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States of Consciousness Flashcards

1
Q

What is the Rancho Los Amigos Scale?

A

The Rancho Los Amigos Scale
- monitor changing conditions in a patient recovering from a disorder of consciousness
- assessment levels of the scale describe patient’s cognitive function with regards to arousal levels, behavioural responses, and task performance

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2
Q

Rancho Los Amigos Level 1

A

No response, total assistance → coma

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3
Q

Rancho Los Amigos Level 2

A

Generalized response, total assistance → vegetative state

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4
Q

Rancho Los Amigos Level 3

A

Localised response, total assistance → minimally conscious state
staring in direction; grabbing; nonverbal

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5
Q

Rancho Los Amigos Level 4

A

Confused and agitated, maximal assistance → low arousal and sleepiness
hitting, foul language, confabulation

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6
Q

Rancho Los Amigos Level 5

A

Confused, inappropriate, and non-agitated, maximal assistance → post-traumatic confusional state
purposeful interactions; post traumatic amnesia

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7
Q

Rancho Los Amigos Level 6

A

Confused, appropriate, moderate assistance → post traumatic cognitively impaired state
emerged from post-traumatic amnesia; focal injuries better evaluated

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8
Q

Rancho Los Amigos Level 7

A

Automatic and appropriate, minimal assistance → higher brain function improving
improvements in memory, awareness, perception; planning still difficult; low safety awareness

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9
Q

Rancho Los Amigos Level 8

A

Purposeful and appropriate, stand-by assistance → explore returning to work/school
continued cognitive deficits

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10
Q

Rancho Los Amigos Level 9

A

Purposeful and appropriate, stand-by on request → increased independence
tasks; consequences; accurate ability estimation; increased frustration

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11
Q

Rancho Los Amigos Level 10

A

Purposeful and appropriate, modified independent → physical independence
compensatory strategies

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12
Q

What are the two clinical components of consciousness

A

Arousal (wakefulness)
Awareness (subjective experience)

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13
Q

Arousal - neuronal and behavioural markers

A

neuronal - sensory info passed from brainstem to cortex; high energy demand; electrical activity in corticothalamic system; cerebral cortex active
behavioural - eye-opening; brainstem responses; sensory impulses received

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14
Q

Awareness - neuronal and behavioural markers

A

neuronal - connectivity of frontoparietal networks and thalamus
behavioural - ability to respond to both external and internal stimuli

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15
Q

Disorders of Consciousness - meaning; three categories plus transitional state

A

DoC: altered states of pathologic consciousness
- withdrawal of excitatory synaptic activity across cerebrum
- widespread disfacilitation; sharp reduction in cerebral metabolic rate
Coma, VS, MCS; Acute confusional state

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16
Q

Coma

A

lack of arousal and awareness; no spontaneous or stimulus induced arousal, eye-opening, or sleep-wake cycles

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17
Q

Vegetative State

A

wakefulness without awareness; spontaneous eye-opening, sleep-wake cycles, external arousal with no signs of conscious perception

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18
Q

Minimally Conscious State

A

wakefulness with partial awareness; non-verbal, inconsistent but reproducible command following

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19
Q

Acute Confusional State

A

transient period between MCS and full consciousness; fluctuation of behavioural responses

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20
Q

disfacilitation

A

active inhibition

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21
Q

Two possible misdiagnoses of DoC

A

Brain death
Locked-in syndrome

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22
Q

Brain Death

A

complete and irreversible loss of brain function

23
Q

Locked-in Syndrome

A

cognitive motor dissociation: intact consciousness, sensation, and cognition; limb and facial muscle paralysis
- ascending (sensory/afferent) signals intact
- descending (motor/efferent) transmission interrupted

24
Q

TBI - definition; classification

A

Traumatic brain injury caused by blow to head or violent movement of head

Mild - loss of consciousness for 15 min or less; predominantly blast, non-penetrating; includes concussion

Moderate - loss of consciousness for 15 min to a few hours, followed by a few days/weeks of confusion; blast + acceleration/deceleration, typically non-penetrating

Severe - loss of consciousness for 6 hours or longer (after injury or period of clarity); complex, blast + acceleration/deceleration + penetration; includes coma, VS, and MCS

