TBI

Question 1

Rancho Los Amigos Levels of Cognitive Functioning

Answer 1

A descriptive scale of response to stimuli that is useful for communicating or documenting general cognitive and/or behavioral status. Rating scale I-VIII.

Question 2

RLA I

Answer 2

No response. Completely unresponsive to any stimuli.

Question 3

RLA II

Answer 3

Generalized response. Pt reacts inconsistently and nonspecifically to stimuli.

Question 4

RLA III

Answer 4

Localized response. Pt reacts to inconsistently but specifically to stimuli

Question 5

RLA IV

Answer 5

Confused/agitated. Pt is in a heightened state of activity. Behavior is bizarre and non purposeful relative to immediate environment. Recall and attention span are poor.

Question 6

RLA V

Answer 6

Confused-inappropriate. Pt able to respond to simple commands but not able to do complex tasks. Memory is impaired. Verbalization is inappropriate.

Question 7

RLA VI

Answer 7

Confused-appropriate. Pt is dependent upon external input but can perform consistently. Memory improved.

Question 8

RLA VII

Answer 8

Automatic-appropriate. Can perform automatically and appropriately in structured environments. Judgement remains impaired.

Question 9

RLA VIII

Answer 9

Purposeful-appropriate. Pt acts appropriately though not perfectly. May have some problems in stressful or unusual circumstances.

Question 10

Glasgow Coma Scale

Answer 10

An objective way to describe a pt’s level of consciousness. Consists of eye opening, best motor response, and verbal response.

Score ranges from 3-15.
3-8: severe brain injury
9-12: moderate brain injury
13-15: minor brain injury

Question 11

Alertness

Answer 11

Pt can open eyes, look at examiner, respond fully and appropriately to stimuli

Question 12

Lethargy

Answer 12

Pt appears drowsy, can open eyes, look at examiner, respond to questions but falls asleep easily

Question 13

Obtundation

Answer 13

Pt can open eyes, look at examiner, but responds slowly and is confused. Pt demonstrates decreased alertness and interest in the environment

Question 14

Stupor

Answer 14

Pt can be aroused from sleep only with noxious stimuli, verbal responses are slow or absent, pt returns to unresponsive state when stimuli are removed, demonstrates minimal awareness of self and environment

Question 15

Coma

Answer 15

A state of unconsciousness from which a pt cannot be aroused. Eyes remain closed, no response to external stimuli or environment

Question 16

Vegetative state

Answer 16

A state characterized by the return of sleep/wake cycles, normalization of respiration, HR, BP, and digestion, lack of cognitive response. Can be aroused but is unaware.

Question 17

Persistent vegetative state

Answer 17

A state lasting >1 year for TBI and >3months for anoxic brain injury

Question 18

Minimally conscious state

Answer 18

A state characterized by severely altered consciousness with minimal but definite evidence of self or environmental awareness

Question 19

What could cause an elevated temperature in a pt with brain injury?

Answer 19

Infection

Central origin: damage to the hypothalamus or the brainstem

Question 20

Asymmetrical Tonic Neck (ATNR)

Answer 20

Rotation of the head to one side produces flexion of the skull limbs and extension of the jaw limbs

Question 21

Symmetrical Tonic Neck (STNR)

Answer 21

Flexion of the neck produces flexion of the UE and extension of the LE. Extension of the neck produces extension of the UE and flexion of the LE.

Question 22

Positive Supporting Reflex

Answer 22

Contact to the ball of the foot in the standing position creates rigid extension of the LEs

Question 23

Associated Reactions

Answer 23

Strong voluntary movements in one body segment produces involuntary movement in another resting extremity