Quiz 4 Study Content Flashcards
1
Q
What are the early stages of recovering consciousness?
A
- Wakefulness
- Awareness: Arousal, Attention, Purpose
- Perception and Recognition of Information
2
Q
What are the Later Stages of Recovering Consciousness?
A
- Speed of information processing
- Memory
- Reasoning and Problem-Solving
- Executive Functioning
3
Q
What are some common early symptoms when someone recovers consciousness?
A
- Confused
- Unable to Pay Attention
- Unaware of Where they are
- Unaware of What date it is
4
Q
How many Levels of Rancho Los Amigos are there?
A
- 10
5
Q
Describe Rancho Level 1
A
- No Response
- Requires Total Assistance
- Coma
6
Q
What does treatment focus on in Rancho Level 1?
A
- Managing Medical Issues
7
Q
Why does impaired consciousness occur in Rancho Level 1?
A
- The Brainstem does not connect to higher function areas of the brain
8
Q
In Rancho Level 1, what can the patient not do?
A
- Follow Commands
- Communicate
- Respond to Pain
9
Q
Describe Rancho Level 2
A
- Generalized Response
- Requires Total Assistance
- Vegetative State
10
Q
What is occurring in the brain of someone in Rancho Level 2?
A
- Brainstem is recovering
- Connection to higher order regions of brain are not stable
11
Q
What are patients in Rancho Level 2 able to do?
A
- Open Eyes
- Have Periods of Wakefulness
- Have some form of sleep/wake cycle
12
Q
What are Patients in Rancho Level 2 unable to do?
A
- Follow Movement
- Focus on People or Objects
- Verbally Communicate
13
Q
Describe Rancho Level 3
A
- Localized Response
- Requires Total Assistance
- Minimal Conscious State
14
Q
What happens to the level of consciousness in Rancho Level 3?
A
- Level of consciousness continues to improve
- Awake more often, longer period of time
15
Q
What does Rancho Level 3’s localized response include?
A
- Staring in direction of sound
- Looking at picture
- Grabbing toward tubes or catheter
- Pulling away from pain
- Localizes to pain
16
Q
What do patients in Rancho Level 3 still struggle with?
A
- Verbally communicate
- Responding consistently
- Process auditory and visual stimuli fast
- They have decreased arousal
17
Q
How can you help someone in Rancho Level 3?
A
- Calm soothing voice
- Avoid complex medical information
- Remind them who you are and what day it is
- When touching, explain
- Keep comments, questions, and commands short and simple
- Allow up to 10sec to respond
- Provide small amount of stimulation, combined with rest
18
Q
What should you remember about patients in Rancho Level 3?
A
- Behaviours not intentional
- Easily fatigued and need plenty of rest
19
Q
What occurs between Rancho Level 1 and 3?
A
- They are waking up
- It is hard work
- They need plenty of rest
20
Q
Describe Rancho Level 4
A
- Confused and Agitated
- Requires Maximal Assistance
- Emerging Consciousness State
21
Q
What is happening in the brain of a patient in Rancho Level 4?
A
- Brain is still in low arousal and sleepy
- Outwardly, seen as agitation and restlessness
22
Q
How might agitation be expressed in Rancho Level 4?
A
- Hitting Behaviour
- Foul Language
- Yelling
- Restlessness
- Short Attention Span
23
Q
What is Confabulation?
A
- Filling in Memory Gap with stories
24
Q
Describe the memory of a patient in Rancho Level 4
A
- No day-to-day memory
- Confabulation, to fill in memory gaps
- May have significant sleep disturbances
25
What tasks can be used to help with memory for patients in Rancho Level 4?
- Brushing Teeth
- Writing their Name
- Sorting Objects by Color
- Simple Activities they enjoy
26
Will a patient in Rancho Level 4 remember this period?
- NO
27
Describe Rancho Level 5
- Confused
- Inappropriate and Non-Agitated
- Requires Maximal Assistance
28
What is Rancho Level 5 characterized by?
- Wakefulness with awareness
- Purposeful Interactions
- Process Meaning
- Difficult to Complete Tasks Accurately
29
What is Post-Traumatic Amnesia?