25
Glasgow Coma Scale - purpose; three categories assessed; result classification
Objectively describes extent of impaired consciousness Assesses eye opening, verbal response, and motor response 3 (deep coma) - 15 (fully awake) Mild TBI 13+; Moderate TBI 7-12; Severe TBI 3-6
26
Common diagnostic tests used to identify brain damage
Rancho Los Amigos scale JFK coma scale Standard diagnostic tests (x-ray, CT, MRI) Neuropsychological assessment
27
JFK coma scale (5 categories)
hearing, vision, movement, communication, arousal
28
Neuropsychological assessment - what is assessed; how does it contribute to recovery process
Hand-eye coordination and cognitive skills (psychological, personal, and interpersonal thoughts, behaviours, and skills) Evaluates multiple aspects of mind to develop effective care plan
29
Common behavioural, cognitive, and emotional symptoms following TBI
behavioural - sleep pattern changes, personality changes, trouble communicating, inappropriate action cognitive - balance, walking, headache, trouble speaking and/or swallowing, lack of bowel/bladder control, motor impariment, seizure, vision problems, sensory perception changes, poor concentration, memory impairments, difficulty forming sentences/choosing vocabulary emotional - depression, mood swings
30
Main goals of treatment and rehabilitation programs
early weeks - stabilizing physical condition, preventing complications, addressing medical issues follow-up - regular appointments, outpatient therapy, or rehabilitation facility rehabilitation - relearn basic skills, independence; safety → awareness → stretching/strengthening/balance → date, time, location, memory
31
Signs and symptoms of TBI (CPPB)
Cognitive - thinking, attention, memory, decision-making Perceptual - sensory and spatial/temporal orientation problems Physical - headache, fatigue; consciousness issues Behavioural - irritability; changes in affect
32
TBI assessment using amnesia length
Mild <24 hrs Moderate >24 hrs, <7 days Severe >7 days
33
TBI assessment using imaging
Mild - negative Moderate - transient changes Severe - positive, lasting abnormalities
34
Chronic Traumatic Encephalopathy
Repeated head traumas can cause gradual brain degeneration; mild TBIs Eg., Aaron Hernandez
35
What are the (3) major neuro-physiological processes that take place following TBI as part of the healing process?
Cell dysfunction - cell death, decrease in cortical inhibitory pathways Cell genesis - neuronal and nonneuronal cells recruited to replace damaged cells Adaptive plasticity - systems remodeling, relearning and cortical changes for recovery
36
How can neuroplasticity be directed and leveraged in brain recovery? How can it “go wrong” (what are its limitations)?
Training induced recovery to avoid compensation - subcortical connectivity must be preserved (extensive white matter damage may lead to permanent deficits) - directed training must occur (avoid maladaptive changes) - molecular mechanisms must be revealed
37
Static protective mechanisms promoting recovery from TBI
Factors that cannot be modified - age (young children - reduced recovery patterns; older people - slower recovery) - sex/gender (men 3x more likely to die from TBI) - cognitive reserve (intelligence and education level pre-injury - return to baseline) - psychiatric history (disorders common after TBI - PTSD, depression, anxiety, etc.)
38
Dynamic protective mechanisms promoting recovery from TBI
Factors that can potentially be modified through intervention - leveraging socioeconomic status (SES - can also be considered static) (access to care, reduced stress levels with economic resources) - family and social support (increased well being) - nutrition - exercise (increases neurogenesis in hippocampus; decreases in neuronal apoptosis) not too soon after injury (2 weeks)
39
Axonal shearing
Axons in brain are stretched to point of breaking; damaged cells die and release toxins that spread to neighbouring cells
40
Brain herniation
rising pressure inside brain or hematoma; parts are shifted out of place
41
Cerebral atrophy
loss of nerve cells and connections between them in the brain
42
Edema
swelling inside the skull; brain cells are squeezed, interrupting blood flow and oxygen to brain tissue
43
Hematoma
pool of blood or bruise inside skull caused by damaged blood vessels; can increase pressure inside skull
44
Hemorrhage
internal or external bleeding caused by damage to a blood vessel
45
Intracranial pressure (ICP) monitoring
monitoring of pressure inside skull using threaded catheter or sensor
46
Shock
body response triggered by loss of blood to brain; can indirectly injure brain tissue
47
Sympathetic storming
elevated stress response; thought to be a sign of returning activity to sympathetic or protective nervous system
48
What is the typical course of cognition rehabilitation (and how may it differ between mild, moderate, and severe TBI)?
Early weeks: - stabilizing physical condition - preventing complications - addressing medical issues Follow-up: mild - regular follow-up appointments moderate - outpatient therapy, testing, monitoring severe - rehabilitation facility; continuing outpatient therapy
49
Principles that need to be considered and balanced in the rehabilitation process following TBI?
Spontaneous reorganization - first stage in recovery - renewal and stabilization of functional brain networks; enhanced neuroplasticity - may lead to compensation rather than recovery without training (learned non-use) Training-induced recovery - second stage in recovery - longer-term improvement - shift neuroplasticity towards healing injured system
50
angiogenesis
new blood vessels
51
synaptogenesis
new synapses (points of contact between neurons)
52
neurogenesis
neurons de novo (anew)
53
Self-taught compensatory strategies - how are they different from rehabilitative interventions?
Reliance on uninjured areas to compensate for loss of injured area function; can prevent healing of injured area by rewiring networks (can shape neuroplasticity), rather than rebuilding loss
54
How does experience interact with the post-stroke CNS environment to promote restorative plasticity?
Regenerative and degenerative responses are influenced bidirectionally (contribute to and are influenced by behaviour); behavioural interventions can improve functional outcome

PSYC 301 (1 decks)

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