS
- noxious stimuli may trigger storming
- mgmt of tone/posturing to reduce risk fo skin breakdown or contracture
PT Exaimination for DoC
- knowledge of neuroanatomy (imaging and how we will expect them to preset)
- knowneldge of pathophysiology
- pt history
- review of systems
- PERCAUTIONS!! and moi? vitals like ICP
- test and measures (activity domain v participation domain)
what’s a participation domain outcome measure for DoC?
disability rating scale (DRS)
coma to community patients
0 is no disabiltiy and 29 is extreme vegitative state
what are activity domain scales for DoC?
- functional assessment measure (FAM)
- FIM
what are body function and structure domains for DoC?
- GCS
- Rancho
- disorders of consciousness scale (DOCS)
- JFK coma recovery scale revised (CRS-R)
- Modified ashworth sclae (MAS)
what are general goals for patients with DoC
- 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
general ways to treat DoC
Choosing activites that will acitivate their Reticular System
- early mobilization
- organized sensory stim
- reduce secondary compliations
- family/caregiver education
- collab with interdisciplinary team
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
endurance/upright tolerance
which state of DoC is it better for patient to do an organized sensory stimulation? (i.e. auditory, tactile, visual, olfactory, gustatory, kinesthetic, vestibular)
MCS rather than vegitative state
ways to manage spasticity
prolonged stretching
WB
Encouraging active mvmt
bed/wheelchai positioning
casting/splints
meds
family/caregivied education for rancho lvl I, II, III
- 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
what can we as PT teach family?
- minimizing caregiver burden
- stimulation technique
- PROM, stretching and positioning
- transfer training using appropriate bodymechanics/technique
prevent secondary impairments such as
pressure ulcers
contractures