- No day-to-day memory
30
Describe some symptoms of Rancho Level 5
Increased
- memory (slightly): mainly step-by-step recovery
- Distractability
- ability to follow commands consistently and correctly
Decreased
- awareness of injury
- problem-solving
- error recognition
- attention
- initiation
31
Describe Rancho Level 6
- Confused Appropriate
- Requires Moderate Assistance
- Emerges from Post-Traumatic Amnesia
32
What can patients in Rancho Level 6 Recall?
- the Date
- Where they are
- How to get to different places
33
In Rancho Level 6, the patients are in a Post Traumatic Cognitively Impaired State. What impairments might they have?
- Attention
- Information Processing
- Memory
- Executive Functioning Skill
34
Describe the Changes from Rancho Level 5 to Rancho Level 6
Increase
- day-to-day memory (still impaired)
- recognition of problems and impairments
- Independence
35
What are still some issues that a patient in Rancho Level 6 will experience?
Decreased
- problem-solving skills
- flexibility of thought
- memory for new information still impaired
- Needs assistance with compensation strategies
- May not understand importance of therapy
36
Describe Rancho Level 7
- Automatic and Appropriate
- Minimal Assistance for Daily Living Skills
- Experiencing Consistent Day-to-day memory
37
What are some improvements that occur in Rancho Level 7?
- Wakefulness
- Awareness
- Perception
- Attention
- Memory
38
What is a Focal Injury?
- An injury to a specific part of the brain
39
What part of memory is still impaired in Rancho Level 7?
- Limited Recall on complex information
40
What are some continuing impairments in Rancho Level 7?
- recall on complex information
- Executive functioning
- deficits in focal injuries
- Overestimation of abilities
- concrete Thinking
- Slow processing speed
- Decreased Organization
- Poor Attention to details
- Minimal awareness of errors
41
What are some examples of Focal Injuries?
- Physical Limitations
- Speaking
- Communication Impairments
- Poor Memory
- Executive Functioning Challenges
42
Describe Rancho Level 8
- Purposeful and Appropriate
- Requires Stand-by Assistance
43
What are some characteristics of Rancho Level 8?
- Requires less assistance
- Readiness to return to work or school
- Deficits in Focal Injury Areas
- Low frustration tolerance, irritability, and depression
- Awareness of Impairments
- Improved organization
- Increased insight and self-evaluation
- Recognizes decreased social interaction
44
Describe Rancho Level 9
- Purposeful and Appropriate
- Requires Stand-by assistance on Request
45
What are some marked improvements in Rancho Level 9?
- Increased independence
- Thinks about consequences
- Accurate estimate of abilities
- Increased Frustration related to limitations
46
Describe Rancho Level 10
- Purposeful and Appropriate
- Requires modified and dependent assistance
47
How do patients in Rancho Level 10 live?
- Independently
- May require assistance with physical limitations due to focal injuries
48
What are the Two clinical components of consciousness?
- Arousal = wakefulness
- Awareness = Subjective Experience
49
Describe Arousal in terms of Consciousness
- Wakefulness
- Vigilance and Alertness during wakefulness
- Presence of eye-opening and brainstem responses
50
What are the Neurobiological Markers of Wakefulness?
- Passage of sensory information from brainstem to cortex
- High energy demand and electrical activity within corticothalamic system
51
Describe Awareness in terms of consciousness
- Subjective Experience
- Response to external and internal stimuli in integrated manner
52
What is the Neurobiological Marker of Awareness?
- Anatomical and Functional Connectivity of the Frontoparietal Networks and the thalamus
53
Consciousness is based on sensory information flow from upper brainstem to cerebral cortex. How does it get there?
- Travels via the reticulo-thalamocortical and extra-thalamic pathways
54
How does the Ascending Reticular Activating System in the Upper Brainstem send projections throughout the cortex?
- Directly
- Through the Thalamus
- Through the hypothalamus
55
What is the Thalamus a Gate for?
- Arousal
- Awareness
56
What is the one sense the thalamus is not a relay system for?
- Smell
57
What does the Thalamus act as a relay station for?
- All sensory impulses (except smell)
- Conscious recognition of pain, temp, touch, and pressure
58
What are the central thalamus and frontal lobe closely linked by?
- A direct corticothalamic connection
59
What are the three disorders of consciousness?
