TBI and GCS Scale

Question 1

List the 3 categories of TBI based off the GCS scale

Answer 1

Mild: 13-15
Moderate: 9-12
Severe: <8

Question 2

List the GCS Scale

Answer 2

Eye Opening
Spontaneous 4
To speech 3
To pain 2
No response 1

Best Motor Response
Follows motor commands 6
Localizes 5
Withdraws 4
Abnormal flexion 3
Extensor response 2
No response 1

Verbal response
Oriented 5
Confused conversation 4
Inappropriate words 3
Incomprehensible sounds 2
No response 1

Question 3

What two things have been shown to be a predictor of poor recovery in patients with moderate to severe TBI?

Answer 3

low initial scores on the GCS
(motor score & pupillary activity)

Question 4

What is decorticate rigidity?

Answer 4

UEs are in flexion posture while LE are extended

Question 5

What is decerebrate rigidity?

Answer 5

both UEs and LEs are in extension

Question 6

List the 8 stages of Ranchos Los Amigos

Answer 6

1. No response
2. Generalized response
3. Localized response
4. Confused-agitated
5. Confused-inapproprite
6. Confused-appropriate
7. Automatic-appropriate
8. Purposeful-appropriate

Question 7

Name Stage 1 of Ranchos Los Amigos

Answer 7

No response

Question 8

Name Stage 2 of Ranchos Los Amigos and what occurs

Answer 8

Generalized Response

-Pt reacts inconsistenly and nonpurposefully to stimuli in a nonspecific manner

Question 9

Name Stage 3 of Ranchos Los Amigos and what occurs

Answer 9

Localized Response

-Pt reacts specifically but inconsistently to stimuli. Responses are directly related to the type of stimulus presented

Question 10

Name Stage 4 of Ranchos Los Amigos and what occurs

Answer 10

Confused-Agisted

-Pt is in a heightened state of activity. Behavior is bizarre and nonpurposeful relative to the immediate environment

Question 11

Name Stage 5 of Ranchos Los Amigos and what occurs

Answer 11

Confused-Inappropriate

-Pt is able to respond to simple commands fairly consistently. However, with increased complexity of commands or lack of any external structures, responses are nonpurposefull or random

Question 12

Name Stage 6 of Ranchos Los Amigos and what occurs

Answer 12

Confused-Appropriate

-Pt shows goal-directed behavior but is dependent on external input or direction

Question 13

Name Stage 7 of Ranchos Los Amigos and what occurs

Answer 13

Automatic-Appropriate

-Pt appears appropriate and oriented within the hospital & home settings; goes through daily route automatically but frequently robot-like

Question 14

Name Stage 8 of Ranchos Los Amigos

Answer 14

Purposeful-Appropriate
-Pt is able to recall and integrate past & recent events and is aware of and responsive to environment. shows carryover for new learning and needs no supervision once activities are learned

Question 15

How frequently show TBI pts be respositioned?

Answer 15

every 2 hrs

Question 16

If a lesion occurs to the front lobe from a TBI what would we expect to see from a pt? (5)

Answer 16

1. Contralateral paralysis and paresis
2. Apraxia or motor planning difficulty
3. Loss of bilateral control of posture
4. Nonfluent aphasia
5. Unstable emotions; unpredictable behaviors

Question 17

If a lesion occurs to the parietal lobe from a TBI what would we expect to see from a pt? (4)

Answer 17

1. Loss of contralateral stimulus location
2. Tactile agnosia (loss of two points, asterognosia, etc.)
3. Impairment of taste in contralateral side of tongue
4. Visual-spatial disorders

Question 18

If a lesion occurs to the temporal lobe from a TBI what would we expect to see from a pt? (3)

Answer 18

1.Subtle decreases in hearing
2. Fluent aphasia
3. Impairment of learning & memory

Question 19

If a lesion occurs to the occipital lobe from a TBI what would we expect to see from a pt? (3)

Answer 19

1. Contralateral homonymous hemianopsia
2. Impairment of vision and/or visual agnosia
3. Perceptual impairment

Question 20

Depending on time frame, how do we label TBI?

Answer 20

mild: 0-30mins
mod: >30 mins but <24 hrs
severe: >24hrs