TBI Flashcards
Rancho Los Amigos Levels of Cognitive Functioning
A descriptive scale of response to stimuli that is useful for communicating or documenting general cognitive and/or behavioral status. Rating scale I-VIII.
RLA I
No response. Completely unresponsive to any stimuli.
RLA II
Generalized response. Pt reacts inconsistently and nonspecifically to stimuli.
RLA III
Localized response. Pt reacts to inconsistently but specifically to stimuli
RLA IV
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.
RLA V
Confused-inappropriate. Pt able to respond to simple commands but not able to do complex tasks. Memory is impaired. Verbalization is inappropriate.
RLA VI
Confused-appropriate. Pt is dependent upon external input but can perform consistently. Memory improved.
RLA VII
Automatic-appropriate. Can perform automatically and appropriately in structured environments. Judgement remains impaired.
RLA VIII
Purposeful-appropriate. Pt acts appropriately though not perfectly. May have some problems in stressful or unusual circumstances.
Glasgow Coma Scale
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
Alertness
Pt can open eyes, look at examiner, respond fully and appropriately to stimuli
Lethargy
Pt appears drowsy, can open eyes, look at examiner, respond to questions but falls asleep easily
Obtundation
Pt can open eyes, look at examiner, but responds slowly and is confused. Pt demonstrates decreased alertness and interest in the environment
Stupor
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
Coma
A state of unconsciousness from which a pt cannot be aroused. Eyes remain closed, no response to external stimuli or environment
Vegetative state
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.
Persistent vegetative state
A state lasting >1 year for TBI and >3months for anoxic brain injury
Minimally conscious state
A state characterized by severely altered consciousness with minimal but definite evidence of self or environmental awareness
What could cause an elevated temperature in a pt with brain injury?
Infection
Central origin: damage to the hypothalamus or the brainstem
Asymmetrical Tonic Neck (ATNR)
Rotation of the head to one side produces flexion of the skull limbs and extension of the jaw limbs
Symmetrical Tonic Neck (STNR)
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.
Positive Supporting Reflex
Contact to the ball of the foot in the standing position creates rigid extension of the LEs
Associated Reactions
Strong voluntary movements in one body segment produces involuntary movement in another resting extremity