- Coma
- Vegetative State (VS)
- Minimally Conscious State (MCS)
60
What do the Disorders of consciousness have in common?
- Withdrawal of excitatory synaptic activity across the cerebrum: causes dis-facilitation of neocortical, thalamic, and striatal neurons
- Widespread dis-facilitation: leads to sharp reduction in cerebral metabolic rate
61
Describe a Coma in terms of Arousal and Awareness
Unconsciousness
- Lack of Arousal
- Lack of Awareness
62
Describe a Coma in Clinical terms
- complete loss of spontaneous or stimulus induced arousal
- No eye opening
- no sleep-wake cycle
63
What are the neurological characteristics of a coma?
Structural Lesions usually involve:
- Diffuse cortical
- white Matter Damage
- Brainstem lesion
64
What is the Rehabilitation goals for someone in a Coma?
Those who survive this stage:
- awaken
- Transition to Vegetative or minimal conscious state
- happens within 2-4 weeks
65
Describe the Vegetative State in terms of Arousal and Awareness
Unresponsive Wakefulness State (UWS)
- Arousal (wakefulness)
- No Awareness
66
What are the Clinical characteristics of the Vegetative State?
- Unconscious, dissociative state of wakefulness
- Eyes open spontaneously
- Sleep-wake cycle present
- Can be aroused externally, no signs of conscious perception
- act spontaneously out of context
67
What are the Neurological characteristics of the Vegetative State?
- Presence of wakefulness: preserved brainstem functioning
- Lack of awareness: underlying cortical dysfunction
- Activation of primary cortical areas
- No activation of higher order cortical areas
68
What are the Rehabilitation goals of a patient in a Vegetative state?
- With Proper Medical Care: Survive many years
69
Describe the Minimally Conscious State in terms of Arousal and Awareness
- Arousal (wakefulness)
- Partial Awareness
70
What are the clinical characteristics of the Minimally Conscious State?
- Severe impairments of consciousness
- Wakefulness and partial preservation of awareness
- Purposeful behaviour
- Inconsistent but reproducible, command following
71
What are the Neurological characteristics of the minimally conscious state?
- Preservation of corticothalamic connections
- retain the capacity for cognitive processing
- Exhibit visual pursuit, emotional responses, and gestures to appropriate environmental stimuli
- Unable to communicate their thoughts or feelings
72
What are the Rehabilitation goals of the minimally conscious state?
- Recover at better rates than Vegetative states
73
What is the Acute Confusional State?
- A transient Period between Minimally conscious state and full consciousness
74
What are the clinical characteristics of the Acute confusional State?
- Experience transient periods of disorientation and agitation
- Day-to-day fluctuation of behaviour responses
75
What may the Acute Confusional State include?
Periods of
- Irritability
- distractibility
- Anterograde Amnesia
- Restlessness
- Emotional Lability
- Impaired Perception
- Attentional Abnormalities
- Disrupted Sleep-wake cycle
76
What are the rehabilitation goals for the Acute Confusional State?
- Behaviour consistency (regardless of situational stress)
77
What are some conditions often confused with Disorders of Conciousness?
- Brain Death
- Anarthria
- Locked-in Syndrome
78
What is Brain Death?
- Complete and irreversible loss of brain function
79
What are the 3 clinical indicators of Brain Death?
- Coma (of known cause)
- Absence of Brainstem Reflexes
- Apnea (cessation of breathing)
80
What is Anarthria?
- A severe form of dysarthria: a motor speech disorder
81
What are the characteristics of Locked-in Syndrome?
- Intact consciousness
- sensation and cognition
- paralysis of limbs and facial muscles
- Some patients can communicate through vertical eye movements and blinking
82
What is Locked-In Syndrome Caused by?
- damage to the ventral pons and the corticospinal pathway
83
Why is Locked-In Syndrome often misdiagnosed as a Disorder of Consciousness?
- Lost speech and motor control
84
How can you differentiate between Locked-In Syndrome and Disorder of Consciousness?
- Locked-In syndrome brain metabolism is similar to healthy individual
85
What terms are used to describe the level of Traumatic brain Injury?
- Mild
- Moderate
- Severe
86
Describe a Mild TBI
- Lose of consciousness for 15min or less
- Can be called a concussion
- Some memory lose or dazed and confused
87
Describe a Moderate TBI
- Loss of Consciousness from 15min- a few hours
- Days-weeks of memory loss or confusion
88
Describe a Severe TBI
- Unconscious for a significant amount of time
- Less than 10% of all TBI
- Can be Vegetative or minimally conscious state
89
Name at least 6 possible symptoms of TBI (14)
- Poor coordination
- Blurred Vision
- Headaches
- Trouble speaking/swallowing
- Trouble with bowel control
- Motor impairments
- Vision Problems
- Poor Sexual Function
- Personality changes
- Memory impairments
- Mood Swings
- Trouble Choosing Vocabulary
- Struggle with Reason, Focus, and Logic
- Poor Concentration
90
What are the ranges of the Glasgow Coma Scale?
- 3-15
91
What does a high score on the Glasgow Coma Scale mean?
- Fully awake person
92
What does a low score on the Glasgow Coma Scale mean?
- Very Deep Coma
93
What does a score of 13-15 on the Glasgow Coma Scale mean?
- Mild TBI
94
What does a score of 9-12 on the Glasgow Coma Scale mean?
- Moderate TBI
95
What does a score of 3-8 on the Glasgow Coma Scale mean?
- Severe TBI
96
What is Axonal Shearing?
- Axons are stretched to the point of breaking, causing damaged brain cells to die
97
What is a Brain herniation?
- Rising pressure inside the brain, causing parts to shift out of place
98
What is a Cerebral Atrophy?
- Loss of nerve cells in the brain
- Loss of connections in brain
- Can be focused in one area or whole brain
- Caused by stroke, trauma, or other disease
99
What is an Edema?
- Swelling inside the skull
- Squeezing brain cells
- Interrupts blood flow and oxygen to brain tissue
100
What is a Hematoma
- Pool of blood or bruise inside the skull
- increase pressure in brain
- Damaged blood vessels
101
What is a Hemorrhage?
- Internal or external bleeding caused by damaged blood vessel
102
What is Intracranial Pressure Monitoring?
- Monitoring of the pressure inside the skull using a threaded catheter or a sensor
103
What is Shock?
- Body response triggered by loss of blood to brain
- Can indirectly injure brain tissue
104
What is Sympathetic Storming?
- Elevated stress response that occurs in a third of brain injuries
- Can occur at any time
- Possible sign of returning activity of the nervous system
105
What are the consequences of damage? (TBI)
- Clinical condition
- Reduced Performance
106
What is the Process of Damage?
- Neurodevelopmental/degenerative
- TBI
- ABI
107
What is the Cause of Damage?
- Tumors
- Infections
- Genetics
- Cervrovascular Disorders
- Toxins
- INjuries
108
Who can Brain Injuries affect?
- Anyone
109
Who is most susceptible to TBI's?
- Children under 4
- Adults between 15-25
- Adults over 65
110
What is the leading cause of death and disability for Canadians under the age of 40?
- Brain Injury
111
Which age range is more susceptible to TBI's from Falls?
- Children aged 0-14
- Adults 45 years and older
112
What is the most common cause of TBI for people aged 15-44 years?
- Vehicle crashes
113
What kind of TBi can be diagnosed using objective tools like CT scan?
- Moderate and severe TBI
114
What is influential in the Prognosis of a Mild TBI?
- Extent of damage
- location of damage
- response time
- treatment
115
What are the primary damage/injury mechanisms of a Mild TBI?
- Predominantly blast
- non-penetrating
116
How long does the loss of consciousness last for a Mild TBI?
- under 30minutes
117
How long does Amnesia last for a Mild TBI?
- under 24 hours
118
What are the imaging results of a Mild TBI?
- Negative
119
What are some comorbidities that occur with a Mild TBI?
- Post-traumatic stress disorder
- overlapping symptoms
120
What is the outcome of a Mild TBI?
- Transient neuropsychiatric deficits
- Mostly full-recovery
- Long-term neuropsychiatric especially after repeated injuries are frequent
121
What are the Primary damage/injury mechanisms of a Moderate TBI?
- frequently mixed
- Blast + Acceleration/deceleration
- Typically non-penetrating
122
What is the time frame for an alteration to consciousness following a moderate TBI?
- 30min - 24 hours
123
How long is the Amnesia period for a Moderate TBI?
24 hours - 7 days
124
What score on the Glasgow Coma Scale signifies a moderate TBI?
9-12
125
What do imaging results for a moderate TBI show?
- Transient Changes
126
What are some comorbidities that occur with moderate TBIs?
- PTSD
- Other Injuries
127
What are some outcomes of a moderate TBI?
- Mild-to-moderate
- Typically chronic
- Neurological and neuropsychiatric abnormalities
128
What are some primary damage/injury mechanisms of a severe TBI?
- Complex
- Blast + acceleration/deceleration + penetration
129
What is the timeframe of alteration to consciousness for a Severe TBI?
- more than 24 hours
130
What is the timeframe for Amnesia in Severe TBI?
more than 7 days
131
What is a score on the Glasgow Coma Scale that correlates with a severe TBI?
- Under 9
132
What are common imaging results of a Severe TBI?
- Positive
- Lasting Abnormalities
133
What are some common comorbidities of a Severe TBI?
- Polytrauma: multiple-organ injuries
134
What are the outcomes of a severe TBI?
- Death
- Significant neurological and neuropsychiatric deficits
- Severe, chronic physical and neuropsychiatric disabilities
135
What are some symptoms of brain damage?
- Headache or dizziness
- Difficulty concentrating
- Sensitivity to Light
- Ringing in the Ears
- Fatigue
- Vomiting
136
What are the Four Major Categories of symptoms of Brain Damage?
- Cognitive
- Perceptual
- Physical
- Behavioural / emotional
137
What are some cognitive symptoms of brain damage?
Reductions
- Thinking
- Attention Span
- Memory
- Decision-making
138
What is some perceptual symptoms of brain damage?
Reduced
- senses
- spacial orientation
- temporal orientation
139
What are some physical symptoms of brain damage?
- Headaches
- Fatigue
- Consciousness issues
140
What are some Behavioural/Emotional symptoms of brain damage?
- Irritability
- Changes in Affect
141
What are some signs of a concussion?
- Loss of consciousness
- Disorientation
- Incoherent Speech
- Confusion
- Memory Loss
- Dazed or Vacant Stare
142
Why is it important to monitor and watch for signs and symptoms of a concussion following a head injury? how long should you watch?
Why
- May not be immediately obvious
- can worsen over time
How long
- 48 hours
143
What levels of TBI have been associated with Neurodegenerative Disease? What is the difference?
All of them
- Moderate and Severe TBI associated with increased risk of dementia
- Mild TBI: single injury does not increase risk.
- Repeated Mild TBI: linked to greater risk of CTE
144
What is CTE?
- Chronic Traumatic Encephalopathy
- A form of Dementia
145
Who is Aaron Hernandez? What did autopsies after his death reveal?
Former Professional Football player
- Arrested for murder
- Took his own life
Autopsies
- Revealed he had severe CTE
146
What happens to neuroplasticity following a brain injury?
- boosted
147
What are the phases of neuroplasticity following a TBI?
- Cell Dysfunction
- Cell Genesis
- Adaptive Plasticity
148
What are the stages of Cell Dysfunction following a TBI?
- Cell Death
- Edema (swelling due to trapped fluid)
- Metabolic Depression
- Axonal Growth Inhibition
149
What are the stages of Cell Genesis following a TBI?
- Gliogenesis: supports neurons
- Neurogenesis
- Angiogenesis: Development of new blood vessels
150
What are the phases of Adaptive Plasticity following a TBI?
- Functional Plasticity: receptor function and cell signaling
- Network re-learning
151
Describe the Cell Dysfunction Phase of Neuroplasticity following a TBI.
- cell death
- decrease in cortical inhibitory pathways
- Recruit or unmasking of latent and secondary neuronal networks
152
Describe the Cell Genesis phase of neuroplasticity following a TBI
- Neuronal Proliferation
- Neuronal and Nonneuronal cells recruited to replace damaged cells
153
Describe the adaptive Plasticity phase of neuroplasticity following a TBI
- Systems remodeling
- relearning
- cortical changes for recovery
154
What is the First Stage in Recovery from a TBI?
- Spontaneous Reorganization
155
What do Acute and immediate recovery of locally damaged brain tissue and subacute and chronic recovery involve?
- Renewal and stabilization of functional brain networks
156
What does enhanced neuroplasticity of the first stage of TBI recovery involve?
- Activation of learning networks
- facilitate relearning
157
How do we compensate for lost function in TBI recovery?
- Early recruitment of contralesional homologous brain regions or perilesional regions
158
How long does Spontaneous Recovery last after brain damage?
- Stroke: 3 months
- TBI: 6 months
159
When does the Upregulation of proteins involved in neuronal growth and guidance occur following TBI injury?
- A relatively narrow window of time after injury
160
What does the Spontaneous plasticity in recovery from brain damage reflect?
- Development of compensatory motor patterns
- not true recovery of the original kinematic patterns
161
How can short-term plasticity following brain damage be harmful in the long term?
- Contralateral homologous region recruitment becomes maladaptive (competing with recovering network)
- Learned non-use
162
What is Learned non-use?
- Failure to re-associate the function to the relevant brain region during recovery
- Result of Spontaneous Reorganization of Circuitry interfering with regaining of function
163
What is the Second Stage of Recovery from brain damage?
- Training-Induced Recovery
164
How does training help with brain damage recovery?
- Induce plastic changes in the brain
- Promote Longer-term improvement
165
What is the shift between early stages of recovery to later stages of recovery? Why does it happen?
Early
- Greater Neural Dynamics and flexibility
Later
- Increasing efficiency
- Decreasing Malleability
Why
- longer-term improvements
166
What are the Activation Shifts during the rehabilitation process?
- Early recruitment of contralesional homologous brain regions
- Activation of learning structures
- Settling toward an ipsilesional or distributed recruitment pattern
- Successful functional recovery
-
167
What is the idea of rehabilitation for brain injury?
- Support the damaged system
- relearning and restoring functional capacity
168
What happens to cortical plasticity if subcortical connectivity is not preserved?
- not possible
- severe permanent deficits
169
What might spontaneous plasticity with no directed training result in?
- negative consequences resulting from maladaptive changes
170
What is unknown about plasticity and rehabilitation limitations?
- molecular mechanisms behind the recovery cascade
171
What are the Static Protective Factors for promoting recovery following TBI?
- Age
- Sex/Gender
- Cognitive Reserve
- Psychiatric History
172
How is Age a Protective Factor in TBI recovery?
- Younger children reduced recovery
- TBI may interact negatively with aging
- Highest Recovery in older children and young adults
173
How is Sex/Gender a Protective Factor in TBI recovery?
- Men 3x more likely to die from TBI
- Progesterone is a protective factor
174
How does Progesterone act as a protective factor for TBI recovery?
- Reduce Inflammation and Apoptosis in hippocampus
175
How is intelligence and education level act as a protective factor for TBI recovery?
- Cognitive Reserve effect
176
What is a cognitive reserve effect?
- Preinjury intellectual and cognitive abilities are predictive for recovery trajectory
177
How does Psychiatric History Act as a Protective factor for TBI recovery?
- Correlation between preinjury psychiatric disorders and novel psychiatric disorders following a TBI
178
What is a Dynamic Protective Factor? How about a Static?
Dynamic
- Potential to be modified through intervention
Static
- Cannot be changed
179
What are the four dynamic protective factors of TBI recovery?
- Leveraging socioeconomic status
- Family and Social Support
- Nutrition
- Exercise
180
How is socioeconomic status a factor in TBI recovery? why is it dynamic?
How
Access to:
- appropriate medical care
- rehabilitation services
- educational training programs
- reduced stress
Why
- provide access to those things at different levels of SES (medcare)
181
How are family and social support a protective factor in TBI recovery?
- Improved family functioning
- increased social support facilitate
- Parental warm
- Reduced stress
- Decrease depression
- Increase well-being
182
How is nutrition a protective factor in TBI recovery?
- Brain = high metabolic organ
- Animal models support nutrition as protective factor
- Human models inconsitent
183
How is exercise a protective factor in TBI recovery?
- Increases neurogenesis in the hippocampus
- Supports learning and memory
- Decrease neuronal apoptosis
- Regular noncontact activities help
184
What does it mean to find a sweet spot in brain rehabilitation?
- Neuroplasticity benefits from active training
- Brain is Vulnerable so needs to be protected
